UCLA Department of Obstetrics and Gynecology Faculty Research and Clinical Interests
- High-risk pregnancy, prenatal ultrasound, genetic testing, and congenital heart disease, either affecting the mother or fetus
- Obesity and reproduction
- Assisted reproduction
- Fertility treatment outcomes
- Male Emergency Contraception Knowledge and Use
- Medical education
- Maternal quality of care indicators
- Health Policy
- Preconception care/ reproductive life planning
- Second Trimester D&E Safety
- Novel Prenatal diagnostic testing
- Androgen Excess as a Mechanism for Adipogenic Dysfunction in PCOS Women
The goals of this U54 grant are to 1) compare differences in SC abdominal adipogenesis in lean PCOS women vs. age- and BMI-matched controls; 2) examine effect of 6-month flutamide therapy in lean PCOS women on SC abdominal adipogenesis, metabolic function and ovarian folliculogenesis, and 3) determine the underlying mechanisms whereby androgen inhibits adipogenesis.
- Glucocorticoid-Regulated Cumulus Cell Lipid Homeostasis and Human Oocyte Quality
The goals of this grant are to 1) correlate follicle fluid cortisol levels and cumulus cell triglyceride (TG) content with pregnancy outcome by in vitro fertilization (IVF); 2) examine differential actions of cortisol and insulin on cumulus cell TG content via hormone sensitive lipase-induced lipolysis, and 3) determine differential effects of cortisol and insulin on cumulus cell energy production.
- Resistance Of Cumulus Cell Mitochondria To Stress In Vitro as a Predictor of Oocyte Competence During Ovarian Stimulation For In Vitro Fertilization (IVF)
The primary aim of the present study is to establish a cumulus cell mitochondria in vitro bioassay to assess oocyte developmental competence in women undergoing stimulation for IVF. Thus far data show that resistance of cumulus cell mitochondria to stress in vitro positively predicts ovarian responsiveness to follicle stimulating hormone (FSH) administration and numbers of normally cleaving embryos in women with the greatest ovarian reserve.
- Studying the mechanisms by which environmental pollution contributes to poor pregnancy outcomes. These studies are in collaboration with Dr. Sherin Devaskar from the Department of Pediatrics, Dr. Kyung Sung in Radiology, and Beate Ritz in Epidemiology to develop and evaluate new magnetic resonance imaging technologies to assess the impact of environmental pollution exposure on prediction of placental insufficiency. This will establish the potential for early recognition of placental insufficiency and develop preventive and therapeutic strategies targeting reversal before encountering detrimental consequences.
Obstetrical simulation - many great opportunities for resident research projects
- Optimizing pregnancy outcomes from assisted reproductive technologies (ART)
- Fertility preservation in cancer patients
- PCOS and reproduction
Otto Martinez, PhD
Current NIH-supported research projects in my group include the following:
- Contribution of immune system activation driven by HIV infection to the genesis of B cell malignancies (NHL and Hodgkin lymphoma)
- Anti-inflammatory and anti-tumor growth potential of statins in HIV-infected persons receiving effective anti-retroviral therapy (cART)
- Antibodies to transferrin receptor (TfR1/CD71) as potential therapy for AIDS-NHL
- Role of microbial translocation to the genesis of AIDS-related cancers
In addition to this, I am PI of a large prospective HIV cohort study, the Multicenter AIDS Cohort Study (AMCS), so have access to multiple research opportunities that are tied to that ongoing study, which is funded by the NIH through 2019.
- Therapeutic targeting of platinum resistant tumor initiating cells in ovarian cancers
The development of effective therapies for ovarian cancer is crucial as outcomes have not improved significantly over the last several decades. The most prevalent and aggressive subtype of ovarian tumors is high-grade serous cancers (HGSC) a disease that more recently has been discovered to originate from the fallopian tube. A major challenge in treating HGSC is relapse of disease despite standard therapies.
This clinical observation suggests that a subset of HGSC cells with tumor initiating potential are resistant to therapy. Guided by our previous work in isolation of fallopian tube epithelial progenitors (Paik et al., 2012), we have characterized a sub-population of HGSC tumor cells with cancer initiating potential. The tumor initiating sub-populations of HGSCs do not express cell surface CA125, the most common biomarker used for detection of ovarian cancers. These cells are resistant to carboplatin standard therapy (Janzen, 2015). Current work in my laboratory is aimed at uncovering mechanisms of therapy resistance utilized by this cancer initiating population and finding pharmacologic strategies that can be used to eliminate them. For example with the addition of birinapant (a drug that degrades inhibitors of apoptosis proteins) to carboplatin we can eradicate the tumor initiating HGSC cells (Janzen, 2015). This therapy was effective in up to 50% of tumors tested in pre-clinical models. Other strategies are being tested including the efficacy of reactivating p53 mutated in 90% of HGSCs as a therapeutic approach (Soragni et al., 2016). We envision that our work in HGSCs will define new and more effective standards of treatment for patients with this aggressive cancer.
- Defining mechanisms of hormone sensitivity and resistance in endometrial cancers
Hormonal therapy can be effective in up to 50% of endometrial tumors, but is not widely embraced in clinical practice due lack of lack of reliable biomarkers that can predict a favorable clinical response.
Estrogen drives endometrial carcinogenesis and the progesterone hormone opposes this effect. As a first step to gain mechanistic insight into stromal vs. epithelial signals that may modulate hormonal sensitivity, we established an endometrial cancer preclincal model (Memarzadeh et al., 2010). The power of this system is that we can independently induce genetic changes in epithelium or stroma in order to accurately recapitulate mutational patterns occurring in human tumors (Memarzadeh et al., 2010). Using this model we have made three key discoveries: (a) deletion of PTEN in endometrial epithelia can initiate endometrial cancers that closely resemble human disease (Memarzadeh et al., 2010), (b) progesterone hormone anti-tumor effects are mediated through the stroma and loss of stromal progesterone receptor expression is sufficient to induce progesterone resistance (Janzen et al., 2013b), and (c) PTEN-null endometrial tumors were sensitized to PARP inhibition in a low estrogenic hormonal milieu as estrogen levels modulated Rad51 protein expression and function (Janzen et al., 2013a).
The overall goal of our ongoing work is to elucidate mechanisms that govern progesterone sensitivity or resistance in endometrial carcinoma and discover strategies that can broaden the clinical utility of hormonal therapy in this disease. We hope that based on insights gained through our ongoing work we can develop a diagnostic tool that can help identify patients best suited for hormonal therapy.
- UCLA MFM representative for the University of California Fetal Care Consortium (UCfC), a multi-specialty group with representatives at each of the UC medical centers with a shared interest in collaborative research, development of best practices and education in the field of perinatal medicine.
- Lead PI on multicenter RCT of indomethacin or nifedipine for tocolysis (ION study) as part of UCfC.
- Co-chair of monochorionic twin working group of the UCfC. This group has developed a SCAMP (standardized clinical assessment and management plan) for the management of monochorionic twins across all the UC campuses, and is engaged in research in this area.
- Participating as a co-investigator in the PARENTS study (See Janzen's interests).
- Curriculum Development (Pediatric Gynecology, Ultrasound)
- Physician well-being
- database analysis (retrospective),
- clinical decision making utilizing EHR (retrospective and prospective),
- fetal anomalies (more for case reports and case series)
- twins, maternal complications in pregnancy
- Curriculum development and education, quality control
Sandra Orsulic, PhD - Gynecologic Oncology
- molecular basis of ovarian cancer using both animal and cell based models of disease
- cancer associated fibroblasts and molecular signatures of disease
- Cost-effective healthcare delivery
- Measuring healthcare quality
- Medication management of fibroids
- Minimally invasive surgery
- Chronic pelvic pain
- Hormonally mediated mood disorders
Current National Institutes of Health (NIH) 1RO-1 is entitled Profiling Vulvodynia Based on Neurobiological and Behavioral Endophenotypes. Overall Project Goals: The goals to this project are to 1) characterize alterations in multimodal structural brain and connectivity indices in vulvodynia; 2) characterize the connectivity indices in vulvodynia and identify the association between structural (grey and white matter) and resting state alterations with clinical, behavioral and genetic parameters; and 3) identify vulvodynia patient subgroups based on endophenotype clusters by applying advanced mathematical classification techniques to the brain, biological, behavioral and clinical endophenotypes.
I am also completing analysis of data from a National Vulvodynia registry: Defining Clinical Subtypes of Vulvodynia for Improved Diagnosis and Treatment.
Recently completed NIH R21 project uses brain scanning (functional magnetic resonance imaging) to study the brain circuits important for emotion regulation in women with and without PMDD. Other current studies address the effect of oral contraceptives on the reward network and estrogen, dopamine and self control.
Deriving Novel Biomarkers of Localized Provoked Vulvodynia through Metabolomics: A Biological System Based Approach
Overall Goals: This study proposes to assess the microbiome (vaginal microbiota and metabolites) in provoked vulvodynia. This proposal builds on an ongoing study, R01HD0767556, where we are extensively phenotyping provoked vulvodynia subjects using functional and structural brain imaging together with clinical (symptom severity, disease duration), genetic and physiological measures.
- IUD in immunocompromised women
- Contraception in medically complex patients
- Contraception education/counseling
- Geographic Information Systems &FP service provision
- Reproductive health and the environment
- Baby friendly hospital initiatives and breastfeeding promotion
- management of non palpable etonogestrel implant, predictors of complications in second trimester abortion.
- Assessing quality of life improvements for women who undergo myomectomy
- Safety of different laparoscopic gynecologic surgery techniques
- Resident education and feedback
- Teaching of laparoscopy skills in simulation labs
- Transgender sexual health and surgical management
- novel therapeutics for cervical cancer
- gynecologic cancer survivorship
Area of interest: Family planning, patient education, patient and provider perspectives on healthcare, integration of technology and patient care.
- Mobile application for contraception education
- Comics for contraception education
- Mobile application evaluation for pelvic floor exercise education
- Oral contraceptive prescribing patterns
- IUD -perspectives from Primary Care Residents
- Family planning values in different ethnic groups
- Shared decision making in contraception
- Mobile application usage in pregnancy
- Contraception uptake and usage in special population
Google Scholar Link: https://scholar.google.com/citations?user=tbJUSC8AAAAJ&hl=en
- LARC Methods
- Contraception in medically complex patients
- LGBTQ+ Health
- Medical education with surgical simulation
- Surgical outcomes of robotic pelvic surgery
Cecilia Wieslander, MD-Female Pelvic Medicine and Reconstructive Surgery
- understanding of pelvic organ prolapse, urinary incontinence and their treatments in patients with low health literacy.
Dorothy Wiley, PhD, RN – UCLA School of Nursing
- Evaluation of anal cancer screening strategies using HPV testing, anoscopy. This is an ongoing study with large database.
- Contraceptive decision making and counseling
- Adolescent gynecology
- Abortion provision
- physician disclosure of personal information, and doctor patient relationship