T      he University of Vermont offers the opportunity for excellent education in all clinical and research
       aspects...
A. Brief Description of the Fellowship Program:
Overall Goals: This three year fellowship is designed to afford fellows an...
YEAR TWO


T      he second year fellow is focused on research (90% time) and has limited obligations in the outpatient
  ...
2.      A graduate seminar course Special Topics in Obstetrics and Gynecology: Molecular Endocrinology of
        Female R...
She takes responsibility for the completion by the fellow of at least one clinical and one basic science research
paper. S...
Laparoscopies                          77
       Hysteroscopies                         82
       Laparotomies            ...
4.    Storment JM, McBean J. The use of early pregnancy monitoring algorithms improves care for
      disorders of the fir...
Circulation Frontier (Japanese) 5(1):32-41, 2001.
4.   Clark BM, Tischler MD, O’Connell M, Sites CK. Physiologic memory of...
5.      Cooper BC, Sood AK, Davis CS, Ritchie JM, Sorosky JI, Anderson B, Buller RE. Preoperative
        CA-125 levels: a...
F. Research Support (Extramural Grants and Contracts, Total Costs Awarded):
1.    Hormone replacement and metabolic cardio...
CLINIC: 2000 square feet - two nursing offices; one for general clinical, and one for IVF and research
functions. Three M....
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  1. 1. T he University of Vermont offers the opportunity for excellent education in all clinical and research aspects of Reproductive Endocrinology. This program provides experiences in reproductive surgery, assisted reproductive technologies, and the management of infertility, reproductive endocrinology, medical endocrinology, and pediatric endocrinology. Fellows develop expertise in clinical and basic science research. Working in the academic medical center, the fellow develops skills in the education of residents and medical students that will prepare him/her for a career in academic medicine. The fellowship, which has always offered a three-year program, provides protected time for clinical education and research development. The first year is dedicated to patient care in the areas of infertility, reproductive endocrinology, pediatric gynecology and endoscopic surgery. The fellow works one-on-one with each of the six Board-certified/board-eligible Reproductive Endocrinologists in the outpatient clinic setting. The surgical emphasis is on operative laparoscopy and hysteroscopy with over 150 cases each year. The fellow also learns outpatient procedures including sonohysterography, hysterosalpingography, follicular monitoring, and transvaginal ultrasound for gynecologic disorders. All clinical activities are performed at Fletcher Allen Health Care, the academic health center affiliated with the University of Vermont. During the second half of the year, the fellow builds his/her own clinical and surgical practice with the guidance of the faculty. The first year fellow will select and develop a clinical research project with direction from the Fellowship Program Director, although the project may involve other faculty mentors. All Fellows participate in a weekly 1½-hour didactic session and a 1½-hour clinical teaching conference. The second year of the fellowship offers protected time for development and completion of the basic science project. The Fellowship Program Director, Dr. Sites, and the Research Division, headed by George Osol, Ph.D., assist the fellow in selecting and conducting the research. Research faculty throughout the College of Medicine are available to provide guidance to the fellow. In addition, the fellow will continue work on the clinical research project selected during the first year. One-half day each week is spent in a continuity clinic for the fellow’s clinical practice. During the third year, the fellow sees all IVF patients, gains skills in medical and pediatric endocrinology, and completes the clinical and basic science research projects. Approximately one half of the fellow’s time is spent in clinical activities during the third year. The fellow evaluates couples referred for assisted reproductive technologies, performs follicular monitoring, manages ovulation induction cycles, participates in oocyte retrievals and embryo transfers, and has the opportunity to work in the IVF laboratory. At the conclusion of the three-year program, the fellow is well trained in all aspects of clinical reproductive endocrinology and infertility, and will have completed one clinical and one basic science research project. 1
  2. 2. A. Brief Description of the Fellowship Program: Overall Goals: This three year fellowship is designed to afford fellows an opportunity to: 1. Capitalize on clinical skills acquired during recently completed residencies to develop clinical expertise in evaluation and treatment of reproductive endocrine and fertility disorders (Year 1). 2. Acquire first-hand experience in designing and conducting clinical research (Years 1 and 2). 3. Acquire first-hand experience in designing and conducting basic research (Years 2 and 3). 4. Learn advanced techniques in assisted reproductive therapies (Year 3). YEAR ONE T he first year of the program is primarily clinically oriented. During the first half of the year, the fellow works closely with each of the attendings in Reproductive Endocrinology to allow one-on-one training in the clinical aspects of the field. During the second half of the year, the fellow takes primary responsibility for a cohort of patients identified as his or her own in the clinic and plays a key role in the management of the overall clinic population. During this year, the fellow supervises all aspects of the division's activities in infertility and endocrine evaluation and management except for those related directly to IVF. The first year fellow is in the operating room each week during both operating days of the division and is given primary surgical responsibility in all cases. Approximately one-third of the fellow’s time is spent in each area of the specialty: infertility, reproductive endocrinology, and reproductive surgery. Care of couples with primary and secondary infertility includes the initial evaluation, interpretation of laboratory tests, and performance of diagnostic procedures including sonohysterography, hysterosalpingograms, and transvaginal ultrasound. As the only Reproductive Endocrinologists in our region, our group receives numerous referrals regarding pediatric endocrinology, amenorrhea, hirsuitism, hyperprolactinemia, and menopausal issues. In the operating room, endoscopic and microsurgical techniques are stressed. A graduate level statistics course is taken during the first year. These skills are considered fundamental to critical reading of current literature and to research study design and are intended to be acquired as early as possible in the fellowship. Successful completion of this course is required for certification by the American Board of Obstetrics and Gynecology. The fellow will develop a project in clinical research during the second half of the first year, with guidance from the Fellowship Director. This endeavor should capitalize on questions originating from first-hand exposure to problems in clinical management, with understanding of study design acquired from the statistics course. The fellow has an appointment as Clinical Instructor at the University of Vermont and obtains hospital privileges at the academic medical center, Fletcher Allen Health Care. This recognizes the role of the fellow as a junior member of the faculty and as a teacher of residents and medical students. As with all faculty, the fellow participates in general Obstetrics and Gynecology night call (in-house call), with one in-house call required per month. The fellow may elect to take additional call as a generalist OB/GYN for additional compensation (above the baseline salary), but only one call night/month is required. The fellow also takes Reproductive Endocrinology call every third weekend with the attending faculty. The first year is the most formally structured of the three years; it has the least free time. The goal is to prepare the fellow to manage most clinical problems in the field. With the commencement of the second year, most clinical responsibilities cease, so that the fellow can focus on learning research. 2
  3. 3. YEAR TWO T he second year fellow is focused on research (90% time) and has limited obligations in the outpatient clinic. The fellow does spend ½ day/week in a continuity clinic, however, to maintain clinical skills. The fellow may elect to participate in procedures and surgeries with his/her own patients, but is strongly encouraged to relinquish all other clinical activities to the new first year fellow. The second year fellow's time is applied to the design and execution of projects in basic and clinical research. Fellows are encouraged to work with departmental faculty or with other faculty within the institution. The Fellowship Program Director is committed to working with each fellow to design basic and clinical projects that are publishable and fundable. The Research Division, headed by George Osol, PhD, is also committed to basic science research education of REI & MFM fellows. Researchers at the University of Vermont have welcomed fellows into their laboratories; many have agreed to participate in the NIH sponsored T32 grant for reproductive endocrine fellows. Financial support is available to cover the costs of fellow research. Fellows are also asked to develop applications for competitive funding during the second year. The clinical research project initiated during the first year is continued or completed in the second year. A full-time research nurse coordinator is available to assist fellows with recruitment and monitoring of clinical subjects, and a Clinical Research Center (CRC), funded by the NIH for more than 30 years, is active at the academic medical center. The second year fellow is expected to exert leadership in the teaching activities within the division (conference and journal club schedules), and to take at least one additional course at the graduate level (required by the Board). Participation in conferences sponsored by Medical Endocrinology is also encouraged. YEAR THREE T he third year fellow manages the care of patients in the Assisted Reproductive Technology program. Duties include patient screening, day to day management decisions (with faculty consultation), and ongoing review of program design and protocols. The fellow performs oocyte retrievals and embryo transfers. There is an opportunity to work with the embryologists in the laboratory, assessing oocytes and embryos, preparing embryos for cryopreservation, and participating in intracytoplasmic sperm injection. The ART program currently provides exposure to approximately100 IVF and 80 Injectable Gonadotropin cycles per year, with anticipated growth to approximately 150 cycles within the next three years. The IVF program is overseen by Peter Casson, M.D. The third year fellow continues his/her continuity clinic. In addition, the third year fellow spends ½ day/week for three months in medical endocrinology and three months in pediatric endocrinology clinic, with the attending physicians in the Departments of Medicine and Pediatrics. By the conclusion of his/her third year, the fellow will complete the clinical and basic science research projects. With approximately fifty percent of the third year fellow’s time dedicated to research, there is adequate time to prepare studies for publication and submit papers prior to the completion of the fellowship. It is anticipated that the fellow will present his/her research at national meetings, and this activity is supported by divisional funds. All fellows are required to complete their primary thesis prior to the end of the fellowship. FORMAL EDUCATIONAL COMPONENTS: 1. Graduate level biostatistics is taken during the first academic semester of fellowship. 3
  4. 4. 2. A graduate seminar course Special Topics in Obstetrics and Gynecology: Molecular Endocrinology of Female Reproduction (OB295) is a course that is administered by the Research Division but team-taught by the members of the Obstetrics and Gynecology Department. 3. An additional graduate level course, in the fellow’s area of research interest, is strongly encouraged during the second year of fellowship. 4. Faculty and fellows conduct weekly didactic sessions. Fellows review key papers in reproductive endocrinology with faculty that pertain to objectives set by The American Board of Obstetrics and Gynecology. 5. Weekly clinical conferences, including surgical reviews and clinical cases, are conducted by faculty, fellows, residents, and staff. 6. The Department of OB/GYN holds weekly grand rounds, weekly gynecologic morbidity and mortality conferences, monthly research seminars, and monthly journal clubs. 7. Weekly medical endocrine conferences are available for the fellows, and attendance is encouraged. WEEKLY SCHEDULES FOR FELLOWS: FIRST YEAR FELLOW'S SCHEDULE Monday Tuesday Wednesday Thursday Friday Morning Surgery Clinic Surgery Clinic Clinic Lunch IVF Conference Didactic Clinical Conference Conference Afternoon Surgery Research Surgery HSG/ Procedures Clinic SECOND YEAR FELLOW'S SCHEDULE Monday Tuesday Wednesday Thursday Friday Morning Research Research Research Research Research Lunch IVF Conference Didactic Clinical Conference Conference Afternoon Research Clinic Research Research Research THIRD YEAR FELLOW'S SCHEDULE Monday Tuesday Wednesday Thursday Friday Morning Clinic*/ IVF Cases IVF Cases Clinic*/ IVF Cases Research Clinic*/IVF cases Lunch IVF Conference Didactic Clinical Conference Conference Afternoon Research Research Research Clinic Research *Clinic IVF/ injectable gonadotropins only (half morning) B. Specific Role of Each Faculty Member in the Fellowship Training Process: CYNTHIA K. SITES, M.D.: Dr. Sites is board certified in reproductive endocrinology and is the Fellowship Program Director. She is responsible for all aspects of fellowship education, both in clinical and research areas. 4
  5. 5. She takes responsibility for the completion by the fellow of at least one clinical and one basic science research paper. She is funded as a principal investigator by the NIH to study hormone replacement therapy and glucose metabolism, and is committed to helping fellows develop skills in writing grants and research papers. She is also active clinically, and participates with fellows in their education in pediatric gynecology, menopause and reproductive endocrinology. JULIA V. JOHNSON, M.D.: Dr. Johnson is board certified in reproductive endocrinology and is the Reproductive Endocrinology Division Director. She is a very active and outstanding clinician who participates in the education of fellows in the office, in the operating room and at didactic sessions. Her primary clinical interests are in menopause, reproductive endocrinology and infertility. Her research interests are in progestins and coagulation. PETER R. CASSON, M.D.: Dr. Casson is board certified in reproductive endocrinology, and is the Director of the IVF Program. The program currently performs approximately 100 cycles per year with clinical pregnancy rates of approximately 40% per retrieval. The fellow is exposed to ICSI, assisted hatching, TESA (in collaboration with Dr. Tom Jackson in urology), and egg donor. Dr. Casson’s research interests involve postmenopausal androgen replacement therapy. DANIEL H. RIDDICK, M.D., PH.D.: Dr. Riddick, also board certified in reproductive endocrinology, is a senior member of the division and a former examiner for the American Board of Obstetrics & Gynecology and president of the ASRM. He is very active clinically, working closely with fellows in the operating room and office. He contributes to the education of fellows at didactic sessions. His experience with Mullerian anomalies is an asset to the division and to the fellow’s education. CHRISTINE A. MURRAY, M.D.: Dr. Murray is board eligible in reproductive endocrinology and has been a strong clinical member of the division. She has extensive training in reproductive surgery which benefits the fellow. She is also responsible for the education of residents on the rotation. Her research interest is in the surgical treatment of polycystic ovary syndrome. JOHN R. BRUMSTED, M.D.: Dr. Brumsted is the Chief Medical Officer for the academic medical center, but continues to participate in the education of fellows, particularly in the operating room. His primary interests are in endoscopic surgery. GEORGE J. OSOL, PH.D.: Dr. Osol is the Director of the Research Division in the department, and has a successful track record of working with both reproductive endocrinology and maternal fetal medicine fellows on their basic science research projects. He is funded as a principal investigator by the NIH to study steroidal modulation of uterine vascular function. He coordinates the OB295 course for fellows (Molecular Endocrinology of Female Reproduction). C. Surgical Experience: T he first year fellow is involved in all surgical cases generated by the faculty and by his/her own practice. In 2000-2001, the first year fellow performed the following cases: 5
  6. 6. Laparoscopies 77 Hysteroscopies 82 Laparotomies 20 Surgery for Developmental Abnormalities 3 These cases include tubal reanastomosis, neosalpingostomies, ablation of endometriosis, laparoscopically assisted vaginal hysterectomies, hysteroscopic myomectomies, endometrial ablations, and resections of uterine septums. It is the goal of the fellowship that all fellows are well trained in the most current endoscopic surgical procedures. D. Publications and Presentations co-authored by Fellows during the Past Six Years (1998-2004) : William F. Ziegler, D.O. 1. Ziegler WF, Bernstein I, Stirewalt W, Brumsted J, Badger G. Changes in blood volume during the menstrual cycle in nulliparous women. The Society for Gynecologic Investigation. March 1998. 2. Ziegler WF, Badger G, Shamonki MI, Sites CK. Factors predicting the success or failure of endometrial ablation. American College of Obstetricians and Gynecologists. May 1998. 3. Ziegler WF, Chapitis J. Comparing freezing in nitrogen vapor to direct plunge on purified human motile sperm recovery. American College of Obstetricians and Gynecologists. May 1998. 4. Ziegler WF, Sites C, Badger G, Shamonki M. Prediction of endometrial ablation success by preoperative findings. Prim. Care Update Ob Gyns 1998 Jul 1;5(4):204 5. Ziegler WF, Chapitis J. Human motile sperm recovery after cryopreservation: freezing in nitrogen vapor vs the direct plunge technique. Prim. Care Update Ob Gyns 1998 Jul 1;5(4):170 6. Walker P, Ziegler WF, Bertagnoll R, Badger G, McBean J. Influence of maternal age on ovulation induction with clomiphene citrate. American Society for Reproductive Medicine. October 1998. 7. Ziegler WF, Bernstein I, Leavitt T, Brumsted J, Badger G. Uterine artery resistance through the menstrual cycle in nulliparous women. American Society for Reproductive Medicine. October 1998. 8. Bernstein IM, Ziegler W, Stirewalt WS, Brumsted J, Ward K. Angiotensinogen genotype and plasma volume in nulligravid women. Obstet Gynecol 1998;92: 171-3. 9. Ziegler WF, Bernstein IM, Stirewalt WS, Badger GJ. Regional hemodynamic adaptation throughout the menstrual cycle. Obstet Gynecol 1999;94: 695-699. 10. Shamonki MI, Ziegler WF, Badger GJ, Sites CK. Prediction of endometrial ablation success according to perioperative findings. Am J Obstet Gynecol 182(5):1005-1007, 2000. 11. Bernstein IM, Ziegler W, Badger GJ. Plasma volume expansion in early pregnancy. Obstet Gynecol 2001;97:669-72 12. Bernstein IM, Ziegler WF, Leavitt T, Badger GJ. Uterine artery hemodynamic adaptations through the menstrual cycle into early pregnancy. Obstet Gynecol 2002 Apr;99(4):620-4. John M. Storment, M.D. 1. Storment JM, Kaiser JR, Sites CK. Transvaginal ultrasound diagnosis of uterine septae. J Reprod Med 43:823-826, 1998. 2. Celia G, Storment JM, Meyer M, Osol G. Evidence for veno-arterial transfer of vasoactive substances in the uterine circulation. Society for Gynecologic Investigation. March 1998. 3. Storment JM, Kaiser JR, Sites CK. Transvaginal ultrasound diagnosis of uterine septae. Poster presentation. American College of Obstetricians and Gynecologists, 46th Annual Clinical Meeting, New Orleans, May 1998. 6
  7. 7. 4. Storment JM, McBean J. The use of early pregnancy monitoring algorithms improves care for disorders of the first trimester. American Society for Reproductive Medicine, Toronto, 1999. 5. Storment JM, Meyer M, Osol G. Estrogen augments vascular endothelial growth factor vasodilator effects. Society for Gynecologic Investigation. March 1999. 6. Storment JM, Meyer M, Osol G. Estrogen augments vascular endothelial growth factor (VEGF) vasodilator effects in the uterine circulation of the rat. Am J Obstet Gynecol 183(2):449-53, 2000. 7. Dickey RP, Pyrzak P, Lu PY, Sartor BM, Taylor SN, Rye PH, Storment JM. Comparison of hCG levels following transfer of embryos on the third day and fifth day post IVF. Accepted for poster presentation at the Annual Meeting of the American Society for Reproductive Medicine, San Diego, CA, October 21-26, 2000. 8. Dickey RP, Pyrzak P, Lu PY, Sartor BM, Taylor SN, Rye PH, Storment JM. Administration of hCG when the rate of rise of E2 slows, results in optimal continuing pregnancy rates in FSH treated IVF cycles. Poster presentation, American Society for Reproductive Medicine, San Diego, CA 2000. 9. Pyrzak P, Dickey RP, Sartor BM, Taylor SN, Lu PY, Storment JM. Serum values of E2 and P4 adjusted to serum volume may change the evaluation outcome of ovarian response, treatment, and result of IVF patients when compared to the absolute values. Poster presentation at the Annual Meeting of the American Society for Reproductive Medicine, San Diego, CA 2000. 10. Storment JM, Clark BM, Tischler MA, and Sites, CK. Echocardiographic changes with hormone replacement therapy: a randomized controlled blinded clinical trial. Poster presentation, Society of Gynecologic Investigation, Los Angeles, 2002. 11. Dickey RP, Pyrzak R, Lu PY, Sartor BM, Taylor SN, Storment JM. Pituitary-ovarian recovery after oral contraceptive use before in vitro fertilization. Accepted for poster presentation at the Annual Meeting of the American Society for Reproductive Medicine, Seattle, WA 2002. 12. Dickey RP, Taylor SN, Lu PY, Sartor B, Storment JM, Pelletier WP, Zehnder J, Matulich E. Spontaneous reduction of multiple pregnancy: incidence and effect on outcome. Am J Obstet Gynecol 2002, 186:77-83. 13. Storment JM, Brumsted JR. Infertility and recurrent pregnancy loss. In: Office Gynecology, 5th ed Curtis M, Hopkins M, Eds. Williams and Wilkins. 14. Storment JM, Brumsted JR. Endometriosis. . In: Office Gynecology, 5th ed Curtis M, Hopkins M, Eds. Williams and Wilkins. Susan C. Conway, M.D. 1. Conway SC, Fernandez EA, Johnson JV, Huot A. Major histocompability complex (MHC) expression on peritoneal mononuclear cells in women with endometriosis. Society for Gynecologic Investigation, March 2000. 2. Johnson JV, Conway SC, Sites CK, Taylor EH, O’Brien SL, Badger GJ, Toth MJ, Poehlman ET. Luteal phase inhibin A predicts menstrual changes in perimenopausal women. Society for Gynecologic Investigation, March 2000. 3. Lewis-Bliehall C, Rogers RG, Kammerer-Doak DN, Conway SC, Amaya C, Byrn F. Medical vs. surgical treatment of ectopic pregnancy. The University of New Mexico’s six-year experience. J Reprod Med 2001 Nov;46(11):983-8. Brian M. Clark, M.D. 1. Clark BM, Johnson JV. Effects of postmenopausal hormone replacement on uterine leiomyoma growth measured by ultrasound. Society for Gynecologic Investigation. March 1999. 2. Clark BM, Johnson JV, Tischler MD, O’Connell M, Sites CK. The relationship of recent hormone replacement therapy use in left ventricular mass, contractile function, and volume in postmenopausal women. Society for Gynecologic Investigation. March 2000. 3. Clark BM, Sites CK. Menopause, hormone replacement, and changes in the cardiovascular system. 7
  8. 8. Circulation Frontier (Japanese) 5(1):32-41, 2001. 4. Clark BM, Tischler MD, O’Connell M, Sites CK. Physiologic memory of cardiac structure and function after discontinuation of hormone replacement therapy in postmenopausal women. Submitted. Jerald S. Goldstein, M.D. 1. Goldstein JS, Munkarah A. Endometrial cancer surgical staging and morbidity in a community hospital. District V Section Meeting of the American College of Obstetrics and Gynecology, June 1999. 2. Bauermann P, Deppe G, Goldstein JS, Malone J, Morris J, Munkarah A, Naar E. Advanced age does not increase the morbidity of surgical staging in women with endometrial cancer (EC). Society of Gynecological Oncologist Annual Meeting, March 2000. 3. Goldstein JS, Sites CK. Selective modulation of sex steroids. In press, Ageing Research Reviews, 2001. 4. Goldstein JS, Badger G, Johnson JV, Cushman M. Effect of depo medroxyprogesterone on coagulation parameters. Society of Gynecological Investigation Annual Meeting, March 2003. 5. Goldstein JS, Sites CK, Toth MJ. Effect of estradiol and progesterone on cardiac protein synthesis in female rats. American Society of Reproductive Medicine, October 2003. 6. Goldstein JS, Sites CK, Toth MJ. Progesterone stimulates cardiac muscle protein synthesis via receptor-dependant pathways. Fertil Steril 82:430-436, 2004. Gwen Goodrow, M.D. 1. Goodrow G, L’Hommedieu GD, Gannon B, O’Connell M, Sites CK. Predictors of decreasing insulin sensitivity in postmenopausal women. Society for Gynecologic Investigation Annual Meeting, 2004. 2. Goodrow G, Cipolla M, Vitullo L. Effect of estrogen replacement therapy on cerebral arteries during stroke in female rats. In press. Menopause. 2004. 3. Goodrow G. Effect of estrogen replacement therapy on cerebral arteries during stroke in female rats. Presented at North American Menopause Society Annual Clinical Meeting, September 2003. Marjorie Dixon, M.D. 1. Dixon M, Osol G, Bonney EA. Failure of decidual arteriolar remodeling in the CBA/J X DBA/2 model of murine recurrent pregnancy loss. Society for Gynecologic Investigation Annual Meeting, 2004. Brian Cooper, M.D 1. Cooper BC, L’Hommedieu GL, Sites CK. Discontinuing combination hormone replacement therapy restores pretreatment insulin sensitivity. Society for Gynecologic Investigation Annual Meeting. March 2004. 2. Swanson PC, Cooper BC, Glick GD. High resolution epitope mapping of an anti-DNA autoantibody using model DNA ligands. J Immunol 1994;152:2601-2612. 3. Eagan MA, Norris JM, Cooper BC, Glick GD. Structural patterns in anti-DNA autoantibodies: a molecular modeling study. Bioorganic Chemistry 1995;23:482-498. 4. Cooper BC, Buekers TE, Flynn CM, Sorosky JI, Buller RE. Asymptomatic lung carcinoma presenting with a large vulvar lesion. J Lower Genital Tract Disease 2001;5(1):48-50. 8
  9. 9. 5. Cooper BC, Sood AK, Davis CS, Ritchie JM, Sorosky JI, Anderson B, Buller RE. Preoperative CA-125 levels: an independent prognostic factor for epithelial ovarian cancer. Obstet Gynecol 2002;100(1):59-64. 6. Lutgendorf SK, Johnsen EL, Cooper BC, Anderson B, Sorosky JI, Buller RE, Sood AK. Vascular endothelial growth factor and social support in ovarian cancer patients. Cancer 2002;95(4):808-15. 7. Cooper BC, Ritchie JM, Broghammer CLW, Coffin J, Sorosky JI, Anderson B, Buller RE, Sood AK. Preoperative vascular endothelial growth factor (VEGF) levels: significance in ovarian cancer. Clin Cancer Res 2002;8:3193-7. 8. Kent KJ, Cooper BC, Thomas KW, Zlatnik FJ. Presumed amniotic fluid embolism. Obstet Gynecol 2003;102(3):493-5. 9. Lowe MP, Cooper BC, Sood AK, Davis WA, Syrop CH, Sorosky JI. Implementation of assisted reproductive technologies following conservative management of FIGO grade I endometrial adenocarcinoma and/or complex hyperplasia with atypia. In press, Gynecol Oncol. E. Areas of Research at the University of Vermont At the University of Vermont, 13 M.D. or Ph.D. faculty members from within our department or outside of it have agreed to mentor fellows. These individuals have included their biosketches in the new T32 National Training Grant in Reproductive Endocrinology funded by the NIH, for which the fellow is eligible. The majority of these mentors are principal investigators funded by the NIH, and have strong track records for successful training in basic, clinical or translational research. Whether or not the fellow decides to apply for these T32 NIH funds, these mentors are committed to working with fellows on research projects. Current areas of research among these mentors can generally be divided as follows: Menopause 1. Effects of menopause and hormone replacement on cardiovascular function and risk for cardiovascular disease (heart ventricle, insulin sensitivity, body composition including fat distribution and skeletal muscle protein synthesis, cytokines, coagulation). 2. Effects of estrogen and selective estrogen receptor modulators on endothelial function and vascular remodeling. 3. Signal transduction mechanisms underlying vascular reactivity (including evaluation of endothelial nitric oxide production and release, and calcium signaling in vascular smooth muscle). 4. Alternative forms of hormone replacement, and predictors of menopause. 5. Androgen replacement therapy in menopause. Polycystic ovary syndrome (PCOS) 1. Effects of surgical and medical treatment on hypothalamic/pituitary/ovarian function, insulin sensitivity and lipids. Pregnancy-related 1. Understanding how endometrial and vascular changes predict fetal growth abnormalities. 2. Effect of pregnancy on arterial and venous growth and reactivity within the uterine circulation. 3. Placental regulation of vascular permeability and signal transfer in venoarterial communication. 4. Understanding how pro-inflammatory and anti-inflammatory cytokines influence recurrent pregnancy loss. 9
  10. 10. F. Research Support (Extramural Grants and Contracts, Total Costs Awarded): 1. Hormone replacement and metabolic cardiovascular risk. National Institutes of Health (R29 AG15121). 12/98-11/03. Cynthia K. Sites, M.D., P.I. $528,500. 2. GCRC CAP. National Institutes of Health (M01 RR10932S2). 7/92-6/02. Cynthia K. Sites, M.D., P.I. $585,439. 3. Progestins and mechanisms of insulin resistance. National Institutes of Health (2 R01 AG15121). Submitted; 7/02-6/07. Cynthia K. Sites, M.D., P.I. $1,613,750. 4. Energetic adaptation to the menopausal transition. National Institutes of Health (R01 AG13978). 8/97-9/02. Dwight Matthews, P.I.; Cynthia Sites, M.D., Co-I. 5. Mechanotransduction by vascular smooth muscle. National Institutes of Health (R01) 7/98-6/03. George Osol, PhD., P.I. $922,992. 6. Steroidal modulation of uterine vascular function. National Institutes of Health (R01) 7/99-6/04. George Osol, PhD., P.I. $1,300,000. 7. Uterine vascular response to steroid signaling. National Institutes of Health (R01 HL63101). 7/99-6/03. Ira Bernstein, M.D., P.I.; Julia Johnson, M.D., Co-I. $1,133,010. 8. Mechanisms of uterine vascular adaptation in pregnancy. National Institutes of Health (R01). Submitted; 4/02-3/07. Natalia Gokina, PhD., P.I. $1,372,710. 9. Phase III Study of DMPA subcutaneous injection – women of childbearing potential in the Americas. Pharmacia and Upjohn. 5/01-5/03. Julia Johnson, M.D., P.I. $189,000 10. Phase III Study of DMPA subcutaneous injection in women with endometriosis in the United States and Canada. 5/01-9/02. Peter R. Casson, M.D., P.I. $39,275. 11. Testosterone transdermal patch in postmenopausal women. Proctor and Gamble. 3/02-3/03. Peter R. Casson, M.D., P.I. 12. A comparison between the effects of tamoxifen and raloxifene therapy on vascular reactivity in a pressurized vascular segment model. ACOG/Solvay Pharmaceuticals Research Award in Menopause. 7/00-6/02. Brian M. Clark, M.D., P.I. (Mentor: Julia V. Johnson, M.D.). $20,000. 13. The effect of hormone replacement on cardiovascular hemodynamics and blood volume in postmenopausal women. ACOG/Parke-Davis Award to Advance Women’s Health Care. 7/98-6/00. John M. Storment, M.D., P.I. (Mentor: Cynthia K. Sites, M.D.). $20,000. 14. Effects of estradiol and progesterone on cardiac protein synthesis and IGF-1 expression. American College of Obstetricians & Gynecologists grants, submitted; 7/02-6/03. Jerald S. Goldstein, M.D., P.I. (Mentor: Michael J. Toth, Ph.D.). $20,000. 15. PI-PLC Function in Pregnant Rat Myometrium. Grant NIH HD28506-06. 12/01-3/03. Mark Phillippe, MD, P.I. $433,722. 16. Ischemia and Reperfusion Effects on Cerebral Artery Function. National Institutes of Health. (R01 #NS40071-01). 4/99-3/04. Marilyn J. Cipolla, PhD, P.I. $1,233,589. 17. Modulation of Vascular Permeability by Myogenic Tone and Cerebral Ischemia. Totman Center for Cerebrovascular Research. 10/00-9/02. Marilyn J. Cipolla, PhD, P.I $10,000. 18. High Resolution Laser Speckle Strain Gauge for Biomedical Research and Diagnostics. National Science Foundation. 8/98-6/02. Sean Kirkpatrick, PhD, P.I., Marilyn J. Cipolla, PhD, Collaborator. $318,049. 19. Cerebrovascular Effects of Tissue Plasminogen Activator. Genentech, Inc., Marilyn J. Cipolla, PhD, P.I. G. Facilities Available: 10
  11. 11. CLINIC: 2000 square feet - two nursing offices; one for general clinical, and one for IVF and research functions. Three M.D. provider offices shared by all M.D. staff. There are: one clinical laboratory, three patient conference rooms, six examination/treatment rooms, and two examination/ultrasound rooms. The clinic is staffed with seven nurses specializing in infertility services. The division of reproductive endocrinology also includes a full-time IVF nurse coordinator, part-time donor oocyte coordinator, clinical research coordinator, psychologist specializing in women’s health, and an andrology laboratory specialist who work closely with the fellows and faculty. There is an academic secretary located in the Given Building who works with fellows and faculty. IN-VITRO FERTILIZATION: In January 1994 the IVF Laboratory relocated to its new and expanded location in the Ambulatory Services Center. Additions include an area for cryopreservation and intracytoplasmic sperm injection and growth of the current IVF laboratory to accommodate the expanding IVF and donor oocyte program. The laboratory is adjacent to the oocyte retrieval/embryo transfer area. All IVF activities including media preparation, oocyte assessment, sperm preparation, fertilization, cryopreservation, and ICSI are performed in the IVF laboratory under the supervision of Calvin Wilkinson, Senior Embryologist. CLINICAL RESEARCH CENTER: There is a twelve-bed General Clinical Research Center (GCRC) at the Medical Center Hospital of Vermont, which has been funded by the NIH for more than 30 years. The Division of Reproductive Endocrinology has frequently utilized this facility to conduct clinical research. Space and financial resources are available for appropriate projects. ACADEMIC OFFICES: Divisional faculty have offices in the Given Building of the College of Medicine, adjacent to the laboratory space and secretarial support. Fellows’ office and laboratory space are located in the College of Medicine adjacent to faculty offices. LABORATORY: There is 3,400 square feet of research space within the department. This space is available for fellows to use as needed. 11

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