With the expansion of the facility almost complete, we are now able to host seminars and even reasonable lecture attendance in our own facility. It, once again, appears time to reconsider how CHR will offer continuous medical education (CME) to colleagues in the field and related specialty areas. The last big reorganization in CHR’s CME activities occurred a little over five years ago, when we decided to change from offering general Ob/Gyn topics in CHR’s monthly GrandRounds to more specialized and concentrated offerings, in reproductive biology and clinical reproductive endocrinology/infertility. This decision was not only based on the fact that CHR in clinical practice and research is dedicated to these areas of medicine, but also on the recognition that within the context of regular CME activities in New York City and surrounding areas, other areas of reproductive medicine, like general gynecology, obstetrics and oncology, usually garner more attention than reproductive biology and endocrinology. Our intent was to supplement this omission.
Since these changes were implemented, gracious support from the Foundation for Reproductive Medicine in co-sponsoring these events offered CHR the opportunity to continue the monthly GrandRounds, even though extramural support from pharmaceutical companies, which in earlier years used to be the mainstay of financial support, completely disappeared due to new federal funding guidelines for the pharma and medical device industries.
We pride ourselves over the last five years to have hosted as speakers many, if not most, of the leading scientists in reproductive biology and reproductive clinical endocrinology (and related areas). In reflection of truly breathtaking and revolutionary work currently going on in many laboratories in this country and elsewhere, we have consciously pivoted toward more basic science rather than clinical talks.
CHR has always pursued two distinct formats of CME: A steady flow of visitors to CHR, on occasion scientific collaborators or even formal Visiting Scientists at CHR, have been enriching CHR’s knowledge base for years. There is only so much one can glean from published papers, and nothing replaces the direct contact with investigators. Small in-house seminars, usually exclusively for CHR staff, have, therefore, been a frequent tradition at CHR for many years.
At the same time, as CHR’s three main areas of activity, Clinical Care, Research and Education (i.e. CME) well demonstrate, since its original inception in Chicago in 1981, CHR has always considered CME of colleagues one of its three main activities and responsibilities. Most educational activities were, therefore, channeled through CHR’s monthly GrandRounds program.
Especially over the last three years, CHR’s GrandRounds have offered a constant flow of talks by many of the most exciting basic scientists working in the field, presenting some of the most groundbreaking research, at times even before publication. Indeed, a 2016 Nature paper from the laboratory of Ali Brivanlou, PhD, at Rockefeller University, that later became finalist for Nature Paper of the Year 2016, was presented to the public for the first time at CHR’s GrandRounds.
In recent years, the pivot toward more basic science subjects in CHR’s CME activities also had several additional reasons: A very important one was, of course, increasing emphasis at CHR on basic laboratory research after recognizing that only better understanding of basic reproductive biology through progress in basic biological research would lead clinical reproductive endocrinology and infertility out of the field’s current stagnation.
Various recent issues of the VOICE addressed CHR’s concerns about several clinical practices that have entered IVF practice over the last decade and, not only failed to contribute to better IVF outcomes but, likely, were responsible for the worldwide decline in live birth rates (including in the U.S.) during this time period, resulting in lower live birth rates in 2014 than 2004. Ineffective additions to practice are a frequently observed side effect of stagnations in medical specialty fields. When real progress takes place, resources go toward such progress rather than ineffective treatments.
CHR’s ability to pivot toward more basic research was also supported by increasingly close cooperation with several leading research laboratories. The first formal such collaboration was established with the mouse laboratory of Aritro Sen, Ph.D. at Rochester University School of Medicine and Dentistry, in Rochester, NY. It immediately demonstrated the mutual advantages and the translational potential of such a collaborative strategy between clinical research and basic science laboratories by providing the necessary experimental understanding how dehydroepiandrosterone (DHEA) supplementation (or testosterone supplementation directly) improves treatment outcomes in women with low functional ovarian reserve (LFOR).
Providing such experimental evidence in animal laboratories is especially important when clinical trials in humans are difficult to conduct, as is the case in women with LFOR. Because women with LFOR often refuse participation in clinical trials that require randomization (and we cannot blame them, considering the limited time they often have left to conceive), animal models in such situations offer crucial evidence for likely effectiveness of treatments. We, therefore, can state with absolute certainty that DHEA supplementation of women with LFOR, which was clinically initiated at CHR, would never have received the wide acceptance all over the world, were it not for these collaborative efforts with Dr. Sen’s laboratory that allowed us to define how DHEA exerts beneficial effects on ovaries.
CHR’s current collaboration with this laboratory regarding clinical use of anti-Müllerian hormone (AMH) as a potential therapeutic agent will, hopefully, be clinically equally successful. It already led to three patent applications.
Likely CHR’s most potentially consequential current collaboration are several projects with the Stem Cell Biology and Molecular Embryology Laboratory of Ali Brivanlou, PhD, at Rockefeller University in NYC. If successful, they will not only greatly affect our understanding of early human embryo development but, will also offer potential for truly revolutionary future infertility treatments. In addition, CHR maintains collaborations with the world-famous Gene Expression Laboratory of Juan Carlos Izpisua Belmonte, PhD, at the Salk institute for Biological Studies in La Jolla, CA, with the laboratory of Dietrich Egli, PhD, in the Department of Pediatrics at Columbia University in NYC and with the Department of Obstetrics and Gynecology at Vienna University School of Medicine, Vienna, Austria.
This is a part of the June 2017 issue of the VOICE.