Buyan Pan ’15, Dominion Fertility

Day 1

My host, Dr. John Gordon ’85 picked me up in DC at 7:15 in the morning to drive over to Dominion Fertility Clinic in Arlington, VA. He introduced me to the nurses and Dr. DiMattina, who founded the clinic. Early in the morning, I watched Dr. G perform vaginal ultrasounds for several patients. It was really interesting to see how they were at different stages of various treatments: for some patients, Dr. G was looking at the thickening uterus lining and how the ovaries were doing, and for one patient, we could already see 20 follicles in the ovaries from stimulated growth, ready to be collected for IVF. The most fascinating one was being able to see the embryo inside the uterus of one of the patients and hear its heartbeat.

Around 10:00, some patients came in for consultation, which I got to watch Dr. G do in his office. It was insightful for me to learn how Dr. G interacted with the patients. He was frank and reassuring when giving them advice, explaining all the different options that were suitable for each couple’s situation, like stimulated vs. natural IVF, frozen embryo transfer vs. using fresh embryos, and the different tests for a couple who wanted to know where they stood in terms of fertility. It was almost overwhelming that there were so many different factors to consider when a couple was deciding on the right procedure for them, like what would be best emotionally, financially, health-wise, etc. I was surprised to learn that the couples who come to the clinic are from different parts of the country, not necessarily all from Virginia, because Dominion Fertility is the only clinic where the percentage of IVFs performed are as high as 70% natural cycle IVF as opposed to stimulated cycle. Since natural cycle produces only one egg and hence one embryo, it makes the successful pregnancy rates seem lower for a clinic, and that’s why not many of them are willing to offer the natural. One final procedure that Dr. G performed before lunch was assisting in the collection of an egg. While Dr. G was with the patient, I went into the lab with Dr. Ning and saw the actual collected egg under the microscope, which was amazing. Dr. Ning cleaned the surrounding of the egg and stored it at the optimum temperature and concentration of CO2.

After a quick lunch out, I had some cool conversations with Dr. G about life at Princeton and about how he decided on reproductive endocrinology after having really enjoyed it during his residency.

When we got back, I followed Dr. Ning again and saw the same egg, this time being fertilized by intracytoplasmic sperm injection (ICSI) and inserted back into the uterus of the patient.

I really felt what Dr. G meant when he said that there was a sense of gratification and accomplishment, as I went through in my head all the patients that we had seen today: from couples seeking the right treatment to those going through the procedures, to the patient who confirmed her pregnancy and heard her baby’s heartbeat, and finally to the couple who brought in their adorable twin babies. It’s a really wonderful thing to see both Dr. G and the couple so happy when the treatments bear fruit.

Overall, the day at the clinic was very busy, with constant patient interactions, ultrasounds, phone calls, filing data, and all kinds of procedures. But it was really helpful to get exposure to this kind of work environment and see all the different aspects of a typical day in the clinic.

DAY 2

Buyan and Dr. Gordon

We started the day early this morning at INOVA Fairfax Hospital, where Dr. G gave a lecture on primary amenorrhea to the hospital’s residents and students at GW and VCU. He talked about the questions that a doctor would ask a patient if she had delayed puberty and about the different paths that would be taken in giving her treatment. It was great to see the academic side of things after getting to know the clinical setting yesterday. Dr. G’s lecture was really interactive and he asked a lot of questions to engage his students.

After the lecture, we went to the clinic in Arlington. Dr. G had three patients whose eggs were ready for collection, so while he was with his patients, I got to go into the lab again to watch Mark, one of the embryologists, go through the process of storing the collected eggs. He let me look into the microscope and explained to me how a darker cumulus around an egg could be an indication of egg immaturity, how to sterilize a pipette, how it’s used to transfer the egg into a medium for storage, how a desiccator is used to create the optimum environment for the eggs, and finally how they’re stored. The whole process was really complex and involved so much detail!

Around noon, we drove out to go to INOVA Fair Oaks Hospital, where Dominion Fertility had an office. Dr. G performed ultrasounds for a patient and did some consulting for another patient and her husband about treatments for ovarian cysts. On the drive back, Dr. G and I talked about the difficulty of identifying causes of cysts, especially given all the different types. We had some stimulating discussions about the ethical considerations and medical difficulties in providing cancer and HIV patients with fertility treatments.

Back at the clinic in Arlington, Dr. G had a meeting so I went into the lab to see the eggs that were collected earlier go through the intracytoplasmic sperm injection (ICSI) process. I found it really fascinating that there was so much dexterity involved in it. Mark and Jerry operated the pipettes with a lot of accuracy and care under the microscope, and I watched each moment a sperm was injected into an egg. It’s amazing to think that such a delicate process which provided an alternative solution to so many infertile couples was discovered by accident by a Belgian scientist, as Dr. G had told me earlier.

DAY 3

We started the day off at the Fair Oaks office with some ultrasounds and consulting for patients, and again it was really nice to see a couple who successfully had a baby from a previous treatment come back because they were ready for a second child. Back in Arlington, I got to see some more egg collections and the whole process of storing them in the lab. Then Dr. G went through the usual schedule of consulting, discussing the different treatment methods – from least to most proactive – with each couple.

I learned so much over the course of my three days with Dr. G. I would definitely recommend this Princeternship to other students. It’s a really good place to explore your interests if you’re looking at medicine as a career. Reproductive endocrinology is a very special field too, and the clinic is a unique, sought-after place where so many different patients go because of the availability of natural cycle IVF which is rarely offered elsewhere. Because of that, you’ll get to meet all kinds of patients and see how the doctors and nurses interact with them. Also, Dr. G is outgoing, helpful, and understanding, and on the way to different places, we had really interesting conversations about his experiences at Princeton, career choices, the daily life of doctors, ethical or political issues that they face, and any questions that I might have. I definitely had an inspiring Spring Break, and I’m really grateful to Dr. G and all the staff at Dominion Fertility for this wonderful opportunity.

Aprilee Velez ’12, Dominion Fertility

Day 1

Dr. Gordon’s days usually start rather early, at 7:30am. Many of his patients stop by before they head to work so mornings are quite busy at Dominion Fertility. I saw Dr. Gordon do a lot of patient monitoring with ultrasounds. Most times the ultrasound was used to check on the quality and number of eggs available. They were also used to check that everything looked normal before treatment could be started, and several times I was able to see babies on the monitor. When the baby has reached a certain number of weeks and a heartbeat can be detected, the patient is sent back to her normal OBGYN with hopes for a healthy, successful pregnancy. At lunchtime we went to INOVA Fairfax Hospital, where Dr. Gordon spoke to resident OBGYN applicants about the great facilities available there. In the afternoon Dr. Gordon did more monitoring, along with patient consultations to discuss their future treatment. I was also able to see a hysterosalpingogram – an x-ray exam that uses fluorescent dye to image the uterus and fallopian tubes in order to detect scarring – at a hospital.

Day 2

In the morning I went with Dr. Gordon to INOVA Fairfax, where he gave a talk to residents on reproductive endocrinology and infertility. Then we went to the hospital’s business meeting, where administrators talked about statistics on patient satisfaction and plans for improving the hospital. I sat in on some more patient consults. We went to an OBGYN office in Reston where Dr. Gordon sometimes sees a small number of patients for consults, but does not actually perform any treatment. I was also able to see a natural cycle IVF egg collection. The embryologist showed me the egg once he had found it in the fractions. In the afternoon a very grateful patient of Dr. Gordon’s came in with cookies to celebrate her daughter’s first birthday.

Day 3

Dr. Gordon again did patient monitoring and consults to discuss a plan of action. We spent some time in the new office in Fairfax, which just opened at the end of last year. At the main office I was able to see an IUI and two more egg retrievals. Both patients were doing natural cycle IVF, and unfortunately the egg could not be found for one woman.

One of the most attractive things about working in reproductive endocrinology is that you really get to know your patients. Since women come in often for monitoring you are always aware of what is going on with them. With just three days at Dominion Fertility I started to recognize some of the women and knew when a certain test proved encouraging or discouraging. This Princeternship was so much more than I expected. I learned about life as a resident (mostly as an OBGYN resident), hospital administration, and infertility treatment. I saw elated women that were so happy to be pregnant, and I saw disappointed women whose treatment did not work out. I am so thankful that I had the opportunity to spend this time with Dr. Gordon.

Charles Fortin ’15, Dominion Fertility

My three days at Dominion Fertility with Dr. John Gordon have been a wonderful formative experience for me.  I stayed in my brother’s dorm at Georgetown University, and although I was originally planning to take the bus, Dr. Gordon generously offered to pick me up and drop me off on his way to and from the clinic.  My goal for this Princeternship was to learn more about the everyday work of a physician and further consider whether or not I want to continue on the pre-medicine track.  After shadowing Dr. Gordon these three days, I know that I would enjoy being a doctor, and I now feel confident moving forward in my study of medicine.  I also have a more objective view of the pros and cons both of working as a doctor and of having a private practice.

Each morning of my Princeternship, Dr. Gordon picked me up from Georgetown at 7:15 am, and we headed over to the Arlington office.  On my first day at Dominion Fertility, I felt well prepared because I had read the three books that he had mailed me a few weeks before, but I was still a little lost as he discussed the different types of treatments that are offered at his practice.  He explained the schedule for the next few days, and when we got to the office, he introduced me to the other doctors, nurses, and staff.  Everyone was friendly and welcoming, and I soon adjusted to the pace and rhythm of the office.  Mornings were spent doing vaginal ultrasounds to monitor the status of growing eggs or check for various problems, after which I shadowed either the embryologists or Dr. Gordon during egg retrievals or embryo transfers.  At first, I had difficulty understanding what was actually happening on the ultrasound screen, but I was excited by how quickly I began to understand what was going on and even predict what Dr. Gordon would determine from the screens.  In the afternoons, he often had consultations with new or current patients to discuss treatment options, and I realized that much of his work also involves counseling, educating, and providing emotional support.

During the day, we also drove to different locations to see patients, visit with other doctors, and for Dr. Gordon to give a lecture to medical students.  We ran a few errands along the way, and although he joked that I would report spending my Princeternship at Home Depot and Guitar World, I actually appreciated seeing the doctor’s everyday life.  I realized that in private practice, a physician has more flexibility in his or her schedule, but, as Dr. Gordon pointed out, the doctor also becomes a small business owner.  I noticed that he did spend a fair amount of time managing the business and considering ways to make the practice more efficient and cost-effective.  Being somewhat independent also gave Dr. Gordon the flexibility to teach and do research, including writing several successful books, which I feel provides stimulating and rewarding diversity to his job.

Charles and Dr. Gordon

As for the specialty of reproductive endocrinology, I learned an incredible amount about the complex facets of this new and developing field.  Although I am still far from choosing a specific field within medicine, I found infertility treatment to be challenging intellectually and rewarding emotionally.  Reproductive endocrinology is an extremely unique specialty that still faces much controversy and is not fully understood, but when successful, the results are undeniable.  As Dr. Gordon likes to say, “once you’re pregnant, you’re 100% pregnant.”  There is nothing more satisfying for an infertility doctor than to have a patient come in with a happy, healthy baby.  On the flip side, reproductive endocrinologists face tough ethical dilemmas on a daily basis.  For example, one morning a couple came in for embryo transfer, and Dr. Gordon informed them that four healthy embryos had been produced during the in vitro fertilization.  Since the couple only wanted to use one, he asked if they would like to freeze the remaining three for future use.  The wife asked to have them disposed of, but the husband wanted to save them in case they changed their minds.  This situation raises many fascinating but unanswerable questions.  Is an embryo a human being?  What is its legal status?  Who has custody of the embryo?  What if a woman has no more eggs but has frozen embryos from a previous marriage that she wants to use, but the ex-husband disagrees?  Should gender selection or other genetic testing be allowed for purely aesthetic reasons?  These and other questions make the daily work of a reproductive endocrinologist challenging and stimulating.

I am so thankful to Dr. Gordon for allowing me to shadow him and sharing his experiences with me.  It was wonderful to meet an alumnus with such enthusiasm and school spirit, and seeing someone who has advanced to the point where I hope to be in twenty or thirty years has made me feel so much more comfortable and confident in my plans for the future.