I was born in the Lower East side of New York City, my father’s hometown, to quite young parents. At six months of age, we moved to Paris, my mother’s hometown, and I played in the streets and parks of Paris until I was 9.  I spent every Wednesday with my maternal grandmother (schools were in session Saturday to Tuesday, and Thursday to Sat), often spending hours in the Bois de Boulogne (a park along the western edge of Paris).  We spent quite a few summers in the South of France where we would raise small chicks and rabbits, which became dinner at the end of our vacation.  I am the oldest of five children. 

My parents later divorced, and my father moved all 5 of us children to the States.  First, we lived in Washington DC, where I attended the French school for one year, and then soon enrolled in the local parochial school.  My childhood included ballet lessons, camping trips, art projects, and lots of neighborhood adventures with my best friend Lucia.

In high school, our family moved to Boston after my father changed jobs.  I spent 3 years at Brookline High School, where I was exposed to a broad palette of academic topics.  I knew that I loved science, so my father recommended I study Latin (the root of many scientific words).  However, I was also fascinated by Asian philosophy and art, so I started studying Mandarin.  I studied both for 3 years.

I applied to college knowing that I wanted not only a strong scientific program, but also the opportunity to continue my Mandarin studies.  Bridging both these diverse interests lead me to the University of Massachusetts at Amherst, where I majored in Microbiology.  My work-study job later evolved into a research opportunity that developed into my Honors thesis.  At the same time, I was also pursuing a minor in Asian Studies, and the opportunity came to be a member of the first group of ten American exchange students to attend Beijing Normal University (teaching university).  This was truly my dream come true, going to mainland China, as the country was slowly allowing westerners to visit.  I spent the summer in Taiwan to further improve my language skills, and then lived in Beijing at the University for one school year. I jumped on every travel opportunity that presented itself, and had some amazing experiences exploring parts of China where no foreigners had been to in many decades.  My language skills truly allowed me to have personal contact with the local Chinese which would otherwise not have been possible.  As the cliché goes, I learned more about myself in China than I did about the Chinese themselves, but this is the beauty of travel and stepping outside of one’s cultural comfort zone. I turned 21 years old in China.

Once I returned to the States, I matriculated and decided that I needed to spend some time with my French family.  I worked in Paris for a year, and traveled extensively throughout Europe.  I then returned to the States and lived in Palo Alto, doing research with a biotech startup company. During this time I was deciding what my next career steps would be.  Should I pursue medicine and apply for an MD, or should I pursue research and apply for a PhD?  Pursuing an MD was more in line with my overall goals, and two years later I was bound for medical school at UC Davis.

I knew that I wanted to pursue women’s health care.  I also was fascinated with the growing field of fertility treatment because it was a triumvirate of scientific, ethical and surgical frontiers, all of which resonated for me.  When I applied for residency, my mentor encouraged me to consider a new program at UCSF, which was a combination of residency and Reproductive Endocrinology (REI) fellowship. While this was a very big commitment to seven years of training, I knew after interviewing that this was a perfect combination for me.  Fortunately, I was accepted, and thus embarked on a long career at UCSF. 

I completed my residence, fellowship, and was on faculty at UCSF for a few years.  During this time, I was very active in basic science research investigating the role of endometriosis and fertility.  In 2000, I left UCSF and joined my 4 current partners at PFC.  We now have created a most unique fertility center, with a state of the art laboratory, dedicated and devoted staff, acupuncture center, research center, and a special combination of personal care with the benefit of input from the five MDs who are seasoned fertility providers. 

While I was a resident at UCSF I met my husband, who himself was an Internal Medicine resident.  After his Chief Residency year, he did a fellowship in Gastroenterology.  Fortunately we were both able to complete all of our training while staying in San Francisco, the city we call home.  We have three wonderful daughters who love adventure, travel, playing sports …… and while none of them will become doctors like their parents, all three have a giving heart and are involved in careers and activities of giving back to their communities.

When not at work, I enjoy time with my family, as well as good food and wine, foreign films, reading, photography, yoga, and just quiet times.

I am privileged to be in a profession where I touch so many people’s lives and dreams.  Every birth announcement is a reminder of this privilege, and every failed treatment cycle is a new commitment to do my best.

-Isabelle Ryan, M.D.

In November I had the opportunity to travel to Shanghai, China to attend a conference on emerging molecular technologies (Molecular Medicine 2010). As an invited speaker, I presented a talk concerning the use of micro-array DNA analysis to evaluate single human embryonic cells for both genetic disease and chromosome copy number (see lead article in this issue). As part of my talk, I presented the case of one of the patients featured in this issue’s Patient Odyssey. She was our first patient to have her embryos screened for both myotonic dystrophy and for chromosome copy number.  As a result of this successful testing, she is due to deliver her healthy daughter soon.

The trip to Shanghai itself was quite interesting. My husband accompanied me and we were there for one week. The population of Shanghai is about 20 million! The number of high-rise buildings and skyscrapers continued for dozens of miles before even entering the city center. The subway system there is excellent and street traffic was not too bad. The traffic was constant, though, with beeping horns heard 24 hours a day. The weather in November was fairly pleasant but the skies were always hazy, with a combination of marine layer and pollution. The city was full of incredible shopping destinations with rows of designer shops with every name brand designer you can think of. The local shops’ goods, however, were very low-end and left a lot to be desired.  In the usual tourist areas, street people were constantly trying to get us to follow them to view their “knock-off” counterfeit goods. We visited several parks and temples and tried to take in as much local culture as possible. The traditional Chinese architecture and culture is disappearing quickly in this fast-paced economy.

We had the opportunity to visit an IVF center in Shanghai, affiliated with one of the local hospitals. This center performs over 2,000 IVF cycles per year (compared to 800 a year at PFC). The center was not as clean as I would have hoped and there was a very crowded waiting room of patients waiting for ultrasound scans, blood tests and procedures. I did not get the sense that providing accommodating customer service was high on their list of priorities. Speaking to one of the laboratory staff there, it does seem as though they do most of the same type of IVF work we do at PFC, with the exception of ovum donation, surrogacy and sex selection, all of which are not allowed in the IVF centers in China.

Overall, it was a fascinating trip and I enjoyed the chance to tell others about the exciting new genetic technology affecting fertility patients.

-Carolyn Givens, M.D.

Born into a musical family, some of my earliest memories are of visiting musicians and musical instrument makers.  I was fortunate to meet Carl Geyer in Chicago, who built some of the world’s finest French horns.  His shop was full of raw materials, the valves, tubes, and bells associated with a French horn.  I watched as Mr. Geyer shaped them into beautiful instruments, ones that professional musicians from all over the world came to play.  For me, these visits became early lessons in craftsmanship, quality and personal responsibility.

My father, a conductor and horn player, expected each of his five children to play an instrument.  I turned to Oboe.  There are many stories about oboe players, mostly revolving around the fact that playing the oboe is a real challenge; the oboe being “an ill wind that nobody blows good”. 

However, I pursued the art and craft of the oboe and learned from some of the top master oboists and conductors of the day.  My instructors came from major symphony orchestras in Indianapolis, Cleveland and Chicago.  I met and was influenced by world renowned conductors and composers;  Leonard Bernstein, Aaron Copland, Dika Newlin, and Peter Shickele.  Working with masters you learn that, while there are many ways to accomplish a task, the path chosen must be done correctly and pursued with passion.

Many years have passed since I played in an orchestra, but those early experiences are still with me each day I practice medicine.  The symphony is a wonderful analogy to describe the work in our practice.   In an orchestra there are nearly a hundred individuals of diverse backgrounds, origins, and personalities. There’s a conductor at the helm, working the notes placed on paper by a master of composition.  The mastery and craftsmanship, performed by a unified team devoted to a single goal, using all the skills available to them, creates a performance of great beauty and power.

Similarly, at Pacific Fertility Center, the doctors compose a treatment plan and direct the team.  We give our staff the best of class tools.  Our staff orchestrates the performance; a highly talented group of people applying their best skills to the unique problems of each individual patient.  It is an honor to work with the patients that entrust us with their care. We continue to pursue the best in fertility technology and pregnancy rates.

On reflection, perhaps I became interested in fertility medicine because it gave me the same sense of structure, purpose and wonder as playing the oboe as a young student.  I was inspired by the announcement of the first pregnancy from in vitro fertilization. The application of medical technology to help a family achieve their dreams was a landmark event.  Controversy and hoopla ensued, but the truth stood clear, that a small baby – a new child – was held in its parents’ arms as a result.   For me, this was a momentous event that inspired me to attend medical school at Indiana University, residency in obstetrics and gynecology at the University of Pittsburgh’s Magee-Womens’ Hospital, and ultimately a fellowship in reproductive endocrinology and infertility at USC.

USC was a crucible of fertility technology.  Roger Lobo was performing extraordinary work on ovulation induction and PCOS.  Some of the pioneers of IVF and oocyte donation were rewriting the book on fertility care.  Lobo, Rick Paulson and Mark Sauer published the first report of oocyte donation in women over 40 years of age (New England Journal of Medicine, 1990).  The protocol diagram in that paper is my design.

After completing fellowship, I returned to Chicago to join Anne Wentz in developing the program for in vitro fertilization at Northwestern University.  Anne came from the Gerogeanna and Howard Jones Institute tradition, and was a real master of the embryo transfer.  We established a successful program synthesizing the best of East and West coast protocols, advancing the theory and practice of embryo transfer, developing new techniques for male fertility problems, and developing fertility preservation for endangered species. 

California called me back, and I joined Pacific Fertility Center (PFC) in San Francisco in 1991.  At PFC, I was fortunate to meet Dr. Herbert who later established The San Francisco Center for Reproductive Medicine.  Dr. Herbert’s vision of patient-centric fertility care was pioneering and contemplated my own interests in quality care.  In 1999, we carried this vision forward joining with Drs. Schriock, Givens, and Ryan from the University of California to form Pacific Fertility Center as we know it today.

Being an early member of the profession, I have been blessed with many opportunities to apply technology to patient care.  I developed an embryo transfer system with Danforth Biomedical and was awarded a patent, “Methods for endometrial implantation of embryos”.  We were early adopters of networking technologies in the early 1990s and developed one of the first fertility support websites, PacificFertilityCenter.com (at that time sfivf.com) in 1993.  My wife was responsible for the early work leading to FertilityWire.com, which continues today as an educational resource for patients.  Ongoing interests in genetics, fertility preservation, and imaging are leading to new developments that we will apply to clinical care in the near future.

Today I am a husband to a remarkable wife and three wonderful girls.  I have many outside interests in skiing, music, bicycling, and aviation.  I was pleased to receive a “Best Doctors in America” award and recognition in “America’s Guide to Top Obstetricians and Gynecologists”. Our entire family went to New York for the American Fertility Association’s Kokopelli Ball, where I received the AFA’s Family Building Award. 

One of my interests includes teaching young doctors that are contemplating their roles in the field, and I was asked to join the faculty at UCSF where I teach these bright young minds.  I am reminded of how unique our profession really is, seeing  it again through their eyes.  Reproductive Medicine has grown much since that first IVF pregnancy and I am proud to be part of its continuance into the future.

-Philip Chenette, M.D.

I was born in 1948 in North Carolina to a red headed father who, sure that I would have similar coloring, nick-named me “Rusty”.  My father was an Ob/Gyn who eventually established his practice in Gainesville, Florida where I grew up in what was then a small southern town. Although the 1950s and 60s were interesting times in the deep south, we were quite fortunate to live in a “university” town with the University of Florida providing an important intellectual and social influence, which wasn’t present in other areas surrounding us. My father was from Manasquan, New Jersey and my mother from Brooklyn, New York, so my siblings (a family of five children) and I were mostly educated in the northeast after primary schooling in Florida. I graduated from high school, The Peddie School, and college, Rutgers University, in the garden state of New Jersey. During one summer of my college years, the summer of 1968, yes, the summer after “the summer of love”, I lived and worked in San Francisco, which is probably a major reason I now reside here. After college graduation, I returned home to attend the University of Florida where I earned an MS degree in Environmental Engineering Sciences and subsequently an MD degree, making me a fourth-generation physician.

I spent one year in St. Louis at Washington University as an intern in Ob/Gyn where I met fellow residents and long time friends Drs. Elliot and Denise Main, as well as my future wife, Katharine. At years end I moved to Nashville, Tennessee and completed both a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology at Vanderbilt University Medical Center. While at Vanderbilt, Katharine and I enjoyed working together.  She as a nurse-midwife and I was a resident.  After the birth of our first child, Katharine became involved with county health care programs and I began my fellowship. I joined the Vanderbilt teaching faculty upon completion of my fellowship and served as the Director of the Reproductive Endocrinology / Infertility Division from 1989-90.

Early in my medical career, I had the good fortune to participate in some “firsts” in the field of reproductive endocrinology and infertility. While at Vanderbilt University, I did pioneering work with the first laser laparoscope and was involved with one of the first assisted reproductive technology programs in the United States. I authored several early articles on endoscopic surgery, including one of the very first articles published on the treatment of tubal disease via laser laparoscopy. I was also fortunate to be a part of those early difficult and formative years in the area of IVF and contributed to numerous articles as we tried to create additional and better ways for success.  

In 1990 I was recruited by the original Pacific Fertility Centers to join their San Francisco clinic, where I was appointed Medical Director. However, desiring to create my own concepts for care, I left PFC to become a partner and Medical Director with the San Francisco Center for Reproductive Medicine. Dr. Chenette joined me very soon thereafter. With much hard work and help from many of our current staff, SFCRM became a leading center for infertility care and assisted reproductive technology services in Northern California. In November of 1999, Dr Chenette and I joined forces with Drs. Givens, Ryan, and Schriock and took over the management of the current Pacific Fertility Center. Our vision was to create a center of excellence that was large enough to do good clinical research and answer some of the important clinical questions in our field. We all came from academic backgrounds and knew the benefits of collegial interaction, but felt there was a better way to offer patient-centered services. PFC is the culmination of our collective dreams and ambitions to create such an optimal center. We are indeed proud of the result.

After years of clinical practice in our field, I find I am most drawn to the numerous and complex ethical issues which are products of our ever changing technologies. This interest has led me to diverse activities as a 22 year membership in the Society for Humanism in Medicine, including the 2003 presidency, and a planned speaking engagement this year at the annual meeting of the American Academy of Child and Adolescent Psychiatry, regarding the ethical issues involving children conceived through reproductive technology.

When there is the “extra” time away from medicine, I enjoy the excitement of international travel, the pleasure of a good bottle of Burgundian wine, the stretch of great contemporary jazz music, and the stimulation of a unique piece of art. I have taken on the “egg” image as a passion for collecting and now own a wonderful group of vintage and modern photographs as well as “eggs” in other media, some of which you will see in our office. I have two wonderful daughters, Sarah and Rachel, and I feel so very fortunate to count myself as one of those who arise each morning looking for this day to be better than the last. 

” When you don’t know something can’t be done, it makes it possible to do.”  -Brother Thomas Bezanson  

Dr. Rusty Herbert, M.D.

After 10 years of publishing newsletters, many with personal stories from our own employees, we have decided that it is time to do personal stories on our own physicians. So this is the first of our five physicians’ own stories we will be sharing with our readers over the next several issues. We hope you enjoy these stories and get to know our PFC doctors a little better.

I was born in Wahiawa, Hawaii in 1957, two years before Hawaii became a state. My mother was a Nisei Japanese woman, born and raised on the Big Island of Hawaii, where I hope, if I live long enough, to retire someday. My father was a Texan, raised on a dry land cotton farm in the Panhandle of Texas. He was adopted so I don’t know his genetic and ethnic background, but we suspect perhaps Welsh-Scottish. My parents met in Hawaii during WWII. I grew up the youngest of four children. I have two older sisters, with whom I am very close, and I had an older brother I loved very much but lost to kidney cancer two years ago. My mother never got to graduate from high school as she had to help her father in his general store, but she was a remarkably intelligent woman with a life-long thirst for knowledge. She received her G.E.D. at age 42; in another time, she could have been a very accomplished career woman. I was very lucky to have her for a stay-at-home mom. My father finished high school and joined the Navy just before WWII. He never went to college, but worked for the US government all his life in civil service for the Army. He rose to quite a high rank by the time he retired, due to his diligence and competence. We lived in Hawaii until I was 8 years old, then we lived in Okinawa, Japan during the Vietnam War (1965-1973). After that, my father was stationed at Ft. Hood, Texas. It was good for him to return to his home state after 35 years on islands, but hard on my mother and me, who had always lived on tropical islands with Asian culture. I graduated from high school in Central Texas and, not knowing what I wanted to do, enrolled at the University of Texas at Austin, because it was inexpensive and close to home. This was a stroke of luck because I received a wonderful education there for very little money, and it paved the way to medical school. I worked all kinds of low paying jobs to help pay my way through college, as my parents didn’t really have much money. I entered the university as an English major, as I loved literature, but quickly realized there would be no work in that field. I took a biology course my freshman year and absolutely fell in love with it. I considered being a biologist, a veterinarian (I love animals!) and eventually realized I wanted to work with people, not animals and not at a research bench. I went to medical school in Dallas, at the University of Texas Southwestern Medical School. This school has an incredible reputation for excellent research (they are always in the top 2-3 medical schools in the nation to receive NIH grant money), a well-developed program of philanthropy that supports their mission, and most of all, the best teachers one could have. I feel truly blessed to have been able to attend that wonderful medical school. During medical school, I had a job (always working!) in a research lab that was doing research on how the genes that make FSH work. That experience exposed me to reproductive endocrinology early in my career. I was even able to publish a few papers during medical school. Small stuff, but it felt great at the time.

During medical school, I discovered I liked many different specialties, but really liked caring for women. It was natural for me to go into obstetrics and gynecology. I stayed at Southwestern because their teaching hospital is Parkland Memorial Hospital, an incredible training ground for residents. During my four years there, I delivered thousands of babies, performed or assisted about 600 Cesarean sections and did all kinds of gynecologic surgery. It was very hard work, but gave me a sound foundation and a lot of confidence that I could do most anything. I remained interested in Reproductive Endocrinology, although at the time, in vitro fertilization was just beginning to develop around the country and wasn’t the major emphasis in the field. Back then, the specialty was more about taking care of menopausal women, doing surgery for infertility (especially endometriosis, because at the time, we thought surgery helped fertility for these patients, something we now know isn’t really true) and doing microsurgery to put the tubes back together for women who had previously had their tubes tied and now wanted to be pregnant again (we now treat this with IVF). I decided that rather than going into practice in general ob/gyn, I would continue two more years of training to become a Reproductive Endocrinologist.

After 17 years in Texas and 8 years at Southwestern, I knew I wanted to go somewhere else and gain new experiences and exposure to different teachers. I only applied to a few fellowship programs and was fortunate to be accepted to my first choice: the University of California San Francisco. During my fellowship there, I met and was taught by the best mentor one could have, who is now my close friend and partner, Dr. Eldon Schriock. At the end of my fellowship, I was incredibly fortunate to be recruited by him and the department to stay on as a faculty member. While there, we instituted many new techniques into the infertility program such as ICSI and PGD. We doubled the size of the IVF program. We also taught many of the Reproductive Endocrinologists that now practice in the Bay Area, including our own Dr. Isabelle Ryan. While at UCSF, we almost merged with Drs. Carl Herbert and Philip Chenette, who were in private practice in San Francisco, but due to a variety of reasons, we were unable to realize the merger with them within the UCSF system. We got to know them very well, though, and we knew we could work together.

Dr. Givens was born in Hawaii in 1957, 2 years before Hawaii became a state.

Since I finished my fellowship, I knew I wanted to be part of a world-class fertility center that could provide the best care for our patients. For many reasons, during the late 1990s, this was becoming more difficult to do within the University. In 1999, when the previously existing Pacific Fertility Center came up for sale, Dr. Schriock and I got together with Drs. Herbert and Chenette and took the opportunity to realize our dream. We were able to recruit Dr. Ryan to join us. It has been a challenging but very exciting 10 years at PFC but now we are all able to say that the dream has become a reality. I am getting to do what I love to do every day.

On a personal level, I met my husband Michael when I was at UCSF. We were so sure about each other that we married 7 months after we met! I was a little older by then and at first we struggled with the idea of whether we would try to have a family. Since neither of us had any family living close by and my professional career (as well as his business) was very time consuming, we realized we would be stressed-out parents living the day-care life. We finally decided to live child-free. I only regret not having adult children to be proud of and having grandchildren to spoil. We now live in Marin and our children are our two dogs that I adore and spoil way too much. I love gardening, boating, cooking, reading and travelling. I don’t really have a passion for any particular hobby, just a passion for my work. But someday, as I said, I hope when I retire to return to Hawaii. Even though we left there when I was young, it is a big part of my family’s history and culture. I feel most at home with the aloha I feel when I am there. I would love to volunteer at an animal shelter after retiring. I still sometimes wish I had gone into veterinary medicine, but I think I will enjoy it more as a volunteer and since I have the best job in the world, that will have to wait for another lifetime.

— Carolyn Givens, M.D.