Professional Medical Education :: CHR
As a clinical research center dedicated to dissemination of the most up-to-date medical knowledge to the Ob/Gyn community, Center for Human Reproduction makes selected Grandrounds presentations available to the public. Please note that copyright belongs to each presenter. Any use of the material beyond your personal professional education, without explicit consent from the presenter, is strictly prohibited.
May 14, 2013: David H Barad, MD, MS; Vitaly A Kushnir, MD; Norbert Gleicher, MD
Context: Considering the heavy emphasis on basic sciences in our 2013 series, we decided to dedicate CHR's annual research update to more clinical issues. In the first lecture, we will address how current federally mandated outcome reporting of IVF cycles, proposed as a possible template for outcome reporting in other medical areas under Patient Protection and Affordable Care Act (PPACA), fails in its purpose by allowing a small group of centers to mislead the public about their center's performance. The second will present on the improvements in follicle recruitment from long-term, combined androgen (DHEA) and FSH exposure, further evidence that we now have the ability to therapeutically intervene into earlier stages of follicle maturation. The third will address one of the most heatedly discussed issues in reproductive endocrinology and infertility: whether a twin pregnancy represents a positive or negative outcome of infertility treatment. CHR investigators have had a very visible presence in this still ongoing dispute, mostly representing the opposing opinion to what currently is widely considered "politically correct."
- Describe the federally mandated outcome reporting system for IVF cycles and its shortcomings
- Explain how androgen-FSH synergism improves ovarian stimulation in diminished ovarian reserve
- Contrast differences of opinion about risks of twin pregnancies as a result of fertility treatments
April 9, 2013: Carolyn Bondy, MD
Context: Turner syndrome is often not diagnosed until a woman is in her 30s, and even after diagnosis, many women do not receive essential screening for associated medical conditions, adequate counselling or treatment for ovarian failure. Modern studies show that Turner syndrome is more prevalent than appreciated, and the "characteristic" stigmata affect only a small minority of patients. Clinicians must consider Turner syndrome in the differential diagnosis of hypergonadotropic hypogonadism in women of all ages, and be informed on the most effective screening tests such as cardiac MRI to detect aortic disease and the most up-to-date recommendations on reproductive issues. The lecture will provide updates on clinical signs and diagnostic tests and review recommended screening tests upon diagnosis. Both spontaneous and assisted fertility rates and outcomes will be covered, with a summary of current guidelines for reproductive success in women with Turner syndrome.
- Describe the three leading features suggestive of Turner Syndrome diagnosis
- Identify four important screening tests for newly diagnosed patients
- Explain current ASRM guidelines on assisted pregnancy for women with Turner Syndrome
October 9, 2012: Aritro Sen, PhD
Context: While several interventions to improve fertility outcomes for women with diminished ovarian reserve (DOR) has been proposed, the management of patients who respond poorly to ovarian stimulation remains a challenge to clinicians and patients. In the last few years several studies have reported a potential benefit of pre-treatment with androgens/DHEA prior to fertility treatment in women with DOR. A new concept has emerged suggesting that sufficient androgen signaling through the androgen receptor (AR) is necessary for normal follicle development and function. Given the emergence of androgens treatment in fertility protocols in treating DOR, understanding how androgen actions regulate follicular development is highly warranted. This lecture will provide data/evidence from a combination of animal model studies along with detailed in vitro signaling studies for a better understanding as to how androgens modulate follicular growth and development and further comprehend some of the recent clinical data regarding androgen effects in infertility treatment.
- Explain the importance and physiological actions of androgen - androgen receptors in normal follicular development.
- Discuss the intra-cellular mechanisms by which androgen - androgen receptors regulate various aspects of follicular development and female fertility.
- Explain how androgen (DHEA) priming in IVF protocol works as a fertility treatment option in women with DOR. practice
The Center for Human Reproduction: Essential Roles of Sperm Centrosome during Fertilization, Infertility and ART
September 11, 2012: Gerald Schatten, PhD
Context: Idiopathic infertility, both male and female, are likely the result of defects in the organelles and components which are essential for successful fertilization but are transmitted as extra-nuclear elements. Diagnosis of these types of cytoplasmic and epigenetic anomalies is predicted to help with improved ART success rates, since some patient couples may find that they are unlikely to enjoy benefits without donor gametes. Further, the missing components may be introduced and finally understanding of these critical elements vital for fertilization and the onset of development may lead to improved contraceptive strategies. Male factor infertility may result in the embryo failing to divide even after it is scored as a successful fertilization. Physicians and their laboratory colleagues will be encountered to expand their diagnostic horizons regarding the reasons why development arrests.
- Discuss with confidence factors within the oocyte which might cause fertilization to fail and development to arrest.
- Articulate clearly how sperm, which might appear to swim like Navy SEALS, are ineffective for completing the sperm's obligations during fertilization - and that even ICSI will be ineffective for this form of male factor infertility.
- Explain how imprintopathies and centrosomopathies are novel causes of infertility, which may soon bring relief to patient couples currently suffering from intractable infertility. practice
June 12, 2012: Norbert Gleicher, MD
Context: The aging ovary represents one of the major remaining challenges in reproductive medicine. It was chosen as the main theme of research at CHR about a decade ago. Two key events proved groundbreaking: the discovery that DHEA supplementation improve ovarian reserve and pregnancy chances in women with diminished ovarian reserve (DOR), and confirmation of the hypothesis that the FMR1 gene may be involved in regulating ovarian function. During 2011/2012, CHR completed an important second phase of this research: we started understanding how DHEA effects take place, and how wide spread effects of the FMR1 gene are, reaching far beyond our medical specialty. This second phase of our research will be presented in this year's Research Update. With expansion of our basic science team in the laboratory, we are now entering a very important third phase, attempting to elucidate the molecular biology of ovarian aging.
10-Year Anniversary at 21 East 69th Street: CHR's Fertility Research Accomplishments in These 10 Years
September 13, 2011: Norbert Gleicher, MD
Context: "Translational research" in medicine is "a way to rapidly translate findings in basic research into medical practice" (Wikipedia). It is different from speculative "basic research", which often takes decades to yield clinically applicable results, and "applied research," which, while impacting practice quickly, usually offers only incremental progress rather than radical breakthroughs. The importance of translational research has been recognized by the NIH and academic medical centers, leading to establishment of innumerable new research centers with primary goals of advancing translational research. Translational research within a private practice setting is, however, largely unprecedented. The 10-year anniversary of CHR at its current location, therefore, presents a unique opportunity to demonstrate how significant an impact one small, private fertility center has exerted on world-wide practice over the last 10 years by successfully moving findings in basic research into routine clinical practice.
- Compare basic strategies that allow private practice frameworks to establish translational research centers
- Discuss the reasons why CHR has primarily been concentrating on the "older" patient
- Explain the mutual dependency of research and clinical practice
- List prime examples of translational research conducted at CHR that have affected practice
May 10, 2011: Tommaso Falcone, MD
Need Statement: Some surgical interventions, such as excision of endometriomas, may decrease, rather than improve, fertility. However, many physicians lack sufficient understanding of the consequences of surgical interventions in women of reproductive age. In this lecture, outcomes of surgeries for advanced endometriosis, types of fibroid surgery that may improve fertility, and conditions of tubes that should be surgically removed, will be discussed.
- Understand the consequences of removing an ovarian endometrioma
- Evaluate which fibroids should be removed
- Discuss different surgical techniques that may help surgical outcomes
May 11, 2010: Norbert Gleicher, MD & David Barad, MD, MS
Need Statement: Women above age 40, represent the most rapidly growing age group having children in the US. As more women at advanced ages seek to achieve pregnancy, their need for fertility-supporting services has significantly increased, leading to the "graying" of patient populations in infertility centers. CHR is a private and freestanding fertility center, which has gained national and international prominence for its special expertise with women with diminished ovarian reserve, whether due to physiologic aging or due to premature ovarian aging. This expertise primarily derives from a close integration of basic research and clinical practice in areas relevant to the ovarian aging process over the last 6-7 years. Consequently, CHR has been able to make a number of breakthroughs, which have very beneficially affected the medical care of women with diminished ovarian reserve. The last year was especially productive in this regard, not only leading to a better understanding of the ovarian aging process but also to better diagnosis of clinical conditions and better patient selection for various treatment options. This meeting will report on the progress made in these areas.
- Know what constitutes ovarian reserve
- Discuss how ovarian reserve is best assessed, and limitations of such assessments
- Determine how diminished ovarian reserve is best treated
- Assess what expected outcomes of treatment are, including miscarriage and live birth rates
June 16, 2009: Norbert Gleicher, MD & David Barad, MD, MS
Need Statement: The quality of ovarian function is a basic component of female infertility. How well a woman's ovaries accomplish their function has in the literature, to a significant degree, been equated with the concept of ovarian reserve (OR) which, in turn, is believed to reflect the number of functionally active remaining follicles. OR declines with advancing female age in predictive ways but approximately 10% of all women are, for various reasons, believed to deviate, and to prematurely lose OR. They, thus, develop diminished ovarian reserve (DOR) prematurely, a condition for which researchers at CHR have coined the term premature ovarian aging (POA). This annual "Research Update" will offer a review of recent research at CHR, which over the last few years has disproportionately to other subjects focused on the accurate and timely diagnosis and treatment of DOR, due to its various potential causes.
- Know the major causes of POA
- Be aware of more accurate assessment methods of OR than are currently in routine use
- Understand that DOR< at least in some women, is predictable
April 21, 2009: Ann Partridge, MD
Need Statement: Cancer survivors, particularly young women, constitute a growing number of women seeking fertility treatment to have biological children after treatment. Thus, appropriate and timely dissemination of knowledge to cancer patients, regarding their options for fertility preservation, is becoming more and more important.
- List the risks of premature menopause and infertility in young women treated for cancer
- Discuss the limitations of literature, particularly with regard to actual fertility after treatments
- Contrast pros and cons of different fertility preservation strategies
April 14, 2009: David Barad, MD
Need Statement: In our daily practice, we are each called upon to provide our patients with an understandable and balanced interpretation of existing medical evidence, to help guide their treatment. In the case of patients dealing with menopause-related symptoms, these discussions have become increasingly difficult. This lecture will review some of the latest findings regarding menopause and how those findings will impact our daily decisions in caring for patients.
- List ways in which hormonal therapy can be individualized
- Discuss key evidence regarding coronary heart disease, breast cancer, venus thromboembolic events, stroke and osteoporotic fractures
- Describe three effective menopausal therapy talking points that help patients make informed decisions about hormone therapy