CHANGE: In Medicine and In Life

1. CHANGE:In Medicine and In Life Ronald C. Strickler MD MBA Chair Emeritus, Women’s Health Services Henry Ford Medical Group Professor, Obstetrics & Gynecology Wayne State University School of Medicine Detroit Michigan

3. In Vitro Fertilization/Embryo TransferTimeline • 1932 Aldous Huxley’s Brave New World anticipates developments in reproductive technology as our ability to engineer life in a baby farm • 1959 Chang Worcester Instit Rabbit embryo created • 1972 Shettles N.Y. Columbia Human IVF experiment ended • 1973 Wood/Leeton/ Monash UnivIVF embryo implantation failure Trounson • 1976 Edwards/Steptoe Cambridge IVF embryo ectopic gestation • 1978 Edwards/Steptoe Oldham Hospital Louise Brown, 5’ 12”, planned C/S

4. In Vitro Fertilization/Embryo TransferTimeline • 1979 Stimulated ovulation (Clomiphene – AUZ; Gonadotropins – USA) • 1983 Victor Gomel British Columbia First Canadian IVF baby Bob Casper Toronto hCG supports luteal phase • 1985 Ron Strickler St. Louis First Missouri IVF babies • Trans-abdominal ultrasound guided embryo transfer. • Fertility & Sterility 1985;43:54-61 • Late 80s Transition from Laparoscopic Egg Capture to Ultrasound-guided Egg Capture: Trans-vesicle to Trans-vaginal GnRH agonist suppression of spontaneous egg release

5. In Vitro Fertilization/Embryo TransferTimeline • 1992 Palermo (Devroey & Van Steirteghem) Intra-Cytoplasmic Sperm Injection VrijeUniversiteitBrussel Initial fears that a selection mechanism was being by-passed and there would be a high rate of genetic abnormalities proved unfounded Male infertility revolutionized: immature sperm (epididymis & testis extracted), incapable of zona binding/penetration, can give healthy babies

6. In Vitro Fertilization/Embryo Transfer Today • 21st CenturyMature Technology

7. In Vitro Fertilization/Embryo Transfer Today • 21st Century Spin-Offs

8. In Vitro Fertilization/Embryo Transfer Today • 21st Century Spin-Offs • Pre-implantation Diagnosis (PGD) • Parents known carriers • Child born with a specific disease • Pre-implantation Screen (PGS) • Advanced maternal age • Recurrent miscarriages unexplained

9. In Vitro Fertilization/Embryo Transfer Today • 21st Century Spin-Offs • Each year, 1-4000 newborns in the USA have mutant mitochondrial DNA (37 genes susceptible to hereditable mutations). • Unfertilized egg from a healthy donor: • Remove the spindle complex with its 23 chromosomes • Insert the spindle complex from the mother transmitting the mutant mtDNA. • In-vitro fertilization with sperm from the intended father. • Three Person Parenting

10. In Vitro Fertilization/Embryo Transfer Tomorrow • 21st Century Spin-Offs • Clustered Regularly Interspaced Short Palindromic Repeats • Immune system of bacteria

11. TRANSITION IVF, an idea when we were beginning our careers, to a mature technology creating spin-offs, is not an isolated example of how medicine has changed and how we have changed with it.

12. Gynecology in Evolution

13. Obstetrics in Evolution

14. Institutions Change

15. Cultures Change: Stop Physician Burnout

16. Cultures Change: Stop Physician BurnoutStrategies to make it work • Balance work and non-work goals • Make conscious choices • Set realistic goals • Consciously rebalance as you and your family evolve and grow • Compromise • Keep work demands in perspective • Self-awareness is the first hurdle • Choose to invest in non-work activities • Spirituality Lisa MacLean, M.D. Director of Physician Wellness, HFHS

18. Dad’s Farewell ‘Twas all a dream: Trumpet and organ led. ‘Twas end and beginning: Dad’s slow pace, Husband’s smile ahead ‘Twas every girl’s fairy tale: Rings slipped, promises said. ‘Twas like a feast: Family and friends breaking bread. ‘Twas part of your being: African drums, costumes red. ‘Twas truly a gala: Laugher-filled dance, grilled cheese for bed. ‘Tis ever your memory: 11-7, the day that you wed. Much love Ms Laura Dad 11-26-09

19. Jean Words can not say what a heart has never felt. Sentences can not construct what a brain has never known in broken form. .Expressions are hollow when one has never been empty. It is not that we, men of medicine, have not seen, heard, touched, and smelled death. We have. In our healing white coats, with empathy, we have held a hand, dabbed a tear, shared an embrace, as our words that storied life’s finality go unheard through grief-struck ears. That was death of him or her. That was death that brings no sorrow. This death is loss: my wife, my best friend, my confidant, my rock, my compass, my soul-mate, my love, my life. I say the words I said to others: they are the sounds of silence. This death takes a part of me. Words can not say what a heart has never felt. Sentences can not construct what a brain has never known in broken form. Expressions are hollow when one has never been empty. Ronald C. Strickler, MD For Cecil Collins-Williams In our healing white coats, with empathy, we have held a hand, dabbed a tear, shared an embrace, as our words that storied life’s finality go unheard through grief-struck ears. This death takes a part of me. Words can not say what a heart has never felt. Expressions are hollow when one has never been empty.

20. 6T7 A warm June sun: Orange orb on cloudless blue, Shadow towers on campus green hue. Two lines, young faces, energized, eager, wide-eyed. Onlooker faces that nurtured, encouraged; now flush with pride. Today black gowns, soft, loose, academic-rank adorned. Tomorrow starched white coats, doctors of medicine. Graduation. Convocation. Celebration. We are the class of 6T7. A late-spring sun. Life-spawning, nurturing rays Guide our paths, energize our days. We scattered like leaves, some in circles, some with direction, Landing in hamlets and cities, and some, foreign nations. We marry, birth children, love, laugh and live. We give of ourselves on earth, and some called to heaven. For everyone there is a season. We are the class of 6T7.

21. A near-solstice sun. Light the broad shoulders Of medical giants who taught us to look farther, act bolder, Be better, invent the future: our role in succession. With art and science, with pride of profession We cared, healed, comforted, and wept in empathy. We innovated, discovered, and moved the horizons of medicine. Clinicians. Scientists. Scholars. We are the class of 6T7. A fiftieth sun. New physicians hear their names, Feel the fur hood, move the tassel, say the oath, take the reins. We are their teachers, mentors, role models, and inspiration To be the keepers of knowledge, the imaginers of medical transformation. We pass the torch, aflame with new knowledge, but rich with open questions To a new generation: quintessence of medicine, lead the procession. Serve brave, serve unafraid, as we age and fade. We are the class of 6T7.

22. Founder: Diane Strickler RN, BSc, MSW

23. THANK YOU FOR ALLOWING ME TO BE A PART OF THIS 50TH REUNION PROGRAM.