NICHD Pediatric and Adolescent Gynecology Training Program
- Veronica Gomez-Lobo, MD, Program Director
- Jacqueline Maher, MD, Staff Clinician
- Raghuveer Kavarthapu, PhD, Staff Scientist
- Kirsten Das, MD, Clinical Fellow
- Rama Kastury, DO, Clinical Fellow
- Courtney Mascoe, MD, Clinical Fellow
- Sreeramya Balasubramanian, BS, Intramural Research Training Award Fellow
- Elizabeth Varghese, MD Candidate, Medical Research Scholar Program
- Taylor Badger, MD Candidate, Special Volunteer
- 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 Fellowship in Pediatric and Adolescent Gynecology (PAG) is a two-year fellowship program comprising faculty from The National Institute of Child Health and Human Development (NICHD) and Children's National Hospital (CNH). The fellowship is housed within NICHD at NIH, and the care of patients will take place at NIH and CNH.
The goal of this fellowship is to train graduates of an ACGME–accredited Obstetrics and Gynecology Residency in the gynecologic care of patients between birth and age 21. The fellow will learn the diagnosis and management of common problems in pediatric gynecology, as well as uncommon and more complex conditions, such as congenital reproductive anomalies and anorectal malformations, variations in sex characteristics (VSC), pediatric and adolescent pelvic masses and gynecologic malignancies, gynecologic disorders in medically complicated children, reproductive endocrinopathies, fertility preservation, sexual abuse, and vulvar conditions. In addition, fellows will receive training in and support for research development. Our goal is that graduates will pursue careers that advance the field of pediatric and adolescent gynecology in all areas, including research, education, and patient care.
Our fellows will interact with fellows in reproductive endocrinology, infertility, and pediatric endocrinology within NICHD, as well as with pediatric surgery, pediatric urology, and adolescent medicine fellows at CNH. Opportunities for collaboration with Women and Infant services fellows at MedStar Washington Hospital Center are also available. Such interaction nurtures a rich academic environment, which promotes excellence in clinical care, education, and research. Furthermore, our location in the Nation's capital allows fellows to become involved in advocacy through the American College of Obstetrics and Gynecology (ACOG).
The fellowship will entail 70% clinical work and 30% research, with rotational blocks dedicated to a fellow's research time. During clinical time at CNH, fellows will participate in general pediatric gynecology clinics, as well as in a variety of specialty clinics staffed by the PAG team. Multidisciplinary clinics are for the care of patients with fertility preservation, menorrhagia, VSC, Turner syndrome, anorectal malformations, gender development concerns, vulvar conditions, and complex endocrinology conditions. In addition, fellows will have opportunities to rotate with providers specializing in eating disorders and child abuse. At the NIH, fellows will participate in the consult service and assist in the gynecologic care and research for studies in McCune-Albright syndrome, congenital adrenal hyperplasia, Turner syndrome, Mullerian agenesis (MRKH), fertility preservation, and androgen insensitivity syndrome (AIS).
Research Program
The research and laboratory program includes five IRB (institutional review board)–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 and Bioinformatics Cores, and with NICHD's Section on Epigenetics.
The program includes research on fertility preservation in children, 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 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, given that 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, differences in sex development, and in 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, individuals with Turner syndrome with Y chromosome material who undergo prophylactic gonadectomy, individuals with classic galactosemia, and for adolescents with recent primary ovarian insufficiency (POI), individuals with differences in sex development, and adolescents with diminished ovarian reserve. 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 the 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, 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, the androgen-insensitivity syndrome (AIS), is a state in which the body cannot sense the male hormones in blood or tissue. Because this is a rare condition, little is known about 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 the North American Society for PAG (NASPAG) website. They are accepted in July before the anticipated start date, and interviews are typically held in August or September before the start date. The 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: https://www.cc.nih.gov/training/gme/programs/pediatric_adolescent_gynecology.html
Publications
- Mumford K, Hendricks S, Gomez-Lobo V. Should ovarian tissue cryopreservation in pediatric patients with Turner syndrome be limited to the research setting? J Pediatric Adolesc Gynecol 2023 36(6):566–568.
- Hartwick Das KJ, Hood C, Rutenberg A, Lobo VG. Pediatric and adolescent obstetric and gynecologic encounters in US emergency departments: a cross-sectional study. Ann Emerg Med 2023 81(4):396–401.
- Dwiggins M, Shimy J, Galloway LA, Hoefgen H, Patel V, Breech L, Gomez-Lobo V. Effects of ovarian tissue cryopreservation on primary ovarian insufficiency in girls undergoing bone marrow transplantation. J Pediatric Adolesc Gynecol 2023 36(2):128–133.
- 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 Pediatric Adolesc Gynecol 2022 35(5):558–561.
Collaborators
- Jeffrey Baron, MD, Division of Translational Medicine, NICHD, Bethesda, MD
- Gerard T. Berry, MD, Boston Children's Hospital, Boston, MA
- 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
- Judith L. Fridovich-Keil, PhD, Emory University, Atlanta, GA
- Catherine Gordon, MD, Office of the Clinical Director, NICHD, Bethesda, MD
- Yasmin Jayasinghe, MBBS, FRANZCOG, PhD, Royal Children's Hospital Melbourne, Parkville, Australia
- Joshua Johnson, PhD, University of Colorado Anschutz Medical Campus, Aurora, CO
- Kent Lai, PhD, University of Utah, Salt Lake City, UT
- Monica Laronda, PhD, Northwestern Medicine, Chicago, IL
- 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
- Kathleen O'Neil, MD, Penn Medicine, Philadelphia, PA
- Kyle Orwig, PhD, University of Pittsburgh, Pittsburgh, PA
- Karl Pfeifer, PhD, Section on Genomic Imprinting, NICHD, Bethesda, MD
- M. Estela Rubio-Gozalbo, MD, PhD, MosaKids Children's Hospital, Maastricht, The Netherlands
- 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
- Jack Yanovski, MD, PhD, Section on Growth and 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
