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In addition to  monitoring pregnancies via ultrasound, Dr. Jeffrey Dungan performs a variety of prenatal procedures that test for chromosomal abnormalities such as cystic fibrosis and Down's syndrome.

Northwestern doctor sheds light on challenges of fertility medicine

by Julia Hawes
Feb 25, 2009

From prenatal genetic testing to the recent controversy over Nadya Suleman, known in the tabloids as “Octomom,” fertility doctors have often been drawn into the national spotlight for their work with expectant mothers and those who are trying to become pregnant.

Dr. Jeffrey Dungan of  Prentice Women’s Hospital serves as both the medical director of the genetic counseling graduate program at Northwestern University and a professor in reproductive genetics at the Feinberg School of Medicine.

In the ultrasound clinic at Prentice, Dungan evaluates and tests expectant mothers for chromosomal abnormalities, either through amniocentesis or chorionic villus sampling, which can be done earlier on in the pregnancy. He also tracks mothers, like Suleman, who have undergone in vitro fertilization, and whose multiple-births must be monitored closely for complications.

Here, Dungan discusses the field of reproductive genetics and the occasionally controversial field of fertility medicine.

Do you find it challenging to be a male doctor in a female-centered field?

There are certainly some patients—and this applied more to general obstetrics and gynecology than the genetics part of it—who direct themselves towards female providers and don’t want to see a male. That’s understandable and it doesn’t hurt my feelings. The majority of patients don’t really care. As long as you treat them well and respectfully, they don’t care what your gender is.

Has it been an asset at all to have some distance from what your patients are going through?

I guess I hadn’t really thought about it from that angle. I think male physicians can have emotional components to their work too—you’re not completely separated out from that. I know that I’ve heard OB/GYN female docs say that they feel almost a little put off if they hear somebody picked them just because they’re female. They want to be known for their intellect and skills. It kind of swings both ways.

What are the most controversial areas of the field, or areas that you find patients have the most misconceptions about?

This is not unique to OB/GYN, but there’s frequently a lot of perceptions about the relative safety or effectiveness of medications or interventions. For example, in taking care of women who are menopausal, there’s a lot of hype about this so-called bioidentical hormones. [Actress] Suzanne Somers is on the stump for that and talks about how this is the only thing you should consider using, saying, “It’s safe and I feel 20-years-old.” Well, that’s just ridiculous. First of all, there’s not even a common agreement about what bioidentical hormones even means, and it’s never been proven that they’re any different than the standard hormone therapy we give to menopausal women. People hear advertisements and we have to undo all of that, bring them back to reality. It’s not controversial, but tedious because we have to undo false communications.

Then, this woman who just had octuplets draws attention to multiple pregnancies and having IVF fertility treatments. People see that here was this woman who was able to carry eight fetuses to at least some semblance of viability, when in reality, the vast majority of human beings who have eight embryos will lose all of those fetuses because they’re just not built to carry that many.

What are some of the biggest challenges in your field?

The whole issue of reproduction and carrying pregnancies—there’s a lot of emotional attachments to that. And certainly abortion and pregnancy termination, for whatever reason, whether it’s strictly elective or due to some fetal abnormality, I’d say that’s one of the major hot button topics or aspects of what we do. Our professional organization, ACOG [American College of Obstetrics and Gynecologists]… has issued several statements saying that despite what personal feelings you may have, if a patient shows up and is requesting a termination of pregnancy, you don’t have to provide that service, but you have to find someone who is willing to do that. You shouldn’t let your personal beliefs get in the way of taking care of the patients. The issue of abortion, especially with what I do in prenatal testing, is the biggest elephant in the room when you have those conversations.

Another area that always causes a lot of concern, especially in the younger population, is the genetic predisposition to malignancies and trying to decide what kind of interventions would be appropriate for them. It’s obvious that if you have your ovaries removed, it removes your ability to have your own biological children and that’s, of course, huge. It’s impossible to put yourself in that position. Those cases can be pretty challenging.

Can you think of a particularly rewarding case with a patient?

We had an interesting patient last year who had two previous pregnancies [in which] there were significant brain abnormalities in the fetus that were detected by ultrasound. We were able to suspect a particular condition and there was a researcher in Iowa who was dong genetic testing for this disorder. So we sent some DNA to him and he confirmed that it was this condition, and she was able to have prenatal testing much earlier in a subsequent pregnancy. And fortunately for her, that subsequent testing pregnancy was unaffected. Anytime you’re able to help a patient understand something better or achieve some goal that they might not have otherwise had the opportunity to do—that’s very rewarding.

What areas have you seen improved in women’s health?

Getting Pap smears to reduce cervical cancer is one of the biggest success stories in terms of screening in women’s health. Cervical cancer used to be relatively common, and it’s become less common than it is in other countries. So that intervention has been pretty effective. Colon cancer screening is getting a lot of attention these days but again, there’s still a sizable portion of the population who aren’t doing what they should.