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20 Questions: Laura C. Londra, MD, FACOG, Reproductive Endocrinology

Laura C. Londra, MD, FACOG, is a reproductive endocrinology and infertility physician at Ohio Reproductive Medicine in Columbus, as well as an adjunct instructor at Ohio State University in the division of reproductive endocrinology and infertility, Dept. of Obstetrics and Gynecology. As a native of Argentina, Londra attended Universidad Nacional de La Plata (1988-1993), before receiving her MD from Universidad de Buenos Aires (1993-1995). She completed a residency in obstetrics and gynecology at Hospital de Clinicas, University of Buenos Aires (1995-1999), followed by a fellowship in reproductive endocrinology at the Instituto de Ginecologia y Fertilidad de Buenos Aires (2000-2002). In the U.S., Dr. Londra completed a residency in obstetrics and gynecology at Wayne State University, Dept. of Obstetrics and Gynecology in Detroit (2008-2012), and a fellowship in reproductive endocrinology and infertility at Johns Hopkins University, Dept. of Gynecology and Obstetrics in Baltimore (2012-2015).
Dr. Londra received the Pacific Coast Reproductive Society Scholarship Award (2013, 2015), Midwest Meeting Reproductive Endocrinology and Infertility Symposium Scholarship (2014), and Edward E. Wallach Fellowship Research Fund Award for fellows research initiatives in reproductive endocrinology and infertility (2014). She’s been published in numerous journals, including International Journal of Women’s HealthFertility and SterilityInternational Journal of Gynecology and ObstetricsSeminars of Fetal and Neonatal Medicine, and Case Reports in Obstetrics and Gynecology. She is a member of the Howard Kelly Society, Johns Hopkins Alumni, and the American Society for Reproductive Medicine, as well as a junior fellow in the American College of Obstetricians and Gynecologists and fellow in Society of Reproductive Endocrinology and Infertility. Dr. Londra is a Diplomate of the American Board of Obstetrics and Gynecology, and prior to her current work, she was on staff at Instituto de Gynecología y Fertilidad (2002-2006).
When did you first decide to become a physician? Why?
I was one of those skinny girls who was a little bit of a late bloomer, and my mother was concerned. She took me to the office of the physician who delivered me, and as it turned out, I was alright. But that gave me the opportunity to realize what an Ob/Gyn does, and that was it. I fell in love with the reproductive system, so to speak.
How/why did you choose the medical school you attended?
In Argentina, at public universities you are first required to successfully complete a year of required subjects for your particular area of interest. If you pass, you don’t have to pay tuition, but you do have to buy your own books and supplies, cover your living expenses, etc., but classes are pretty much free. On the other hand, there are also private universities, where you have to pay. There are no student loans at all, so unless you or your family has the money for tuition and expenses saved up already, it would be very difficult to study medicine. I was fortunate to pass my first year exams and go the University of Buenos Aires.
What surprised you the most about your medical studies?
I am always amazed at how much the biologic, social and historical aspects of medicine are intertwined. Inequality and specifically the fetal origins of adult disease (also known as developmental origins of adult disease) are fascinating issues for me, and it has implications for multiple areas in medicine, not only reproduction. I encourage anyone who hasn’t come across this to check it out through the work of David Barker, a brilliant British epidemiologist who first described it.
Why did you decide to specialize in reproductive endocrinology and infertility?
There are no physicians in my family, but I had an early interest in the biologic and societal implications of reproductive medicine. At some point in my Ob/Gyn training I was very enthusiastic about gynecologic surgery, and I briefly thought of going into gynecological oncology. But soon after I had exposure to IVF, and I never looked back. In recent years, reproductive endocrinology and infertility has started to move away from surgical procedures, because of the increased efficiency of IVF with less need for specific surgical treatments for infertility, and because of the growth of minimally invasive surgery subspecialists. Interestingly, despite not doing as much surgery as I had envisioned, I do not miss it and am more than ever excited about all the new developments within assisted reproductive technologies.
If you had to do it all over again, would you still become a reproductive endocrinologist? Why or why not? (If not, what would you have done instead?)
Yes, I would absolutely still be a reproductive endocrinologist. Now that I am a parent myself, more than ever it is incredibly rewarding to tell a husband and wife that they are pregnant. That never gets old. There is no greater thrill than helping people to build a family. If I wasn’t a physician, I have always thought it would be interesting to be a journalist. However, as I have progressed in my reproductive medicine career, I am more satisfied with my career choice.
Has being a reproductive endocrinologist met your expectations? Please explain.
My expectations have been far exceeded. While in Argentina, I started to come to the US for meetings and to present research, but I didn’t want to move to the US only for career reasons. I was already in my mid-30s when I met my husband, who is American, and only then was the decision an easy one. Trouble was, I had to do both my residency and fellowship again. I started the residency with a one-year-old child at home and pregnant with my second baby. It was a difficult first year to say the least. But later, I was fortunate to do a fellowship at Johns Hopkins, and meet some of the pioneers of IVF, such as Dr. Howard Jones, who with his wife Georgeanna Segars Jones performed the first successful IVF in the US. I really enjoyed my fellowship time at Johns Hopkins. After fellowship, I started with Ohio Reproductive Medicine, which is affiliated with The Ohio State University. I do feel that I have the best of both worlds: I can do clinical work but still be involved with research, but I have a healthy dose of autonomy for the endeavors I choose to pursue. Coming from Argentina and being published in multiple journals including the official journal of the American Society of Reproductive Medicine, Fertility and Sterility, has been rewarding. My most recent publication had the honor of being selected for discussion by a worldwide audience of more than 500 fertility specialists during the online live Fertility and Sterility Journal Club. This opportunity definitely exceeded my expectations.
What do you like most about being a reproductive endocrinologist?
The science and the humanity behind the specialty can be challenging and thought provoking. Helping a family complete the circle of life is rewarding. In addition to infertility, I have always been interested in bioethics, and there are many aspects of assisted reproductive technologies that have ethical implications. From a more practical and personal perspective, I appreciate not to have to take in-house calls and spend nights and holidays at the hospital any more. (I did plenty of that during my training.)
What do you like least about being a reproductive endocrinologist?
The reality is that everyone can have a family if they really want via insemination, donor gametes, surrogacy, adoption, and so on. But everyone has very personal views about this, and telling someone a negative test result, or even that attempting pregnancy might not be the best idea given certain biologic limitations or personal health risks, can be heartbreaking. Financial constraints for treatments are also a source of distress in the relationship with patients sometimes.
Describe a typical day at work—walk me through a day in your shoes.
When I am on call I start my day at 7:30 a.m. with ultrasound sessions, followed by procedures until about noon. Being on call means that I take after hours consults from patients during that week and that next weekend, but we have a good support system. I see consults in the afternoon until about 5 p.m. If I am not on call, I do consults and procedures scattered during the day as convenient. I also attend Grand Rounds and educational sessions a couple of times a week at nearby hospitals. Luckily for me, traffic in Columbus is not bad. I try to finish my notes while in the office, but still bring my laptop home to look up patients in the EMR system and to work on my research. I was recently named a CREST Scholar for the 2015-2016 Clinical Reproductive Scientist Research Training (CREST) Scholars Program, so this is currently taking up quite a bit of my nights and weekends. (Note: Dr. Londra was one of four reproductive endocrinology and infertility physicians in the US to be selected for this prestigious annual award, which consists of a Clinical Research Scholarship funded by the American Society of Reproductive Medicine and the National Institutes of Health and is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Clinical Research Training Program at Duke University and ASRM.)
On average, how many hours a week do you work? How many hours of sleep do you get per night? How many weeks of vacation do you take annually?
I spend 45 hours a week in the office, but it probably goes over 70 when you factor in time spent on research, licensing, credentialing, meetings, conferences, marketing, being on call, and reading current research. This year I got a scholarship for clinical research so I have homework and some study to do. I already have some extracurricular projects after that is finished. For health reasons I always try to get eight hours of sleep a night. For years I have taken call at the hospital and moonlighted, so I have had my share of sleepless nights. I am very much aware of the importance a good sleep routine. I am entitled to three weeks of vacation each year, but I have never been good at taking long vacations. We like to take short breaks where we combine a professional meeting and add two or three days of vacation before or after. We recently did this with our children for a conference in Barcelona and were able to catch up with some friends as well.
If you have family, do you feel you have enough time to spend with them? Why or why not?
Having children during residency and fellowship is hard, because nobody can give you that time back. I am lucky in that regard, as my husband quit his job when I started residency. Because of this I can almost always go to the big events like piano recitals, figure skating competitions, sports games, birthday parties, etc.
How do you balance work and your life outside of work?
Every night we always try to have a family dinner together either before or after everyone’s activities. Having moved several times for residencies, etc., my advice is to try to live near schools, parks and work. And if given the choice, do piano lessons, etc. at home. Less time in the car is more time at home.
Do you feel you are adequately compensated in your field? Please explain.
Yes, I feel very fortunate. Growing up in a small city with limited opportunity, my sisters and I saw my father and mother struggle to provide opportunity for us. My sisters and I all feel that their sacrifices have paid off in the end.
If you took out educational loans, is/was paying them back a strain? Please explain.
In Argentina, there is no student loan system like there is here in the US. Most of the time, I was working multiple part-time, temporary jobs while in school. Having done a residency and fellowship in Argentina and a residency and fellowship in the US, I would have accumulated a lot of interest to pay back if I had taken out loans
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
I would have started my career earlier in the US. I would have tried to avoid having babies while in residency, then I would have had more time with them, and maybe….? Who knows? It sounds cliché to say that women who want to work full time have a hard time balancing work and family. I heard someone saying that there is no need to be balanced, and it might be true. Some things are more important than others, at certain times, when you keep in mind the big picture. To achieve the things you want, your life is going to be unbalanced from time to time, and that might be the price. We can’t be perfectly balanced and do everything we are supposed to do all the time during the course of our life. One big thing I would warn myself: Medicine is not just any career, it takes over your life if you let it, be careful. I did not fully understand this when I chose medicine. I thought I would be able to pursue many other interests on the side…so far that has not been the case.
What information/advice do you wish you had known prior to starting medical school?
I was not really aware of how time consuming my career and my job would ultimately be. I find myself saying if all my job consisted of was seeing and treating patients, then it wouldn’t be too hard. But there’s way more than that; you need to comply with many requirements, commit to continuous education, be responsible to help run an office or at least know what’s going on because many other people’s jobs and careers are connected to your competence and success.
From your perspective, what is the biggest problem in health care today? Please explain.
In my view, health care is too expensive in the US with too many middlemen between the physician and the patient, pushing up the cost. Despite spending a lot of money, results are not up to par with the effort (for example, maternal mortality should be much lower for the money we spend). As physicians, we also have a great responsibility to better use these resources. I know part of our society thinks physicians make too much money, but I would argue that the third parties are too much of a drag on the system. I am amazed how often I have to write a check to pay some required fee that appears to offer little or no value to the patient or physician. Physicians should have more say in health policies, because we are the ones ultimately held responsible for results.
Where do you see reproductive endocrinology in five years?
Several things come to mind when I think about the immediate future:
Assisted reproductive technology is not only about advancing and improving treatments for infertile couples, but also introducing technology that helps fertile couples with hereditary diseases avoid transmitting a specific problem to their offspring. The ability to perform embryo biopsies and know the genetic make-up of the future baby has very powerful implications for families.
In vitro fertilization has contributed a great deal to our understanding of reproductive issues that are very difficult to tease out in spontaneously conceived pregnancies. For example, we have a better understanding of the influence of the uterine environment at the time of implantation in obstetric outcomes and health of the offspring. This knowledge is important not only for infertile couples, but also for women who get pregnant spontaneously but develop problems in pregnancy such as intrauterine growth restriction, preterm birth and preeclampsia.
The concept of fertility preservation for individuals who undergo cancer treatments will hopefully solidify and gain acceptance. In recent years, as treatment for certain cancers allow people to get cured of their cancer, it is important to have ways to preserve their gametes and reproductive organs and protect them from the damage by chemotherapy drugs or radiation therapy.
In short, assisted reproductive technologies is not an area of medicine restricted to people who cannot have children and have the money to pay it. It is a very active field with ramifications that are not immediately apparent.
What types of outreach/volunteer work do you do, if any?
We just moved to Columbus six months ago, so I’m pretty much still figuring things out. As selfish as it may sound, I have a hard time volunteering my time outside my family activities, because I felt so deprived of time with my children after going through residency when they were little, and I still feel I need to catch up. As a family we love to participate and support any community or charity event that we come across. I have my eye on one of the free clinics supported by the local Columbus Medical Associations but have not committed yet.
What’s your final piece of advice for students interested in pursuing a career in reproductive endocrinology?
Be mindful of the various social, cultural, religious, and scientific aspects that are a part of reproductive endocrinology. I see women of different ethnic and social origins, and have to be ready to understand the kind of pressures and constraints they are under. Patients are going to ask you very significant questions on a daily basis: Can I have a family despite XYZ? Is this embryo my baby or is it a bunch of cells? Should I have more children at this time in my life, or am I taking too much risk? What does it mean for my family if I use eggs/sperm from a donor? Are you saying that I would not be able to carry a baby myself but I could instead use a surrogate? Some funny ones too: Do you mean I’m really, finally…pregnant? It is a specialty that is going to touch all your social and moral values, so make sure you have them clear and be prepared to change as current knowledge changes. It is at the same time a wonderful opportunity to be an advocate for women and for families, so if that is something you feel strong about, you will be inspired every day you go to work.