100 Questions and Answers About Infertility

 John D. Gordon

Part Two of my interview with Dr. John D. Gordon. For Part One, click here.

When patients ask you for advice on the web, how do you typically respond?

JDG: If they don’t tell me how old they are, I ask how old they are. I’ll ask if there’s a sperm issue sometimes. Usually they lay out in their little shorthand exactly what they’ve been through. I’ll get these six-paragraph descriptions of everything they’re doing.

It’s hard. There’s this old joke: What’s the difference between God and a reproductive endocrinologist? The answer is: At least God knows he’s not a reproductive endocrinologist.

There is a feeling that there’s nothing you can’t accomplish with modern science, and there are certainly some physicians who play into that. That’s not always true. Sometimes things defy explanation; we don’t understand why things haven’t worked. The patient has been through an awful lot, spent $100,000, and has nothing to show.

At that point, it’s incumbent upon somebody to say, “This is about being a parent. Your goal is to become a parent. Obviously, your goal was to be genetically the parent, biologically the parent. But maybe that won’t happen. Therefore you might have to consider what does it mean to be biologically the parent, but genetically not the parent with donor egg or donor sperm? Or to be neither genetically nor biologically the parent and to pursue adoption? Or not to have a family and have a different life?”

Those are important things to present to couples. We’ve all seen patients who ended up broke, divorced, and unhappy at the end of this road. That’s not what we want to see. It’s a terrible outcome.

How did you choose fertility as your specialty?

JDG: My father and my brother are general surgeons, and general surgeons have a different view of the world. The old adage: “A chance to cut is a chance to cure.” Why would you want to be anything else except a surgeon?

I thought I wouldn’t go to medical school because I didn’t see myself as a surgeon. Then I came to the conclusion that I really like science and helping people so maybe medicine would be a good career.

I went to medical school, and thought maybe I’d be a pediatrician. I went on my first rotation and it was a disaster. I didn’t get along well with the residents, and I found it too traumatizing to deal with the sick children—it just broke my heart.

Then I did a rotation in Internal Medicine at the VA Hospital in Durham. That was really sad because all these guys were coming in with multiple medical problems and they’re constantly being admitted. They didn’t get better that quickly. It was depressing.

I went right from there to OB/GYN. I didn’t really know anything about women’s health, except that my father said the OB/GYN guys never slept because they were up all night delivering babies. I did the rotation; I loved it. There was medicine; there was surgery. The women were generally compliant patients. They listen to what the doctor has to say and don’t ignore medical advice–not like men. Men are terrible patients. And delivering babies is really exciting.

Then I did an elective in reproductive endocrinology. It was emotionally charged, but it was very goal-directed. You knew if you accomplished the goal or not, which I liked.

What’s it like being a man in a “women’s field”?

JDG: In the mid-Atlantic and the South, there are some women who prefer to have a male physician. Rarely do you find this in California. The default mode is “I want to go to a female physician because she understands me better.” I can’t argue with that: I can’t say what labor feels like; I can’t say what it’s like to have a bad period or an ovarian cyst.

At times, it would go in the other direction where male physicians were almost demonized: “Why are you in this profession? You shouldn’t be here.” There was a paucity of men in the program, and nationwide that’s continued where there are very few men going into obstetrics and gynecology.

You were immediately suspect. I remember one night being on obstetrics call at Kaiser. A woman was in labor, and I went in and introduced myself. She said, “I want a woman.” I told her, “It’s August. The only woman I have has been an intern for three weeks and she’s only done a handful of deliveries.” She said, “That’s who I want.” I’ve delivered like a thousand babies at this point. Fortunately, things went fine.

The good thing is in a subspecialty, you have patients who say, “I want the best doctor. I don’t care–male or female.” You’re somewhat protected in a subspecialty.

My wife had a female obstetrician for her first pregnancy and said she would never have one again. She felt all her symptoms were ignored or dismissed; she felt no one really was listening to her. It’s true a woman has experience of these things, but if a woman says, “This hurts,” I’m not going to say, “No, it doesn’t.” If she says “Every time you do a pap smear my cervix hurts,” I’m not going to say that’s impossible, because I don’t have a cervix. If you tell me it hurts, I’ll believe you.

What should patients look for in a physician?

JDG: There are a couple of things. The first thing is: What is the experience of the physician? Where did they train? Are they board-certified? What has been their reputation, and what are people’s experience with them and their practice?

The second thing is with IVF, it’s very important to have a good IVF lab. If you don’t have a good IVF lab, you could be the best, most caring physician in the universe and you’re not going to get people pregnant the way you should. That’s something the patients never see. They have to evaluate it based on statistics. The problem is there’s that old adage: There’s lies, there’s damned lies, and there’s statistics.

The problem with comparing practices based on statistics is that there’s a patient selection phenomenon going on as well. What I’ve always told patients is if you’re looking to compare two practices, look at their donor egg pregnancy rates because they should be a level playing field. Everyone has young donors, and everyone has older women who need donor eggs. Their donor egg pregnancy rates should be a yardstick by which you can compare practices–apples to apples and oranges to oranges.