Reproductive Endocrinology And Infertility Clinical Training Program

子宫肌瘤，俗称子宫肌瘤，是女性生殖道最常见和最常见的疾病之一。一些子宫肌瘤与罕见的遗传综合征有关，如遗传性子宫肌瘤病和肾癌。为了了解与HLRCC相关的肌瘤相关的细胞事件是否类似于普通或非综合征性肌瘤，在过去的一年里，我们使用基因图谱实验来比较这两种类型的肌瘤。我们发现，虽然这两种类型的肌瘤都有低水平的富马酸水合酶，但与普通肌瘤相比，HLRCC综合征肌瘤的糖酵解酶有显著的过度表达。我们用实时逆转录聚合酶链式反应证实了这些基因的过度表达。有趣的是，在整个糖酵解过程中，糖酵解酶的过度表达是一致的，除了一个HLRCC标本中的磷酸甘油酸激酶。我们对这些发现的解释是，糖酵解途径在HLRCC肌瘤中上调，而Krebs循环功能由于富马酸水合酶水平低而减弱。简而言之，这些结果表明，尽管与罕见综合征相关的平滑肌瘤在物理上可能类似于常见的非综合征平滑肌瘤，但这些肿瘤之间有显著的区别。 子宫内膜异位症的诊断对患者和提供者来说是一个问题，因为需要手术，但一个长期存在的问题是手术中子宫内膜异位症病变的出现。在过去的一年里，Stratton和Stegmann博士将活检结果与病变外观相关联，以确定最有可能代表子宫内膜异位症的病变的特征。结果表明，与流行的观点相反，没有一种颜色与子宫内膜异位症有很高的相关性，对患有子宫内膜异位症的女性进行手术时，应该考虑并活组织检查任何可疑的病变。具体地说，细微的病变与黑色或混合颜色的病变几乎一样有可能包含子宫内膜异位症。总体而言，最有可能包含经病理证实的疾病的病变是那些宽度为10 mm、深度为5 mm的病变。然而，有经验的外科医生只能正确识别病变%的时间。这项研究表明，活组织检查，而不是肉眼检查，应该仍然是疾病诊断的金标准。 许多妇女在生殖健康方面存在差距。本股一直有兴趣审查这些差异的原因和后果，以努力制定战略，以优化各种族和族裔群体的生殖结果。一个被确认的健康差距是不孕不育治疗的结果。最近，我们发现，非裔美国女性中子宫肌瘤的不同发病率至少部分解释了辅助生殖妊娠结局的降低。在过去的一年里，我们评估了拉美裔夫妇中抗逆转录病毒治疗的使用情况和结果。这项研究表明，与一些人声称的经济壁垒导致利用率较低相反，其他因素也起到了作用。在来年，我们计划启动一项多中心试验，以评估不孕症服务的差异和利用情况。

Uterine leiomyoma, commonly called fibroids, are one of the most common and prevalent diseases of the female reproductive tract.Some leiomyoma are associated with rare genetic syndromes, such as Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC). In order to learn whether the cellular events associated with HLRCC-associated leiomyoma resembled common or nonsyndromic leiomyoma, in the past year we used gene profiling experiments to compare the two types of leiomyoma. We found that while both types of leiomyoma had low levels of fumarate hydratase, there was a significant overexpression of glycolysis enzymes in the HLRCC-syndromic leiomyoma compared to common leiomyoma. We confirmed overexpression of these genes with real-time reverse-transcriptase PCR. Interestingly, overexpression of the glycolysis enzymes was consistent throughout the glycolysis pathway, with the exception of phosphoglycerate kinase in one HLRCC specimen. We interpret the findings to suggest that the glycolysis pathway is up-regulated in HLRCC leiomyoma, whereas the Krebs cycle function was diminished due to the low levels of fumarate hydratase. In short, these results indicate that while leiomyoma associated with rare syndromes may physically resemble common nonsyndromic leiomyoma, there are marked differences between the tumors. Diagnosis of endometriosis represents a problem for patients and providers since surgery is required, but one persistent question is the appearance of endometriosis lesions at surgery. In the past year Drs. Stratton and Stegmann correlated biopsy result with lesion appearance in order to determine the characteristics of lesions most likely to represent endometriosis. The results showed that, in contrast to prevailing opinion, no single colot had a high association with endometriosis and that surgeons operating on women with endometriosis should consider and biopsy any suspicious lesion. Specifically, subtle lesions were nearly as likely to contain endometriosis as were those that were black or of mixed colors. Overall, the lesions most likely to contain pathologically-confirmed disease were those that were >10mm in width and >5mm in depth. However, experienced surgeons were only able to correctly identify lesions 64% of the time. This study suggests that biopsy, not visual inspection, should remain the gold standard for disease diagnosis. Reproductive health disparities exist for many women. Our unit has been interested in examining the causes and consequences of these disparities in an effort to devise strategies to optimize reproductive outcome across racial and ethnic groups. One health disparity idenfied was outcome of infertility treatments. Recently we found that the different incidence of leiomyoma in African-American women explained, at least in part, reduction in pregnancy outcome with assisted reproduction. In the past year we evaluated ART utilization and outcome among Hispanic couples. This study suggested that contrary to claims of some that economic barriers accounted for lower rates of utilization, other factors were responsible. In the coming year we plan to initiate a multicenter trial to assess disparities and utilization of infertility services.