Dr Beryl Benacerraf has revolutionized the prenatal diagnosis of congenital anomalies and improved the detection of gynecologic disorders with the use of ultrasound. Among many, her discovery that a large sonographic nuchal fold in the second trimester is associated with trisomy 21 established the importance of fetal dysmorphology as an instrument for prenatal diagnosis. With this pioneering contribution, she opened the door for what is now known as “genetic sonography,” a modality that has dramatically improved prenatal diagnosis and the characterization of fetal syndromes.
Today, Dr Benacerraf is Professor of Obstetrics, Gynecology, and Reproductive Biology and Professor of Radiology at Harvard University and Brigham and Women’s Hospital. Many recognitions reflect her towering position in the field: she is a recipient of the Ian Donald Gold Medal Award from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) (bestowed in Melbourne, Australia, in 2001) ( Figure 1 ) and an elected Fellow of the American College of Radiology and the Society of Radiologists in Ultrasound. Her awards include the Marie Curie Award from the American Association of Women Radiologists (2008) and the Lawrence A. Mack Lifetime Achievement Award from the Society of Radiologists in Ultrasound (2010).
Among her numerous contributions are observations on the development of human fetal hearing and on the use of ultrasound to monitor invasive procedures, such as amniocentesis, intrauterine transfusions, and midtrimester fetal thoracentesis. Dr Benacerraf has led the way in the detection of anomalies in virtually every part of the fetus. She also introduced the concept that volumetric sonography could be used as a method for the rapid and comprehensive examination of human fetal anatomy. Dr Benacerraf has been an advocate for “ultrasound first” for the assessment of gynecologic disorders.
During her term as President of the American Institute of Ultrasound in Medicine, she promoted the development of a curriculum for training in ultrasound in obstetrics and gynecology, which has been endorsed or supported by all professional societies in the United States, including the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the American College of Radiology, the Society of Radiologists in Ultrasound, ISUOG, and others. ,
For these reasons and more, Dr Benacerraf is recognized as a “Giant in Obstetrics and Gynecology”.
Early Life: From New York to Paris and Back
Shortly after Beryl was born in New York, her family followed her father’s research career to Paris; thus, her earliest years were spent in France. As a single child, she bore the pressure of expectation from parents with exacting standards: her father, Dr Baruj Benacerraf ( Figure 2 ), was already a respected immunologist, and he would go on to become the 1980 Nobel Laureate in Physiology or Medicine.
Beryl was seven years old when the family moved back to New York City where she was introduced to the sights, sounds, and language of her new country. Their home was a “French oasis,” and Beryl recalls her mother working hard to pass on her European upbringing, amid the rush of the very American city. The family spoke French at home and maintained European cultural traditions, such as a formal dinner every evening.
Her parents soon became involved in the city’s cultural side, to which Beryl’s extracurricular activities contributed: “My parents gave frequent dinner parties in New York which were heavily involved with classical music. Whenever there were guests at home, I was expected to perform on the flute.”
An array of interesting people would be seated at the dinner table. From a very young age, Beryl spent time with distinguished people, from gifted musicians to eminent scientists; among the guests were Drs Francis Crick, Leo Szilard, David Baltimore, André Cournand, Lewis Thomas, and Gerald Edelman. “My mother always made sure that I knew the importance of my different background, and that I never be tempted to minimize it,” she said.
As a French-speaking child, Beryl was placed in the Brearley School, a girls’ school in New York. English as a second language was not Beryl’s only challenge: she spoke with a stutter, and unbeknownst to anyone at the time, she could not read in her native language, let alone her second one. Her inability to read was attributed to the change in language, and Beryl was enrolled in remedial reading classes. Reading remained “laborious and unpleasant,” and although she achieved good grades in mathematics, she found the other subjects difficult.
Challenges Early in the Journey
Beryl told me that she would sometimes struggle to finish assignments by the deadlines and that she found an approach to alleviate some of the stress. She would request assignments earlier and earlier, and she worked on them as soon as possible to give herself the best chance of success. “This feeling of immediate pressure whenever a task is assigned to me still haunts me today,” she commented. “To lessen this apprehension, I still often complete the requested tasks on the day they are first ‘assigned,’ lest I get behind and more work comes in.”
Although it started as a coping mechanism, this approach has since earned Beryl a reputation for submitting papers, book chapters, and other work before the deadline—an unusual trait in academia. “This habit keeps me organized and prevents me from taking on more tasks than what I know I can do,” she commented. “Nothing ever piles up and I am never behind in my work, although I work very hard to achieve this peace of mind.”
At the time, though, the reason for Beryl’s challenges with language was unclear. “Little did I know then that I was suffering from dyslexia,” she said. Today, we understand dyslexia as a reading disability that affects the language processing areas of the brain, and those found to have dyslexia are supported with tools and approaches to make reading easier. Beryl did not have this support.
College and Medical School
Beryl graduated high school and was granted early acceptance to Barnard College, where she excelled academically and in other interests ( Figure 3 ). In 1971, she graduated cum laude. After spending a year working with Nobel Laureate Dr Rita Levi-Montalcini in Italy, Beryl attended Harvard Medical School and graduated in 1976 (Alpha Omega Alpha) with the intention of becoming a surgeon.
Surgery was Beryl’s first choice—a path that would have suited her ambidexterity and her love of problem-solving. She applied for surgical internships at the Massachusetts General Hospital and the Brigham and Women’s Hospital. Beryl’s application to Brigham was successful, and life as an intern was “grueling”—she was on call every other night. Given the cultural climate of the 1970s, she worked even harder to compete in a strongly patriarchal environment: “I felt as though I had to prove myself over and over just to be accepted in the group of men.” Beryl decided that surgery was not the right fit, and when she remembered a professor who had observed a special talent in her, she decided to change direction.
From General Surgery to Radiology
Dr Jack Dreyfuss was Professor of Radiology at Harvard Medical School, and Beryl had met him during her radiology rotation at Massachusetts General Hospital. At the end of the rotation, Dr Dreyfuss said he had never seen someone with her eye for visual patterns and diagnosis; he expressed regret that she planned to become a surgeon and to bypass the field of radiology. “He kept insisting that he had never seen such a gift in all his years teaching radiology, and that it was a crime not to pursue an imaging career,” she said. By telling her the truth and supporting her talent, Dr Dreyfuss left an indelible mark in her memory. “He obviously saw a talent that I didn’t know I had,” she said.
Embracing Ultrasound
Ultrasound was a revelation for Beryl. “I entered a whole new world of wonder! I was in the land of pictures and patterns,” she said. “All of a sudden, I was a star beyond anything I have ever dreamed.” It was the technology being used at the time—the late 1970s—and although the images were low resolution and difficult for most to decipher, Beryl could spot an abnormality easily. “It would leap off the image like a beacon! I found it amazing.”
Throughout her career, Beryl has regularly reviewed images from 100 patient examinations a day, and she can correctly identify the anomaly. She attributes her talent to a broad peripheral vision, which enables her to see the whole picture and, therefore, to spot patterns more readily. I, too, believe Beryl has a gift that propelled her to the top of the field.
Capitalizing on this natural talent, Beryl played to her strengths. “I could not have been a lawyer due to all the reading required, and certainly would not have excelled as a professor of literature,” she said. “I focused my life’s work on imaging and radiology.” Beryl completed a Residency in Radiology at Massachusetts General Hospital and then pursued a Fellowship in Ultrasound and Computerized Tomography at Brigham and Women’s Hospital.
Beryl married Dr Peter Libby, who is now Mallinckrodt Professor of Medicine at Harvard Medical School and Chief of Cardiovascular Medicine at Brigham and Women’s Hospital and a top physician-scientist with worldwide recognition ( Figure 4 ). Peter and Beryl wanted to begin their family, and knowing the impact motherhood could have on Beryl’s professional career, they devoted time to plan this step. Beryl told me that she considered that a Fellowship in Ultrasound would be an ideal time and, soon thereafter, Beryl became pregnant. Consequently, she found the subject matter—prenatal diagnosis of congenital anomalies—challenging, because she had not only to identify the anomalies but also to counsel the patients about the short- and long-term implications of her findings.
Obstetrical and Gynecologic Ultrasound: a Passion
Beryl herself experienced a high-risk pregnancy: she had been exposed, in utero, to diethylstilbestrol (DES) because her mother had vaginal bleeding—DES was the standard treatment to prevent miscarriage at the time in Boston. DES exposure is known to predispose to Müllerian duct abnormalities—and Beryl was diagnosed to have a hypoplastic cervix, for which she was treated with cerclage. Despite that treatment, she had contractions during much of her pregnancy, which were treated with the beta adrenergic agent of choice at the time, terbutaline.
During Beryl’s pregnancy, her father, Dr Baruj Benacerraf, was awarded the Nobel Prize in Physiology or Medicine, and the whole family prepared for a trip to Stockholm. Beryl’s obstetrician urged her to take this “unique opportunity” and go with her parents ( Figure 5 ). In the past, premature labor was remedied with alcohol to inhibit uterine contractions. Baruj was aware of this, and he treated Beryl with the most exclusive champagne available in Stockholm during the trip. Beryl recalled that “ultimately, my son, Oliver, delivered at term, does not seem to be the worse for wear.”
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