Groundbreaking project a new revolution in contraception

Robert Hatcher, MD, professor of gynecology and obstetrics at Emory University School of Medicine, was Peipert's mentor in medical school and compares him to Rafael Nadal, the Spanish tennis player who is one of the few to win the world’s four major tennis tournaments.

“Nadal continues to get better and better, and Jeff Peipert is in the same category,” Hatcher says. “It’s exciting to me whenever I have the opportunity to see the best in action.”

Peipert, a national expert on family planning, studies behavioral interventions to prevent sexually transmitted diseases (STDs) and unplanned pregnancy. His colleagues describe Peipert as intense, enthusiastic and disciplined. He’s also known as a dedicated father and a gifted storyteller.

Creating the Choice

Peipert joined the School of Medicine in 2006 as vice chair for the Department of Obstetrics and Gynecology’s clinical research division. His mission was to focus on patient-oriented research.

In December 2006, a foundation contacted Peipert and asked him to plan a project in St. Louis to encourage the use of long-acting reversible contraceptives, such as intrauterine devices (IUDs) and hormonal contraceptive implants. The goal was to decrease the number of unintended pregnancies in the metropolitan area.

He was asked to do some “back-of-an-envelope calculations” for a budget, with no idea of the scope of the project. He e-mailed the head of the foundation asking for some idea of how many patients he should plan to recruit. The director told him to “THINK BIG! Happy Hanukkah!”

Peipert proposed educating participants about the many types of birth control and giving free contraceptives to 10,000 women, a number almost unheard of in most clinical studies.

The costs of available birth control methods vary significantly. Birth control pills may cost between $9 and $90 per month, compared with the up-front costs of IUDs and hormonal contraceptive implants, which can be more than $700.

“Because more than 50 percent of the women chose IUDs, our budget went far beyond what I initially proposed,” says Peipert, who was named the Robert J. Terry Professor of Obstetrics and Gynecology in 2007. “Despite this, the foundation has been incredibly supportive. It is a researcher’s dream.”

Among U.S. women, the birth-control pill is the most common reversible method. In order for it to be effective, however, women must be able to pay for the pill, have access to refills and remember to take it daily. The failure rate of the birth control pill is 8 percent, and the discontinuation rate of the birth control pill also is high.

According to Peipert, IUDs are far more commonly used in other developed countries than they are in the United States. He says recent improvements and new technology in IUDs and contraceptive implants may encourage more women in the United States to try these methods to prevent unintended pregnancy. IUDs and implants have a failure rate below 1 percent.

In preliminary results from the study, called the Contraceptive Choice project, almost 70 percent of the participants chose IUDs or implants. Peipert is inspired by these results.

“Getting more women on long-acting reversible methods of birth control would have a tremendous impact on public health,” he says.

Inspiring others

George Macones, MD, calls Peipert one of the most talented physician-scientists he has ever known.

“He is a great thinker and extremely methodological and organized,” says Macones, the Mitchell and Elaine Yanow Professor and head of Obstetrics and Gynecology and the person who recruited Peipert to WUSTL. “These are the reasons why Jeff was chosen to lead one of the largest studies ever done on contraception. He is truly one of a kind.”

Peipert’s former boss, Donald Coustan, MD, agrees. He says Peipert is one of the most effective faculty members with whom he ever has worked.

“While he was at Brown, he inspired residents and fellows to execute outstanding research projects and secured our place in federal programs funding young faculty’s research endeavors,” says Coustan, professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University. “He also is a genuinely warm, caring doctor and human being — what I would call a mensch.”

Finding his niche

Peipert grew up on Long Island, N.Y. Although Peipert’s sister told him not to bother applying to an Ivy League school because he wouldn’t get in, he applied to Brown University and was accepted. Becoming a student there opened his eyes to diversity, he says, not just in race but also in religion and differing views.

Between his sophomore and junior year, Peipert decided to pursue medicine. His freshman roommate, from Atlanta, encouraged him to apply to Emory University School of Medicine.

He met Hatcher after his first year of medical school, during a summer program in family planning and human sexuality.

“I realized then how important is it to plan your family — to avoid getting pregnant when you don’t want a child and to become pregnant when you want one,” Peipert says. “I realized family planning was something I wanted to study for the rest of my life.”

After medical school, Peipert completed an obstetrics and gynecology residency at Pennsylvania Hospital in Philadelphia. Ironically, Macones was his junior resident at the hospital. Peipert credits a fellowship afterward as a Robert Wood Johnson Clinical Scholar at Yale University with teaching him how to think like a researcher.

In 1992, Peipert joined the medical school faculty of Brown as director of emergency services at the Women & Infants Hospital.

At Brown, Hatcher says Peipert conducted two of the best studies on misinformation about birth control pills.

“Jeff determined that women overestimate the risks of pills and underestimate the health benefits,” he says.

Peipert also researches in-home screening for STDs. Along with Anna Greaseck, MD, then a School of Medicine student, and colleagues, he determined that most women prefer at-home tests for STDs. The researchers also found that a greater percentage of these women followed through and got tested for chlamydia and gonorrhea, compared with the number of women who said they would choose a doctor’s office or clinic for testing.

“The results are important because they show you can increase screening for these infections, which are very common and cause serious health problems such as infertility, ectopic pregnancy and pelvic inflammatory disease,” Peipert says.

And as he fields calls about the Choice project from groups across the country and an organization in England, Peipert says he hopes that he and his team will be able to shape family-planning health policy in the years ahead.

“I hope we can play a large role in the shift in contraceptives, which can greatly affect unintended pregnancy rates,” he says. “That’s very exciting.”

Provided by Washington University School of Medicine in St. Louis