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Babies 'R Us
by Eve Jacobs

David. B. Seifer, MD, professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at UMDNJ-Robert Wood Johnson Medical School and Director of the Division of Reproductive Endocrinology and Infertility, with 3-year-old twins Rachel and Bianca DiSanto.

As David Seifer poses for a picture with Rachel and Bianca DiSanto, his face lights up. The 3-year-old twins playing to the camera are charmers - one shy, one outgoing - both strangely fearless in this medical milieu and full of giggles and energy.

The very fact of their existence is a testament to modern medicine - and, of course, to this medical practitioner. As the specialty of reproductive endocrinology leaps from one discovery to the next, success is more the norm than failure. Seifer says that that is the beauty of the medical specialty he has chosen to practice.

On the waitingroom table in his medical suite, where patients come to seek remedies for their infertility, sits a Winnie the Pooh photo album filled with pictures of infants and toddlers. These photos are sent by proud parents, evidence of the success of this medical practice and also a statement about the strong sense of connectedness they feel to the medical team that has taken care of them.

Jeanne DiSanto, the twins' mother, sends pictures of the girls each holiday season and visits periodically. She describes Seifer as "a gentle man, thoughtful and compassionate, someone who cares about making the medical experience a good one." Infertility breeds anxiety and pain for those who want children, and many of the patients who come to this clinic have already hit a wall in their search for remedies.

"You get crazy, desperate when you're infertile," says Ellen Ruane, who got pregnant by in vitro fertilization and gave birth at age 38 to a healthy girl. "You need a doctor who's calming, reasonable, articulate and on top of his game professionally. That's Dr. Seifer."

That sense of reassuring calm, coupled with a determination to "see the whole picture," is what this reproductive endocrinologist is all about. He works to pose the just-right question, knowing that poised on the back of each answered question is another begging equal time. "Passionate" is the word he uses to describe his involvement in the search for answers. The scientific method is the motif of his practice, his research and his teaching. "I teach this approach to medical students and residents," he explains, "how to think about something, instead of what to think about it." His emphasis is on active learning and discovery.

The approach has served him well, shaping him into the quintessential physician-scientist. It compels him to closely observe each clinical encounter and then to develop a hypothesis about why it's occurring, which leads him to the laboratory to construct an experiment that, in turn, will lead him to new insights and conclusions. "The lens of research has helped me take better care of my patients," he observes. It has allowed him to appreciate subtle relationships and connections between abnormalities of reproductive physiology and the lack of successful conception and, at times, to be able to offer a more effective clinical approach.

His field is rapidly evolving. All of the technologies currently in use on a daily basis - from in vitro fertilization to pre-implantation genetics - were developed in the past two decades, Seifer notes. The next five to 10 years look equally promising to him. Preserving the fertility of young women undergoing chemotherapy for cancer is just one of the accessible goals he sees on the horizon. Stem cells also hold great therapeutic promise, he muses.

Seifer says that caring for patients in this particular specialty is "so compelling." With a practice of "primarily physically healthy individuals who want to have a family," he can deal with "quality of life issues rather than life-or-death situations."

And his personal philosophy blends seamlessly with his doctoring. Having and raising children "is one of life's greatest privileges," he says. "For me to take part in that is so life- and self-affirming."

The major scientific questions he is wrestling with go back to one of his very early interests - the mechanisms of aging. His research over the past 10 to 15 years has focused on the aging of the ovary, specifically the follicle. "We can pretty much overcome any fertility issues now, but we can't yet overcome reproductive aging," he comments. "Those who delay childbearing are our greatest challenge."

The reproductive system shows the earliest signs of aging in the body, he comments; and basic information derived from this research will yield insights into the aging process in general, which may be applicable to slowing down this process. Seifer is also working to characterize a family of growth factors that have so far only been described in animals, but may have particular potential for follicular development and egg maturation in humans. His research has been funded for more than 10 years by the NIH.

What else does a top doc do? Seifer serves on the editorial boards of Fertility and Sterility, the primary publication for this specialty, and the Journal of Pelvic Medicine and Surgery. He is co-editor of several physician textbooks, including Clinical Reproductive Medicine, The Physiologic Basis of Gynecology and Obstetrics, and Office Infertility: Practice and Procedures. He is a member of the FDA Review Panel on obstetrical and gynecologic medical devices and a member of an NIH study section that reviews ongoing research eligible for federal funding in this field. He is also a Board Examiner for physicians seeking certification to practice both obstetrics and gynecology and reproductive endocrinology.

Seifer says a top doc in reproductive endocrinology must have a top team composed of health care professionals who are highly intuitive and compassionate, including embryologists who are outstanding communicators as well as technically competent. That he has.

It is this skilled and caring team - together with their "top doc" - that helps many would-be parents realize their dreams, and changes family portraits for generations to come.