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Reproductive Endocrinology and Infertility

Reproductive Endocrinology and Infertility


Christos Coutifaris, MD, PhD
Chief, Division of Reproductive Endocrinology and Infertility

University of Pennsylvania Health System
Department OB/GYN

Suite 800
3701 Market Street
Philadelphia, Pa 19104

Phone: (215)662-2971
Fax: (215)349-5512

ccoutifaris@obgyn.upenn.edu

Mission Statement

  • Maximize the fertility potential of all infertile couples through the provision of state-of-the-art diagnosis and treatment.
  • Spearhead, through basic and translational research, the understanding of normal and abnormal human reproduction and the establishment of innovative treatments for reproductive disorders.
  • Train clinicians, physician-scientists and clinician investigators for practice and research in the field of human reproduction.

Program

The Division of Reproductive Endocrinology and Infertility (REI) at Penn has a long tradition of new and innovative approaches to the management of infertility. Our pioneering work in such areas as microsurgical techniques, laparoscopic surgery, and in vitro fertilization (IVF) is recognized internationally. The division has served as a focus point for the transfer of technology from the basic laboratory of reproductive biology to clinical practice.

We are also one of eight centers in the United States designated by the National Institute of Child Health and Human Development as a Reproductive Medicine Unit (RMU). The RMU's have been selected to evaluate infertility treatments and assess their effectiveness, as well as to develop objectively new approaches in infertility management. The purpose of the RMU is to provide objective evaluation of such approaches and to confirm or deny their effectiveness.

The cutting-edge team of physician/scientists in the division, each of whom has made significant contributions to the field, is accentuated by the presence of physicians who have completed their training in Ob/Gyn and are initiating their careers in reproductive medicine. Many of these later assume positions of importance, both in the United States and abroad. This effort is supported by a cadre of basic science investigators who interact daily with their clinical counterparts.

The Division of REI offers expertise in the management of such conditions as

  • endometriosis
  • reproductive endocrine disorders
  • uterine myomas (fibroids)
  • diseases of the fallopian tube
  • uterine abnormalities
  • repeated pregnancy loss

Our clinical practice, Penn Fertility Care, has a well-developed program for the management of female and male infertility including techniques of insemination, in vitro fertilization, and intracytoplasmic injection of spermatozoa (ICSI). The IVF program, one of the first in the country, was established in 1981. The division also offers a comprehensive donor egg program.

Overall, the programs of the Division of Reproductive Endocrinology and Infertility offer coordinated, humane care for fertility patients, as well as for women suffering from gynecologic conditions such as endometriosis, uterine myomas, and menopausal and perimenopausal states. Opportunities for participation in research protocols are, from time to time, made available.

Clinical and Research Programs in Infertility

The care of women with reproductive endocrine disorders is centered in the Department of Obstetrics and Gynecology's Division of Reproductive Endocrinology and Infertility (Christos Coutifaris, M.D., Ph.D., Chief). Penn's NIH-funded Reproductive Medicine Unit (RMU) is based in this Division, and has an interlocking arrangement with Penn's Medical Endocrine Division, providing additional emphasis on andrology. Established in 1965, the Division of Reproductive Endocrinology and Infertility has high volume programs (1400-1600 new patients per year) in:

  • reproductive surgery (750-800 procedures/year);
  • assisted reproductive technologies (350-450 procedures/year);
  • the treatment of hypothalamic-pituitary-ovarian dysfunction (300-400 patient visits/year); and
  • family planning (13,000-15,000 patient visits/year).

The Division is located in newly built and dedicated space for out-patient care of patients with infertility and reproductive endocrine problems; an adjacent Ambulatory Reproductive Surgical Facility and Reproductive Laboratory devoted exclusively to the assisted reproductive technologies; a Pelvic Ultrasound Unit; a Family Planning Unit; an Andrology laboratory. The Department has 30 assigned beds in the hospital for in-patient care. Contiguous with the clinical facilities are wet and dry laboratory space equipped for bench and clinical research in reproduction.

The Division has a staff of nine full-time physicians who have subspecialty certification/eligibility in Reproductive Endocrinology and Infertility. Its three-year fellowship program, which has over the years prepared a significant cadre of physician/scientists for leadership roles in academic medicine, is approved for two fellows per year and incorporates an elective track leading to a Master of Science degree in Clinical Epidemiology (MSCE). Clinical fellows have a major role in the care of the Division's patients, as well as receiving supervised training in research. In the past twelve years, the clinical research efforts of the Division have flourished with the establishment of the Reproductive Research Unit (RRU; Kurt Barnhart, M.D., M.S.C.E., Director) and have been complemented by the basic research of the scientists in the Center for Research in Reproduction and Women’s Health (CRRWH), which grew out of the Ob/Gyn department's Division of Reproductive Biology. The Center numbers greater than 50 Penn scientists, the majority of whom have research programs in reproductive biology in areas such as sperm function, fertilization, preimplantation embryo development, implantation, endometriosis, molecular genetics of ovarian and placental function, and osteoporosis. The relevant research programs are mentioned in the narrative below.

Clinical and Research Programs in Andrology

The care of male reproductive disorders is shared among the Division of Reproductive Endocrinology and Infertility, the Department of Medicine's Division of Endocrinology, and the Division of Urology in the Department of Surgery. The Endocrine Division of the Department of Medicine has established an interest in andrologic problems. Directed by Peter Snyder, M.D., Co-PI, these programs focus on the diagnosis and treatment of pituitary adenomas, the regulation of spermatogenesis and the effect of exogenous gonadotropins on spermatogenesis, as well as the influence of male sex steroids on sexual and reproductive function, bone mineral density and muscle strength. These various investigative efforts have received extensive extramural support over the years. This Division evaluates and treats approximately 500 patients for andrologic problems yearly.

The Division of Urology in the Department of Surgery counts among its former trainees and faculty present leaders in Andrology in the U.S. The Division is directed by Dr. Alan Wein, an international authority in prostate cancer and its infertility program is coordinated by Keith VanArsdalen, M.D. This program has focused primarily on the evaluation and surgical treatment of male infertility. In 2006, the program saw 285 new patients consisting of men with varicoceles (40%), oligospermia and azoospermia (25%), men seeking reversal of vasectomies (10%), and congenital or iatrogenic obstruction of the reproductive tract (25%). Dr. Thomas Kolon, a physician scientist with clinical and research interests in pediatric urology and cryptorchidism, was recently recruited to join this Division of Urology at the Children’s Hospital of Philadelphia. His program treats jointly patients with Dr. Snyder and is the largest referral site for pediatric / adolescent urologic problems in the mid-Atlantic region.

Integrated Care of the Infertile Couple

The care of infertile couples and of women suffering from such conditions as endometriosis, uterine myomas, menopausal syndrome, and osteoporosis, and the research activities related to these conditions is coordinated among the Departments of Obstetrics and Gynecology, Medicine, and Urology. There is continuing dialogue through joint management, teaching and research conferences, and joint training and research grants. This interaction is encouraged by a weekly Endocrine Conference in which the Departments of Medicine, Ob/Gyn, and Pediatrics participate, and a postdoctoral research training program in Reproductive Biology which includes training faculty from the Departments of Medicine and Obstetrics and Gynecology. In addition, the Department holds two K12 grants, a WRHR and a BIRCWH. It should be noted that two of the faculty of the Division of Reproductive Endocrinology and Infertility are scholars in these two mentored career development programs. Joint publications and research grants exemplify the success of the academic and clinical interaction.

Programs which Complement Clinical Activities

The Reproductive Research Unit in the Division of Reproductive Endocrinology and Infertility (RRU - Kurt Barnhart, M.D., M.S.C.E., Director) was established in 1994 and is the cornerstone for our Division’s clinical research program. This unit was officially organized when it became evident that the growth of the clinical research initiatives of the Division of Reproductive Endocrinology and Infertility required centralized management and oversight. The unit has dedicated space adjacent to the clinical and academic offices of the Division and includes “dry” laboratory space for coordination of clinical research. A satellite office for clinical coordination and research personnel has also been established within the hospital. The RRU has two Masters-prepared women’s health nurse practitioners, 5 full-time research coordinators, a dedicated administrative assistant, and up to an additional 4 part-time workers. This dedicated clinical research staff work closely with the fellows and is available to perform all aspects of clinical research projects including recruitment, screening, clinical examinations, follow-up examinations, and provision of care outside of scheduled visits, thus allowing continuity of patient care. This staff is also experienced in data management with nine networked, dedicated, PC compatible computers. All computers have internet access. Since the Unit’s inception, research in the Center has increased dramatically. The staff of the RRU have extensive experience in the successful conduct of multi-center clinical trials in women’s health, many of which are NIH sponsored. The lead research coordinator, Kelly Timbers MSN CRNP, CCRC has greater than 15 years of experience in women’s health. During its years of coordinated operation as a unit, more than 1200 women have been recruited into clinical trials. In many instances the unit has been asked to over-enroll subjects due to poor enrolment at other clinical sites. Often this unit has been cited as a model for the conduct of multi-center clinical trials in women’s health. Since 1994, the unit has grown dramatically with current funding exceeding $1.8 million annually.

The Center for Research in Reproduction and Women's Health (CRRWH) includes, as members, over fifty investigators with active research interest in reproductive issues. This Medical Center-wide Center was formally established in 1995 and evolved from the Division of Reproductive Biology of the Department of Obstetrics and Gynecology. The core of the Center still resides within the Department of Obstetrics and Gynecology as most of the investigators have their primary appointments in the Department of Obstetrics and Gynecology. The research focus of the Center is on cellular and molecular aspects of gamete biology (spermatogenesis; sperm motility; fertilization), hormone action (action of steroids; action of gonadotropins and growth factors), genetics (pathogenesis of PCOS; cardiac development) implantation, embryo development and placental function, with extensive use of human material. The Center receives major funding from NIH through a Program Project grant, two NIH cooperative agreements, an NIH contract and numerous RO-1 grants. In addition, the center offers two T32 NIH and foundation-sponsored postdoctoral training programs in research in reproductive medicine. It coordinates its approach to human research with the Division of Reproductive Endocrinology and Infertility, and has identified new opportunities for interaction as funding has become available in such areas as fertilization, implantation, endometriosis, and osteoporosis for which it has ongoing NIH sponsored programs. The Department of Obstetrics and Gynecology has been ranked consistently in the top three nationally in NIH-sponsored research programs the majority of which are part of the CRRWH. In May 1999, the laboratories of the investigators of the Center moved to the newly constructed Biomedical Research Building II/III, where they occupy 30,000 sq.ft. of state-of-the-art research space. In the spring of 2006, the Department of Obstetrics and Gynecology and the Center for Research in Reproduction and Women’s Health jointly announced the establishment of the Women's Health Clinical Research Center under the directorship of Dr. Barnhart. Additional space, personnel and financial resources have been committed to this new administrative unit, charged to coordinate the clinical research efforts of the entire department of Ob/Gyn and the CRRWH.

The General Clinical Research Center of the Hospital of the University of Pennsylvania is a key resource for clinical studies in reproductive medicine. Supported continuously by NIH for more than 45 years, it offers dedicated space and nursing support for approved protocols. Up to ten inpatients can be accommodated at a time. Several of our faculty have helped administer this center. Dr. Kurt Barnhart’s clinical research program has utilized the GCRC facilities for several of its projects. It should be noted that Penn recently participated in the first competition for a CTSA NIH award designed to promote the establishment of the infrastructure needed for the conduct of clinical and translational research. Although a formal announcement of awards will not be made until October 2006, it is anticipated that Penn will be one of the first five sites selected based on the preliminary scoring received and verbal feedback from the NIH. The CTSA awards are supposed to supplement the GCRC infrastructure and it is envisioned that they will eventually replace them. This provides further proof of the outstanding research infrastructure at Penn.

The Center for Clinical Epidemiology and Biostatistics (Brian Strom, M.D., Director) facilitates clinically-oriented epidemiological research, training and teaching. It is composed of 200 individuals including clinical and non-clinical faculty (70), fellows, research staff, biostatisticians, and clerical staff. The Clinical Epidemiology Center is at the forefront bridging clinical medicine with epidemiology, bringing clinical insights into epidemiologic research and vice versa. The faculty works closely with faculty throughout the University of Pennsylvania, and other medical and non-medical institutions. Dr. Strom and his colleagues have a keen interest in reproductive health issues and a number of collaborative studies are currently underway with the Department of Obstetrics and Gynecology. Under the auspices of their training program in Reproductive Epidemiology three of our REI faculty, Dr. Kurt Barnhart, Dr. Clarisa Gracia and Dr. Samantha Butts have received Master of Science degrees in Clinical Epidemiology (MSCE) and are active members of the Center. Several of our REI fellows have been enrolled in the MSCE program of the Center as part of their fellowship in the clinician-investigator track.

The Reproductive Genetics Laboratory of the Department of Obstetrics and Gynecology (Lorraine Dugoff, M.D., Director) provides genetic counseling, cytogenetic and molecular analyses for the diagnosis of genetic disorders. It supports a fellowship program in Clinical Genetics in conjunction with the Division of Human Genetics and Molecular Biology at the Children's Hospital of Philadelphia (CHOP) and the Department of Genetics at the Perelman School of Medicine. Obstetrics and Gynecology faculty in the Division of Reproductive Genetics hold joint appointments in the Department of Pediatrics and Genetics. Dr. Deborah Driscoll, Chair of the Department of Ob/Gyn and a Board Certified Clinical and Molecular Geneticist and member of the Division of Reproductive Genetics spearheads the REI fellow didactics in Genetics.

The Stuart and Emily Mudd Center for the Study of Social and Psychological Aspects of Reproduction (Karl Rickels, M.D., Director; Ellen Freeman, Ph.D., Co-Director) is a unique research and treatment unit sponsored jointly by the Departments of Obstetrics and Gynecology and Psychiatry. Its major investigative efforts, supported by the NIH, are in the study of psychological factors in reproductive failure, the menopause and the premenstrual syndrome. Dr. Rickels, known for his contributions on the psychiatric aspects of reproductive disorders, is an expert in the design and conduct of large scale drug trials.He has been a member of the Treatment and Development and Assessment Research Review Committee of NIMH and routinely advises both the FDA and the pharmaceutical industry on the design and evaluation of clinical trials. Dr. Freeman holds several grants with current total funding for the program in excess of $1,000,000 per year. This research program is housed adjacent to the clinical and research space of the REI division. Over the years, many REI fellows have chosen to perform clinical research in association with this program.


Active Clinical Trials

For a complete listing of all active clinical trials, please visit: http://www.uphs.upenn.edu/obgyn/clinical-trials/


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