Reproductive Health/ Reproductive Medicine Research
The research conducted at the WHO centre for research and research training in Human Reproduction concerns fertility and fertility regulation, endometrial function, steroid hormones, contraception, induced abortion. It includes academic clinical studies and clinical trials supported by pharmaceutical companies or NGOs and extensive national and international collaboration.
Director of the WHO–CCR: Annette Aronsson
Research group leader:
Our research is translational but organized in three areas:
1. Clinical trials at the WHO centre.
Coordinator: Eva Broberg
The research conduced at the WHO center including the development of medical abortion, misoprostol for use in obstetrics and gynaecology and new contraceptive methods such as emergency contraception has had a major impact on women's heath in Sweden and globally.
Development of new contraceptive methods and comprehensive abortion care.
A translational approach from experimental research to clinical trials and public health implementation.
Unsafe abortion is a major contributor to maternal mortality. Therefore effective methods for contraception and safe and acceptable methods for termination of unwanted pregnancies and treatment of incomplete abortion are prerequisites for reproductive health.
Medical abortion that was first invented by our research group and developed in collaboration with WHO is now increasingly used worldwide with major impact on women, their families and society. A simplified medical abortion procedure may include possibility for (i) home administration of misoprostol by the woman herself and; (ii) abortion care (including the examination and ultrasound) conducted by midwives; (Task shifting) (iii) self-assessment of the outcome of treatment (iv) medical abortion carried out by women themselves using telemedicine.
Our research has led to the use of misoprostol on several indications (incl. postpartum hemorrhage, post-abortion care and labour induction) to reduce maternal mortality.
Our research also focuses on the development of new contraceptive methods containing new compounds such as progesterone receptor modulator. In collaboration with WHO new methods for Emergency Contraception (EC) has been developed. However, the current EC Pills are only limited effective. Therefore an important part of the research programme is to develop highly effective Emergency contraceptive methods that can be used on demand and for dual protection. As well as developing and promoting long acting reversible contraception (LARCs = implants and intrauterine contraception).
Although medical abortion is increasing world-wide with major impact on society a serious limitation with mifepristone is that it is only available in about 60 countries and frequently at a high cost. Therefore, misoprostol-alone regimens (although slightly less effective than the combined method and with more side effects) are used for medical abortion where mifepristone is not available.
The implementation of misoprostol has led to reduced maternal mortality and morbidity by:
- treatment and prevention of post partum haemorrhage
- labor induction
- treatment of incomplete abortion and making legal abortion safer and more effective and illegal abortions less dangerous
Misoprostol is safe, easy to use and can be handled by nurse/midwives or women themselves. Read more at www.misoprostol.org
Eva Broberg, RNM, coordinator, research midwife
Karin Emtell Iwarsson, Research midwife
PC Ho, Foreign adjunct professor, MD, Hong Kong University
Annette Aronsson, MD, PhD, Director WHOCCR
Helena Kopp-Kallner, MD, PhD
Ingrid Sääv, MD, PhD
2. Experimental research
Coordinator: Lalit Kumar
Our focus is to explore the basics of female reproductive sciences at the molecular level to understand fertility and its associated disorders with the intention of translating the knowledge to clinical applications.
Studies on human embryo implantation in managing infertility and fertility
Using our 3D-cell culture model for human embryo implantation, we the early phases of the human embryo implantation process. Our study shows that LIF is essential for human embryo survival, leading to implantation and inhibiting LIF by its inhibitor affects human blastocyst survival by down regulation cell survival factor AKT-1 and increase of caspase-3 leading to apoptosis. This information is important in improving the outcome of infertility treatment and design new non-steroidal contraceptive agents.
Studies on endometrial receptivity – two sides of a coin: management of infertility and new strategies for fertility control.
Understanding endometrial receptivity is vital in managing infertility and regulating fertility. Endometrial receptivity in general, is driven by steroid hormone, Progesterone. We work towards identifying progesterone regulated endometrial receptivity genes in endometrium.
Understanding the aetiology of endometriosis and the role of stem cells and its correlation to cancer development
Endometriosis is a gynaecologic disorder with poorly understood aetiology, affecting 10-15% of women causing pelvic inflammation, chronic pain and infertility. The most widely accepted theory on the aetiology of endometriosis is Sampson’s retrograde menstruation. Endometrium consists of a variety of cells expressing markers relevant to attachment, adhesion, migration and stemness. Inappropriately shed endometrial cells during menstruation reach the peritoneal cavity, where they are able to adhere and establish endometriotic implants/lesions. We study the role of different endometrial cell types in the aetiology of endometriosis and its relation with ovarian cancer.
Mifepristone on uterine leiomyoma
Clinical trial conducted by our group on the effect of mifepristone on uterine leiomyoma showed a significant reduction in leiomyoma volume in a subset of patients. Our large scale gene analysis showed that the poor responders had low expression of GSTM1. This information is important in selective medical management of leiomyoma patients.
Effect of mifepristone on BRCA mutated ovarian stem cells and human breast tissue
Ovarian cancer is the fifth most common type of cancer in females and the leading cause of mortality for gynaecological malignancies. BRCA1 and BRCA2 are the most commonly mutated tumour suppressors genes in hereditary breast and ovarian cancer patients. Antiprogestin, mifepristone has been shown to have significant growth inhibition and antitumor effects, including decreased expression in cell proliferation marker KI67. We are now investigating the effect of mifepristone on ovarian stem cell kinetics.
Research Laboratory for Reproductive Health (FRH lab)
Researchers and Postdocs
Lalit Kumar, PhD, Coordinator, Researcher
Carmen María García Pascual
Karin Andersson di Claudio
Nageswara Rao Boggavarapu
Sakthi P Srinivasan
Undergraduate student / Guest researchers
Carolina von Grothusen
3. Global Reproductive Health (GRH)
Coordinator: Marie Klingberg-Allvin
The overall aim of the research group’s projects is to develop new methods and strategies to increase women’s access to reproductive health care services.
More specifically the research focus on development of safe, effective and accepted methods for contraception, abortion and task sharing/shifting related to induced abortion, contraceptives and post-abortion care. The ongoing projects increase understanding of immigrant women’s experiences of induced abortion and post abortion contraception in Sweden is further planned for. The research is in the interface of caring science, public/global health and reproductive medicine/gynaecology. In the future several new concepts and clinical applications will be the focus and integrated in order to systematically translate knowledge into practice and hence assure that health care service is evidence based as well as cost effective.
Researchers and Postdocs
Marie Klingberg-Allvin, Associate professor, coordinator
Josaphat Byamugisha, professor, Head of Dept Makere University, Uganda
Elin Larsson, PhD International Health, Post doc