Reproductive Medicine

A particular focus is infertility and reproductive endocrinology, which links through fertility services on all sites. This work will continue to focus on extending the range of conditions amenable to pre-implantation screening since Professor Lord Winston’s first successful embryo diagnosis here at Hammersmith 15 years ago. We also aim to improve the success of assisted conception, through better embryo culture and implantation, ovarian cryo-preservation from cancer victims, as pioneered by us, and through reduced multiple pregnancy rates.

 

Professor Steve Franks’ Reproductive Endocrine Group has established an ovulation induction regime in anovulatory clomiphene-resistant women with polycystic ovary syndrome (PCOS) using low-dose hFSH to induce only a single follicle to reduce the serious complications of hyperstimulation and multiple pregnancy; this has now been adopted internationally. PCOS is the commonest cause of anovulatory infertility and a major risk factor for type 2 diabetes. Against a background of internationally-acclaimed studies of the prevalence, diagnosis, pathogenesis and management of PCOS, we have used our unique patient tissue resource to implicate hyperinsulinaemia in the mechanism of anovulation, and to show that abnormalities of follicle function can be observed in prepubertal and even fetal life. The chief aim over the next five years, for which rigorous phenotyping and tissue collection is integral, is to elucidate the genetic basis of PCOS, the search for candidate genes having already led to discovery of novel linkages

Professor Lesley Regan & Dr Raj Rai

 

Another pivotal focus is recurrent miscarriage (RM), capitalising on the national referral clinic at St Mary’s, which has an international reputation for rigorous controlled treatment trials, and is widely featured in the media. The unit led by Professor Lesley Regan receives 1000 new referrals each year, ensures follow-up by caring for resulting pregnancies, and maintains a comprehensive database of over 8,000 carefully-phenotyped cases complemented by an extensive tissue archive including parental and fetal DNA and tissue samples; this not only underpins laboratory studies but ensures swift translation from bench to bedside. As European lead centre for antiphospholipid syndrome (aPL) in reproduction, we determined that combination aspirin-heparin treatment transforms the live birth rate from 10% to 75%; it is now the international gold standard. Studies of the deleterious effects of aPL on human trophoblast/decidual function have led to therapeutic avenues in infertility, pregnancy loss and contraception. The identification that many cases of RM result from prothrombotic tendencies detectable in the non-pregnant state has led to our developing cheap near-bedside predictive tests to identify at-risk pregnancies; this will also prove useful in identifying women at increased risk of cardiovascular accidents in later life. The unit will continue pivotal studies of both inherited and acquired thrombophilic defects in RM, including the contribution of the fetal genotype in determining pregnancy outcome. It will also exploit direct synergies with later pregnancy pathologies which arise from our demonstration that pregnancy wastage has aetiologies common to both early and late gestation.