NICHD Pediatric and Adolescent Gynecology Training Program
- Veronica Gomez-Lobo, MD, Program Director
- Veronica Gomez-Lobo, MD, Program Director
- Tazim Dowlut-McElroy, MD, Associate Program Director
- Jacqueline Maher, MD, Staff Clinician
- Ariel Cohen, MD, Clinical Fellow
- Jessica Long, MD, Clinical Fellow
- Rama Kastury, DO, Clinical Fellow
- Courtney Mascoe, MD, Clinical Fellow
- Swetha Naroji, MD, Clinical Fellow
- Taylor Badger, MD Candidate, Medical Research Scholar Program
- Victoria Huynh, MD Candidate, Medical Research Scholar Program
- Kelsey Mumford, MD Candidate, Medical Research Scholar Program
- Sreeramya Balasubramanian, BS, Intramural Research Training Award Fellow
- Sarina Hanfling, BS, Intramural Research Training Award Fellow
- Bohyon Yun, MD, Special Volunteer
- Ananya Krishnan, Summer Intern
- Jennifer Neda John, Summer Intern
- Rashmi Prasad, Summer Intern
- Sajeda Shuaib, Summer Intern
- Hong Lou, MD, Laboratory Manager/Biologist
- Maria De La Luz Sierra, MS, Laboratory Manager
- Harveen Kaur, MPH, Clinical Research Coordinator
- Sofia L. Getachew, MSPM, Fellowship Program Coordinator
The Pediatric and Adolescent Gynecology (PAG) program is uniquely qualified to meet the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s mission to: “lead research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all.” PAG is a relatively new subspecialty within the field of Obstetrics and Gynecology and encompasses gynecologic care from the fetal period into adulthood. Many of the conditions managed by pediatric gynecology are rare diseases and have been poorly studied, and PAG providers have become leaders in the field of fertility preservation in children and adolescents. The NICHD PAG program comprises fellowship training as well as laboratory and clinical research programs.
Fellowship
The NICHD PAG Fellowship includes faculty from three institutions: The National Institute of Child Health and Human Development (NICHD), MedStar Washington Hospital Center (MWHC), and Children’s National Hospital (CNH). The Fellowship has been training fellows since 2010; its mission is to ensure that the graduate possesses the knowledge, skills, and professional attributes essential to function as a consultant to pediatricians, family practitioners, obstetricians, and gynecologists for girls from birth to age 18–21 years with pediatric gynecologic concerns, as well as for older women born with congenital anomalies. Our fellows receive the highest quality training in clinical and surgical PAG, as well as research mentoring.
Currently, the Fellowship alternates between recruiting one or two fellows per year and trains both at NIH and Children’s National Hospital (CNH). A schedule is established by which fellows rotate through general pediatric and adolescent gynecology clinics (including a heavy-menses clinic), and surgeries, specialty clinics (reproductive endocrine, Turner syndrome, PROUD [positive re-evaluation of urogenital differences clinics, or disorders of sex development], and vulvar dermatology clinics), colorectal surgery at CNH, and research and consult/clinics at the NIH Clinical Center. Fellows have thirty percent of their time protected for clinical research, which takes place throughout the two years of training. Structured training includes a series of introductory seminars, monthly PAG lectures, which include a statistics curriculum, specialty clinic conferences (colorectal, Differences of Sexual Development, Turner’s), combined REI (reproductive endocrinology and fertility)/PAG Journal Club/case conferences, and bimonthly laboratory meetings.
Research Program
The research and laboratory program includes five IRB–approved clinical protocols, which are conducted in the ambulatory, in-patient, and operating rooms of the NIH Clinical Center. In addition, laboratory space within the Clinical Center allows for experiments on ovarian tissue and other samples obtained from these clinical protocols. We also work closely with the core facilities within NICHD, including the Molecular Genomics, Bioinformatic, and Mouse Cores.
The program includes research on fertility preservation in children and adolescents and on rare conditions. Fertility preservation has emerged as an important aspect of cancer care in pediatric and adult populations. In December 2019, the American Society of Reproductive Medicine Committee Opinion on fertility preservation in patients undergoing gonadotoxic therapies stated that that ovarian tissue cryopreservation (OTC) should no longer be considered experimental. However, there remain significant gaps in knowledge regarding OTC for fertility preservation in children and adolescents receiving gonadotoxic therapy, as the fertility effect of gonadotoxic therapy as well as the fertility benefits of OTC cannot be ascertained until 5–30 years after therapy. Recently, there has been increased interest in fertility preservation in other populations, including individuals with Turner syndrome, galactosemia, transgender youth, differences in sex development, and young women with recent premature ovarian insufficiency. Such individuals present further unknowns regarding the risks and benefits of OTC, the foremost being that they may have significantly lower populations of follicles than those planning to receive gonadotoxic therapy and may therefore not benefit from this technology. Furthermore, it is important to note that, although pregnancies have been achieved using this technology (in adults), much remains to be elucidated regarding ovarian histology, function, and mechanism of disease in the ovary, and ovarian-tissue cryopreservation has spurred new evaluation of the human ovary. The PAG program developed two protocols for ovarian-tissue cryopreservation in children and adolescents. The first is a protocol for ovarian-tissue cryopreservation for prepubertal children with Turner syndrome, classic galactosemia, and for adolescents with recent primary ovarian insufficiency (POI). The second protocol for children who will undergo gonadotoxic therapy will allow us to collect tissue and data that will inform the first protocol. In both protocols, we are performing oophorectomy for OTC and collecting a small portion of ovary for research. Through these projects we are defining the components and anatomy of the ovary, evaluating the correlation of ovarian reserve markers with histologic findings, and attempting to elucidate crucial signaling pathways regulating follicle activation and loss, through collaborations with NICHD Core laboratories, using methods including RNA-Seq and single-cell analytics.
Patients with PAG conditions (such as reproductive, endocrine, gynecologic tumors, and skin conditions, menstrual abnormalities, and congenital anomalies of the reproductive tract) may provide exceptional gain of knowledge, which may advance research in pediatric and adolescent gynecology disorders, and their evaluation may catalyze the recognition of new disease processes and new research initiatives. Through the PAG conditions protocol, we are collecting deep phenotype data and specimens from PAG patients, thus creating a large database of PAG conditions, which will provide stimuli for new clinical research initiatives. One such condition, androgen-insensitivity syndrome (AIS), is a state in which the body cannot sense the male hormones in the blood or tissue. Because this is a rare condition, little is known regarding the risks and benefits of gonadectomy, optimal hormone replacement after gonadectomy, nor general health in individuals with these conditions. Furthermore, the androgen receptor is found in many tissues in the body, including skin, bone, muscle, and in the neurologic, immune, and metabolic systems. Through the PAG program Natural History study in individuals with AIS, we will provide information regarding health risks and optimal management of individuals with AIS, as well as elucidate the role of the androgen receptor.
Application Information
Applications are submitted using the common application form on NASPAG. They are accepted in July before the anticipated start date, and interviews are typically held in August or September before the start date. Selection of candidates is processed through the National Resident Matching Program (NRMP). One to two positions are available in alternating years.
Please visit the following URL for detailed program information: hhttps://www.cc.nih.gov/training/gme/programs/pediatric_adolescent_gynecology.html
Publications
- Tsui EL, O'Neill KE, LeDuc RD, Shikanov A, Gomez-Lobo V, Laronda MM. Creating a common language for the subanatomy of the ovary. Biol Reprod 2022 doi: 10.1093/biolre/ioac199.
- O'Neill KE, Maher JY, Laronda MM, Duncan FE, LeDuc RD, Lujan ME, Oktay KH, Pouch AM, Segars JH, Tsui EL, Zelinski MB, Halvorson LM, Gomez-Lobo V. Anatomic nomenclature and 3D regional model of the human ovary: call for a new paradigm. Am J Obstet Gycecol 2022 S0002-9378(22)00795-5.
- Ligon JA, Fry A, Maher JY, Foley T, Silbert S, Yates B, Gomez-Lobo V, Wiener L, Shah NN. Fertility and CAR T-cells: current practice and future directions. Transplant Cell Ther 2022 28(9):605.e1–605.e8.
- Finlayson C, Johnson EK, Chen D, Fechner PY, Hirsch J, Rosoklija I, Schafer-Kalkhoff T, Shnorhavorian M, Gomez-Lobo V. Fertility in individuals with differences in sex development: provider knowledge assessment. J Pediatr Adolesc Gynecol 2022 35(5):558–561.
- Maher JY, Islam MS, Yin O, Brennan J, Gough E, Driggers P, Segars J. The role of Hippo pathway signaling and A-kinase anchoring protein 13 in primordial follicle activation and inhibition. F S Sci 2022 3(2):118–129.
- McElroy T, Gomez-Lobo V. Gonadectomy in individuals with Turner syndrome and Y chromosome material: fertility considerations. J Pediatr Adolesc Gynecol 2022 35(4):415–416.
Collaborators
- Jeffrey Baron, MD, Division of Translational Medicine, NICHD, Bethesda, MD
- Ryan K. Dale, MS, PhD, Bioinformatics and Scientific Programming Core, NICHD, Bethesda, MD
- Alan H. DeCherney, MD, Reproductive Endocrinology and Infertility Fellowship Training Program, NICHD, Bethesda, MD
- Francesca Duncan, PhD, Northwestern University Feinberg School of Medicine, Chicago, IL
- Fabio R. Faucz, PhD, Molecular Genetics Core, NICHD, Bethesda, MD
- Judith L. Fridovich-Keil, PhD, Emory University, Atlanta, GA
- Catherine Gordon, MD, Boston Children's Hospital, Boston, MA
- James Graham, MS, ELD, Shady Grove Fertility Center, Rockville, MD
- Yasmin Jayasinghe, MBBS, FRANZCOG, PhD, Royal Children's Hospital Melbourne, Parkville, Australia
- Marissa Lightbourne, MD, MPH, Section on Translational Diabetes and Metabolic Syndromes, NIDDK, Bethesda, MD
- Laverne Mensah, MD, Office of the Clinical Director, NICHD, Bethesda, MD
- Kyle Orwig, PhD, University of Pittsburgh, Pittsburgh, PA
- Karl Pfeifer, PhD, Section on Genomic Imprinting, NICHD, Bethesda, MD
- James Segars, MD, The Johns Hopkins School of Medicine, Baltimore, MD
- Ariella Shikanov, PhD, University of Michigan, Ann Arbor, MI
- Ninet Sinaii, PhD, MPH, Biostatistics and Clinical Epidemiology Service, Clinical Center, NIH, Bethesda, MD
- Eric Widra, MD, Shady Grove Fertility Center, Washington, DC
- Jack Yanovski, MD, PhD, Section on Growth & Obesity, NICHD, Bethesda, MD
- Mary Zelinsky, PhD, Oregon Health & Science University, Portland, OR
- Deena Zelster, MD, Office of the Clinical Director, NICHD, Bethesda, MD
Contact
Veronica Gomez-Lobo, MD, Program Director
veronica.gomez-lobo@nih.gov
Tel: 301-435-6926
Sofia Getachew, MSPM, Program Coordinator
sofia.getachew@nih.gov
Tel: 301-435-6926
Pediatric and Adolescent Gynecology Training Program
NICHD, NIH
10 Center Drive
Building 10, Room 8N248, MSC 1840
Bethesda, MD 20892-23330
