newsmakers: Peter McGovern, MD, and Shirley Fong, MD
media coverage: The New York Times

Investing in Fertility
Futures

by Mary Ann Littell

Co-authors Peter McGovern, MD, and Shirley Fong, MD, recently became newsmakers after their article, "How does age affect fertility?" was published in the journal Contemporary OB/GYN. In May 2004, The New York Times quoted the two extensively in their own article on fertility and older parents.

"It was somewhat surprising to see our article get this attention," says Fong. "I certainly wasn't expecting it."

McGovern, an associate professor of obstetrics and gynecology at UMDNJ-New Jersey Medical School (NJMS), was less surprised.

He says, "Age and infertility is a big topic, but you mostly hear about women. Our article looked at both male and female infertility. Many people don't realize that men's fertility decreases with age too. The decline comes later in life - around 50 - and is more subtle."

Fong is currently in the final year of a three-year fellowship in reproductive endocrinology and infertility (REI) at NJMS. McGovern is director of the program. So the two are, in a sense, student and teacher.

In some ways, they could not be more different. She's a native of Los Angeles, while he hails from Brooklyn. Her education has taken her all over the country, from medical school at St. Louis University to residency in Memphis, and now a fellowship in New Jersey: "The one place I never thought I'd end up!" she says. "I don't like cold weather." He, on the other hand, remained pretty close to home, getting his undergraduate degree at Siena College in Loudonville, NY, attending medical school at NYU School of Medicine, and doing a residency at New York's Bellevue Hospital. He ventured across the Hudson to do a fellowship in REI at NJMS and stayed here.

But where they are similar is that both are united in a common goal: helping women become pregnant who have been unable to conceive, or who suffer from recurrent pregnancy loss.

McGovern accomplishes this in a myriad of ways: directly, through his clinical practice, and indirectly, through his research and teaching activities at NJMS. A father of three, he understands the overwhelming desire to have children. So he finds his work very rewarding. Fong, the mother of two, says, "Pregnancy is so compelling. It's a desire most women have, and it affects their entire lives."

McGovern became interested in the field while a resident. "Delivering babies is the most exciting thing you can do as a physician," he says. "But I found the other parts of pregnancy - understanding the complexities of physiology, hormones, and the ovulation cycle - to be even more intellectually challenging."

Changes in society have affected his field tremendously, he says. "When I did my residency in the late 1980s, an 'elderly' prima gravida was someone over 35. Now we see many women older than that. Some of them got married late. Many of them are in second marriages. Spousal age differences are more acceptable now too - and I don't mean older husband, younger wife. We're seeing 40 year old women with younger husbands, and they want families."

Add to the mix the numbers of people who have been sterilized, either through tubal ligation or vasectomy, but who now want children, and you have the recipe for a thriving practice.

McGovern is one of six NJMS faculty members who comprise University Reproductive Associates (URA), an academic group practice based in Hackensack. The center specializes in endoscopic surgery and advanced reproductive technologies, which include such techniques as in vitro fertilization or intracytoplasmic sperm injection (the manipulation of sperm and/or eggs). They also offer less advanced treatments for infertility, such as intrauterine insemination, oral or injectable fertility medications, or a combination. All but the most complex procedures are done in the URA office, which boasts a state-of-the-art surgical suite.

McGovern and his colleagues are particularly proud of the reduction in the incidence of triplet pregnancy after IVF at URA. "We have been working hard to bring this down," he says. "It's now under 5 percent, and we think we can get it even lower, to around 1 percent. Just two years ago it was 8 to 9 percent."

URA is a training site for the NJMS REI Fellowship Program, which is the only one of its kind in New Jersey. McGovern relishes his role as director.

Says Fong: "It's been a privilege to train here." When she completes her fellowship in June, she is headed to Long Island College Hospital in Brooklyn, where she will direct the division of reproductive endocrinology and infertility, and will also be responsible for teaching OB/GYN residents and medical students.

"I originally planned to go into private practice," she says. "But I really enjoy the challenges of academic medicine, and I like being involved with research. It wasn't something I wanted to give up."

McGovern, who describes research as "the part of my job I like best," is a principal investigator for the Reproductive Medicine Network, which carries out large, multi-center clinical trials in male and female infertility, reproductive diseases and disorders. Among their current studies is one on pregnancy in polycystic ovary syndrome. He has also just completed another study on urine ovulation detection kits, finding a surprisingly high incidence of false positives and false negatives. "It's a huge industry," he says. "Many women think they can't become pregnant without these kits. But if they're not accurate, they're not helpful."

While delivering babies is what attracted both these physicians into the field of reproductive endocrinology and infertility, they don't see the delivery room much anymore. Women who successfully undergo infertility treatment are sent back to their referring gynecologists after 10 weeks. "At that point, we're satisfied that we've done our jobs," says McGovern.

The gallery of baby pictures on his office walls attests to their success.