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Research in Reproductive Health/ Reproductive Medicine

Our research is based at the WHO collaborating centre for Research and Research Training in Human Reproduction.

Research group leader:

Professor/senior physician

Kristina Gemzell Danielsson

Phone: +46-(0)8-517 795 39
Organizational unit: Department of Women's and Children's Health (KBH), K6
E-mail: Kristina.Gemzell@ki.se

Research

The research is translational and organized in three subgroups/areas: experimental research, clinical trials and global reproductive health. Our main vision is to improve management and access to sexual and reproductive health in a global perspective and translate our research into clinical praxis and policy.

Kristina Gemzell Danielsson research group

1. Experimental research

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.

Examples of ongoing studies:

Studies on human embryo implantation in managing infertility and fertility

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. We also have ongoing studies on embryo quality and development, with the intention to develop objective non-invasive methods for embryo quality assessment in assisted reproduction.

Understanding the aetiology of endometriosis and the link to ovarian 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 to 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 those suffering from uterine fibroid related symptoms.

Our research wet lab is located at BioClinicum.

Sub group members

Researchers and Postdocs
Lalit Kumar, PhD, senior researcher
Omid Fridani, PhD, associate professor
Angelique Flöter-Rådestad, MD, PhD, adj senior lecturer, associate professor
Nageswara Rao Buggavarapu, PhD, post doc
PhD students
Sakthi Ponandai-Srinivasan
Suzanna Queckbörner
Carolina von Grothusen
Caroline Frisendahl
Karin Linden
Dora Pavone, exchange student

2. Clinical trials

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 labor 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 misoprostol.org

Sub group members:

WHO collaborating centre
Annette Aronsson, Director, MD, PhD
Ulrika Fundin, study coordinator, RNM
Anette Daberius, study coordinator, RNM
Karin Emtell Iwarsson, study coordinator, RNM
PC Ho, Foreign adjunct professor, Hong Kong University
Marc Bygdeman, professor emeritus
Affiliated post docs and researchers
Christian Fiala, MD, PhD
Helena Kopp Kallner, MD, PhD
Cecilia Berger, MD, PhD
Inga-Maj Andersson, MD, PhD
Ingrid Sääv, MD, PhD
Karin Andersson Di Claudio
Susanne Sjöström, MD, PhD
Kirti Iyengar, MD, PhD
Xiaoxi Sun, MD, PhD
PhD students:
Karin Emtell Iwarsson
Niklas Envall
Johanna Andersson
Karin Brandell
Isabella Bizjak
Kicki Papikonomou
Volodymyr Podolskyi
Sara Hogmark
Anna Nielsen

Visiting Address:
WHO centre, QB:84, Karolinska sjukhuset Solna,
tel: +46 8 517 721 28

3. Global Reproductive Health (GRH)

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.

The research focus on development of safe, effective and accepted methods for contraception, abortion and task sharing/shifting related to comprehensive abortion care (induced abortion, contraception and post-abortion care). The ongoing projects aim to increase the understanding of immigrant women’s experiences of induced abortion and post abortion contraception in Sweden. Women’s Access to comprehensive abortion in low resource settings and humanitarian settings is further under investigation. 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 comprehensive abortion care is evidence based as well as cost effective.

Sub group members:

Researchers and Postdocs

Visiting professor

Marie Klingberg Allvin

Organizational unit: Division of Obstetrics and Gynecology
E-mail: Marie.Klingberg-Allvin@ki.se

Josaphat Byamugisha, professor, Head of Dept Makere University, Uganda
Elin Larsson, PhD International Health, Research fellow
Kakaire Othman, MD, PhD, Post doc
Margit Endler, MD, PhD, Post doc
Rebecca Gomperts, MD, PhD
PhD students
Amanda Cleeve
Ulrika Loi Rehnström
Sarah De Masi
Ritha Bakesiima
Master Students
Maria Persson
Iona Tjoeng