Jordan Lubkeman ’16, Dominion Fertility

Jordan-LubkemanDay 1:
Dr. John Gordon ’85 picked me up in the afternoon during his lunch break and took me to the Dominion Fertility office in Arlington, VA. When we arrived, he introduced me to the other doctors, nurses, and lab technicians. Everyone was very welcoming and friendly. He also gave me a tour of the office, which was comprised of much more than one typically sees on a visit to the doctor’s. There were also hundreds of baby pictures on the walls: smiles and happy faces that showed the clinic’s success in creating families. I then got to watch a few ultrasound inspections, where Dr. Gordon would inspect the thickness of his patients’ endometrial linings and the size of their follicles, if present. He was always sure to explain what he saw to his patients (and myself) which was very beneficial. Later, I got to watch Dr. Celia, the lab director, perform ICSI, intracytoplasmic sperm injection. It was very interesting to learn how a healthy sperm is selected for injection into the egg: many different morphological and physiological factors must be taken into consideration. After I sat in on a consultation that Dr. Gordon gave a new patient couple about possible reasons for infertility, the different sorts of treatment options that his clinic offers, and what the next steps in their treatment could be. He was very adept at explaining everything to his patients and answered any questions they might have. After, we went back to Dr. Gordon’s house because his family was very kind and offered for me to stay with them. On the drive back, we talked about reproductive endocrinology and how Dr. Gordon decided to pursue the field. At his house, I really enjoyed talking with his family and playing video games with his youngest daughter. It was nice to see that although Dr. Gordon is in the medical profession, one notorious for lengthy working hours, he still found time to spend with his family.

Day 2:
The next day, we got to Dominion Fertility’s Fair Oaks office at 7 am to start ultrasound inspections. Some of the patients were at the stage in their pregnancy where the embryo develops a heartbeat. Hearing and seeing the heartbeat via the ultrasound, as well as the joy on the patients’ faces, can only be described as magical. Dr. Gordon was truly creating families for his patients. We then headed back to the Arlington office, where Dr. Gordon had more consultations with returning and new patients. Dr. Gordon was terrific at tailoring the conversations to his patients. For instance, he used a lot more medical terms with a couple of doctors than with other couples who were not. We then went to a meeting with all the doctors and nurses to discuss all the patients and their procedures to make sure that everyone was up to speed on every case. After, I got to go back into the lab to watch Dr. Celia vitrify nine eggs, which was a very complex process that required a lot of care. We also talked about how Dr. Celia decided upon his profession and complex issues such as “embryo homicide,” where labs accidentally thaw embryos, and also about the dilemma of when patients whose embryos are in storage mysteriously disappear. Later, Dr. Gordon had more consultations with new and returning patients, and in between consultations he would phone patients to tell them their test results. He was incredibly busy, but never seemed to get annoyed, tired, or frustrated. At around 5 pm we went back to his house and discussed some of the ethical issues around IVF, why most clinics do not offer natural cycle IVF (Dominion Fertility does) and also life at Princeton.

Day 3:
On the third day, we started at the Fair Oaks office. Some of the patients who were undergoing follicle inspection had been seen on my first day, and it was amazing to see how the follicles had grown in that short amount of time. Lubkeman 4I also got to see Dr. Gordon perform a mock IUI, where he performs the artificial insemination procedure, just without the actual sperm, to ensure that the patient’s cervix or uterus are in no way blocked. After, a lady who was 12 weeks pregnant came back to Dr. Gordon to thank him. All of Dr. Gordon’s patients really appreciate his work. He then had some more consultations. One of them was with a Hispanic couple, and one of the nurses acted as a translator between the doctor and patients. It is really remarkable that the office is able to office this service as well to its patients. I also really enjoyed learning the Spanish medical terms for a lot of what Dr. Gordon was explaining to the couple. Dr. Gordon had many consultations with diverse problems and potential solutions. Fertilization and the achievement of pregnancy are such complex processes where so many issues can arise. I had no idea that even the average “fertile” female will actually only get pregnant 25% of the time when she tries to. Because the future of one’s family is such a sensitive topic, Dr. Gordon also had to be very knowledgeable about the emotions of his patients. While some tears were shed in a consultation, every patient left with a smile and hope for the future. After work, we went to Dr. Gordon’s medical book publishing company, a business he has on the side, to mail some of his books to buyers. He calls it his hobby, and it was nice to see that doctors really do have time for activities outside the office!

Day 4:
During the last day, I got to observe more ultrasound inspections and hear more beautiful fetal heartbeats. Dr. Gordon also had more consultations with patients, many of who had visited other infertility clinics in the area without success and were hoping Lubkeman 1Dr. Gordon would be able to successfully treat them. It was interesting to learn about what makes Dominion Fertility different from the others: chiefly, their use of Natural Cycle (instead of Stimulated Cycle) IVF, where the patient produces one eggs by herself, instead of multiple eggs with drugs. This procedure, understandably, has a lower success rate. Because of the way the government makes clinics publish their success rates, offering Natural Cycle IVF diminishes a clinic’s overall success rate so clinics are less likely to offer the procedure. But often Natural Cycle IVF is the best solution because it is more financially attractive and doesn’t require fertility drugs. Dr. Gordon had been especially busy this day because one of the other doctors was at home due to illness and an inspector from the FDA had stopped by to make sure that their labeling procedures of patients’ sperm, eggs, and embryos met standards and that no disease transmission was occurring. Dr. Gordon was really working hard to balance the clinical, technical, and business aspects of his practice. Later, he performed an actual IUI and then a follicle retrieval procedure and I got to watch in the lab as Mark, one of the embryologists, found the eggs in the solution that Dr. Gordon had retrieved. After, we went to the Fairfax hospital where Dr. Gordon performed six hysterosalpingograms (HSG’s) – Where Dr. Gordon uses x-rays and fluorescent dye to see if the uterus or fallopian tubes of the patient are blocked in any way.  One of Dr. Gordon’s residents, Stacia, was also there. She was very helpful in explaining what Dr. Gordon was looking at in the X-ray pictures, and we also talked about her experiences as a medical student. Dr. Gordon performed the 6 HSG’s with remarkable efficiency – it took him under an hour to complete them all. But they were in no way rushed; he was very careful in carrying out the procedure, making sure that the patients were comfortable, and always took time to explain to the patients what he was seeing in their X-rays. After the HSG’s, Dr. Gordon drove me back to Union Station so I could catch a train back to Princeton.

I really enjoyed my Princeternship with Dr. Gordon at Dominion Fertility and would highly recommend the experience to fellow students. It was clear throughout every procedure and consultation that Dr. Gordon wanted to make sure that the patient was as informed as possible and that he was helping the patient in the best way possible. He practices medicine in a truly open and selfless way, and it was very inspiring to watch him work with this office and patients every day. If I decide to become a doctor, I will certainly try my best to practice with the same high care standards as Dr. Gordon’s. I am incredibly thankful that Dr. Gordon gave me the opportunity to learn so much about his life as doctor, ethicist, counselor, businessman, and father.