MEDICAL HISTORY

TRAILBLAZER: Luigi Mastroianni, Jr, MD, forefather in the evolution of reproductive medicine

William Goodell Professor Emeritus of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Nancy and Richard Wolfson Professor of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania

Luigi Mastroianni, Jr, MD, has been a catalyst in the field of reproductive medicine for more than 50 years. With his study of fallopian tubes in relation to fertility, Dr Mastroianni has made a dynamic impact in the development of oral contraceptives (OCs) and in vitro fertilization. Recently, Christos Coutifaris, MD, PhD, quizzed Dr Mastroianni about his profound effect on reproductive medicine.

CC: How did you become interested in the field of obstetrics and gynecology (ObGyn) and, specifically, involved in the field of reproductive medicine?

LM: My father was an obstetrician in New Haven, Connecticut. He was always so excited about bringing new life into the world. He would go off in the middle of the night to deliver a baby and was never unhappy. Later, when I started my internship at Metropolitan Hospital, I became acquainted with John Rock who, along with Arthur Hertig, had done a vast amount of research on early embryo development and implantation. His work had a profound impact on me.

CC: Tell me about your fellowship with Dr Rock and your work on early oral contraceptives (OCs).

LM: I joined John Rock at the Free Hospital for Women in Brookline, Massachusetts. During my fellowship, John became ill. So twice a week, a colleague and I would deliver charts to him and discuss strategy regarding a small group of patients who were taking SC4642, the first commercial OC. We demonstrated that SC4642 would inhibit ovulation nicely, yet we were still concerned about the amount of estrogen in the pill. My research on the pill continued at the Worcester Foundation where I worked indirectly with Gregory Pincus in analyzing the progesterone levels in women taking OCs.

CC: You are perhaps best known for your contributions to the study of fallopian tubes in relation to fertility. How did you begin your research?

LM: My colleague, C. Lee Buxton, had just become the Chair of the Obstetrics and Gynecology department at Yale. One 10-minute interview later, I became an assistant professor at Yale in 1961. However, the summer months were slow, so I began studying the fallopian tubes in rabbits. I realized tubal fluid was golden—it is where fertilization and development occurs. I obtained 2 rhesus monkeys from Gertrude Van Wagenen to further my studies. This caught the attention of the academic community and I was offered the Chair position at Harbor General Hospital in Los Angeles. There I studied the tubal fluid and its relationship with the zona pellucida and the egg membrane. Working with Luciano Zamboni, I used an electron microscope to study a freshly ovulated egg flushed from the fallopian tube of a patient who was having a vaginal hysterectomy. In addition, by continuing our fertility studies with monkeys, we produced the first artificially inseminated rhesus monkey!

CC: You then became the Chair at the University of Pennsylvania and worked with your close friend Celso-Ramon Garcia. What was that experience like?

LM: At first I wasn’t interested in the position of Chair, but then the Dean saw to it that I would get my own laboratories to continue my research with the Rhesus monkeys. I asked Celso to work with me—he was a dynamic personality who was instrumental in the development of OCs. I was honored to work with him—he was like a brother to me. We spent the next few years studying the estrogen levels in OCs and were able to lower the dosage considerably.

CC: Many young people in our specialty do not know about the role you played in the growth and development of in vitro fertilization; in fact, you and Bob Edwards shared the King Faisal International Prize in Medicine. Can you describe your team’s contributions and the challenges you faced?

LM: We brainstormed the concept of a division of reproductive biology, comprised of PhDs in the basic sciences. Our team presented original research on early fertilization of the human egg, including systems to predictably fertilize human eggs. It was a long, complicated process because we were in a university setting and there was no such thing as an Institutional Review Board. We were unwilling to transfer fertilized eggs, even into the infertile volunteer patients, because we were not sure the eggs were normal. What if that first successful attempt had resulted in a chromosomally abnormal child? Who would take responsibility for that? Our work also caused a lot of political problems in the 1970s because people believed we were stripping the controls of the reproductive process.

CC: Recently, you earned a Masters of Bioethics. What made you decide to return to the classroom at this stage in your career and how has it changed your perception of reproductive medicine?

LM: I ran into Art Caplan at the Univeristy of Pennsylvania and asked if there was an age limit for his bioethics program. Before I knew it, I was in the admissions office filling out paperwork. During my time in the program, I became ill, so I was forced to complete the course via online audio recordings. Art graciously allowed me to qualify for the degree by giving me a final exam. I focused on women donating their ova. I worked harder in that class than I have ever worked before.

This program allowed me to compartmentalize some ideas behind decisions that are made and where ethics may be considered. It taught me that there isn’t always a clear-cut answer for every problem we face as doctors. It reminded me of a case where a patient made a request for a post mortem collection of her husband’s semen for insemination, although the husband issued no formal permission. Ironically, Art Caplan had written an article condemning this practice. In this case, Art decided that the semen collection was acceptable, but the woman decided against using it. I was able to change Art’s mind!

CC: What would you advise the present and future generations of reproductive medicine specialists to focus on?

LM: I would tell young specialists to study something that people have neglected. I was able to build my entire career around the fallopian tube, which was a little-studied aspect in reproduction at the time. I get really excited when I see how much there is for our young physicians to accomplish!

Sexuality, Reproduction & Menopause ©2008 Quadrant HealthCom Inc.