From protecting the ovary to protecting the future fertility of women in the military, Dr. Lynae Brayboy shares some insight into three of our clinical research projects at Women & Infants’ Fertility Center, and the potential impact this research could have.
1. Learning about overall health through pregnancy
In this fascinating clinical research project, we are beginning to view pregnancy as an opportunity to understand a woman’s overall health, not just the health of the pregnancy. Pregnancy is a stress test. Because all of a woman’s organs are stressed during a pregnancy, we can learn from that stress. We want to know what the ovaries, and pregnancy, can tell us about a woman’s overall health.
Can the ovary report what is happening, or what will happen, during a pregnancy? If we can identify a molecular profile that points to an increased risk of problems, we can provide more accurate information on how to mitigate some risks.
This could be very helpful for our infertility patients. Most of our patients who undergo in vitro fertilization (IVF) are slightly older, which increases their risk of developing gestational diabetes and preeclampsia. With the data we hope to develop, we could counsel women appropriately based on their profile to consider weight loss, lifestyle modification or if they should look into a gestational carrier or adoption.
These common pregnancy complications, gestational diabetes and preeclampsia, are really indicators of a larger problem with the woman’s health. They both are telling us that a woman is at risk for cardiovascular disease. According to the American Heart Association, cardiovascular disease is the cause of about 1 of every 3 deaths in the United States and the number one killer of women. It claims more lives each year than all forms of cancer combined.
This clinical research could help us find a way of identifying a problem before a woman gets pregnant. If she is at risk, we could give her individualized medical counseling, instead of sharing statics and figures that don’t specifically apply to her. This would give us a new way of providing personalized medicine.
2. Protecting the ovary to help reduce the need for oncofertility
Similar to the first clinical research project, this project is trying to identify overall health problems by learning from the ovary. With a grant from the National Institute of Child Health and Human Development, this research is one of the largest projects we are currently working on.
Originally, I was interested in this topic because our patients who come in for oncofertility, which is fertility preservation before harmful cancer treatment, are going to have some kind of chemotherapy. That, of course, may likely cause injury and harm to the ovary. Thankfully, we are able to preserve these women’s fertility through IVF and have eggs and/or embryos banked for them.
But what if we could protect the ovary before chemotherapy and eliminate the need for oncofertility? In pursuit of that goal, we are researching multidrug-resistance transporters, specifically multidrug-resistance transporter-1. This is one of the most studied transporters in the world and is most often studied in relation to cancer biology.
We already know that multidrug-resistance transporter-1 is present in the ovaries and actually protects the ovary. We have preliminary data that suggests if a woman does not have enough multidrug-resistance transporter-1, she may be more susceptible to the ill effects of chemotherapy. There is also an indication that if there is not enough of the transporter present or is dysfunctional in the ovaries, there may be abnormal physiology in the mitochondria within the ovary.
The mitochondria are extremely important in reproduction and essential for an embryo’s survival before it implants. If the mitochondria are compromised in some way, fertilization and embryo development may not occur as they should. This could essentially result in infertility.
Understanding the role of multidrug-resistance transporter-1 in protecting the ovary and how we can harness its power would provide a new opportunity to shield the ovary. We could use this knowledge to protect the ovary from life-saving cancer treatment, but it could also allow us to protect the ovary lifelong.
3. The effects of military service on transgenerational fertility
We are very interested in studying the occupational and environmental hazards of women who serve in the military.
We chose this project because clinical research focused on women in the military is usually about sexual assault, post traumatic stress disorder (PTSD) or trying to reintegrate into civilian life. There is very little talk about occupational exposure to toxicants, which could have far-reaching impact on the female soldier’s fertility as well as her offspring’s.
We are looking at the effects of nitrogen mustard, or mustard gas, on the ovary and generational effects. Mustard gas was developed in WWI and has long been used as a chemical warfare agent, with that technically ending with the 1925 Geneva Protocol banning its use in warfare. There is evidence that the Islamic State of Iraq and the Levant, or ISIS, has been using nitrogen mustard.
Our clinical research is examining the effects of this gas on the ovaries, long-term and generationally. If a woman serving in the military is exposed to this chemical, what happens to her ovaries? What will happen to her daughter’s ovaries? Or her granddaughter’s ovaries?
Being exposed to a chemical agent results in different reactions for men and women, in terms of reproduction. Women have a finite number of eggs, and they don’t make new ones. For men, they are always making sperm. If a man was exposed, then there could be an effect on the sperm he is making immediately, then that effect would be clear. That is not the case for women. Whatever the ovaries were exposed to could be detrimental to the health of the ovarian reserve and her overall health.
We are applying for funding for this project and are very passionate about this research.
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At Women & Infants’ Fertility Center, we would not be able to do this important research without talented research assistants like Haley Clark, a former Brown Honors Thesis undergraduate student, and postdoctoral fellow Zijing Zhang, Ph.D. graduate of Cornell.
These are just a few of our ongoing clinical research projects. We are constantly working to expand our understanding of women’s health and implement that knowledge to the benefit of our patients. Unfortunately, women’s health is rarely a top priority for funding. But, there is always an opportunity to donate to our women’s health research, like these projects or others, that might interest you. You can learn more about donating by visiting the Women & Infants donation page.