Since the Annual Meeting for the American Society of Reproductive Medicine is this weekend, we thought our readers would enjoy a blog about the evolution of assisted reproductive treatment written firsthand by a guest blogger who just happens to be the very first Board-Certified Reproductive Endocrinologist in the Washington, D.C. area, Oscar Dodek, MD. Enjoy!
Fertility Within Reach is a growing organization whose goal is to give everyone that wants to have a family but is having difficulty conceiving the financial opportunity to receive optimal treatment. Fertility Within Reach was also the desire of those of us who spent a career battling the multifaceted physical and psychological problems associated with infertility. One of the basic facts of the discipline of medical practice is that in order to have treatment there must be a disease to treat. Given the complexities of modern infertility therapy, it can be stated emphatically that Infertility Is a Disease and that basic fact should be understood by every physician, insurance company and legislator.
The story of fertility versus infertility traces its onset to the Old Testament when God blessed Noah and his sons and said to them, “Be fruitful and multiply and fill the earth.” However, there was no Biblical advice to those who were not fruitful and had that big problem with multiplication called Infertility. Over the ages from Noah through World War II there was virtually no progress and, when I entered George Washington University Medical School in 1952, it is fair to say that there was very little available to help women who were unable to conceive. During my five years of residency training at Mount Sinai Hospital in New York City under Dr, Alan Guttmacher for whom International Planned Parenthood has been named, the emphasis was more on contraception and fertility control. Infertility therapy mainly consisted of artificial donor insemination for those women whose partners had defective spermatozoa. The donors were anonymous house staff members, with no records being preserved concerning the donations, and it is likely that some of the gynecology residents from that era have dozens of children who were born in New York City.
The only significant interventional therapy for women widely utilized and taught at Mount Sinai Hospital during my residency in the late 1950s was the operation of myomectomy. Women with fibroid tumors of the uterus which were large enough or located anatomically to cause problems with initiating or maintaining a pregnancy could have them removed with preservation of the uterus. Many physicians at that time could only offer hysterectomy to women with large fibroid tumors. African-American women are particularly prone to grow significant numbers of large fibroid tumors and myomectomy is a true blessing. I have a film where I removed over fifty fibroid tumors, some softball-sized, from a woman who subsequently had a successful pregnancy and delivery. I showed the film at national conventions and also at a meeting of the Shanghai Ob-Gyn Society in 1980. Few in that Chinese audience spoke English but “WOW” is the same in every language.
There were no fellowships in Reproductive Endocrinology in 1963, when I was discharged after two years as a Captain in the United States Medical Corps. The subspecialty did not become established until the late 1970s. NIH offered a fellowship in the biochemistry of steroid hormones at The Worcester Foundation for Experimental Biology, and this was ideal for someone who planned to make treatment of infertile women a specialty and wanted the most up-to-date information about female hormones. The Worcester Foundation had unraveled some of the mysteries of hormone synthesis, had recently invented Enovid, the first birth control pill, and had established the fact that ovaries produced male hormones (androgens) in addition to estrogens.
Then the excitement began with one major clinical advance after another allowing better and better opportunity for successful infertility therapy. In the practice of Reproductive Endocrinology, I used them all, and it was a magical dream: Radio-Immuno Assay, allowing us to measure minute amounts of hormones in the bloodstream; Ultrasound to accurately visualize pelvic structures and monitor pregnancies accurately; Clomid to induce ovulation: Pergonal to better induce ovulation; microsurgery to delicately remove adhesion and operate on fallopian tubes; laparoscopic surgery to minimize recovery time; and laser surgery to free adhesions and eradicate endometriosis. Then, abracadabra, was the greatest magic of all, the birth of Louise Brown in the United Kingdom on July 25, 1978, ushering in the era of in-vitro fertilization.
With in-vitro fertilization, women with infertility caused by conditions that had made pregnancy impossible in the past can now look forward to a healthy family. Fertility Within Reach wants to make sure that the complex disease known as infertility is treated like other serious complex diseases by the insurance industry and the government.
Oscar I. Dodek Jr., M.D.
Dr. Dodek was the first Board Certified Reproductive Endocrinologist in the Washington, D.C. Metropolitan Area and practiced the specialty in Bethesda, Maryland and at George Washington University for 34 years. He taught in the Biochemistry Department at George Washington and lectured to a generation of students and residents in the Medical Center on the endocrine and infertility problems confronting women. He is a Professor Emeritus at George Washington University and remains as the faculty advisor to the Obstetrics and Gynecology Honor Society.
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