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James Segars, MD
Entry Id: TP-86

Eligibility Criteria
Qualified candidates must have completed U.S.-approved four-year residency in Obstetrics and Gynecology (PL-4) and must be eligible for board certification by the American Board of Obstetrics and Gynecology.

Overview of Program
The Combined Federal Fellowship in Reproductive Endocrinology is comprised of faculty from four government institutions: National Institute of Child Health and Human Development (NICHD), Walter Reed Army Medical Center (WRAMC), National Naval Medical Center (NNMC), and Uniformed Services University of the Health Sciences (USUHS). The Combined Federal Fellowship in Reproductive Endocrinology has the mission to train reproductive endocrinology/infertility fellows who will serve as faculty in military, government, and academic institutions in order to establish and maintain high standards of training for residents in obstetrics and gynecology and fellows in reproductive endocrinology. In addition to military residency graduates, the program accepts civilian graduates of U.S. residencies in Obstetrics and Gynecology.

The three-year training program is structured to capitalize on the particular strengths and resources of each participating federal institution. Specifically, infertility services and operative care is provided by the busy clinical service at Walter Reed Army Medical Center and the National Naval Medical Center. Experience in the Advanced Reproductive Technologies (ART) is provided by rotation in the state-of-the-art WRAMC-ART facility. Second year fellows obtain medical endocrine, pediatric endocrine, and genetic clinical training through rotation on the active inpatient services at the NIH. In addition, outstanding research training is available either though NIH intramural laboratories in the National Institute of Child Health and Human Development. The program is intended to achieve synergistic interaction between the four sponsoring institutions, and provide fellows with an experience and resources not available from a single institution. Since its inception in 1978, the Combined Federal Fellowship Program has trained over thirty fellows who have become prominent leaders in the reproductive sciences.

First Year Fellow
The first year of the fellowship is roughly divided into eight 6-week rotations alternating between the clinical reproductive endocrine service and the WRAMC ART program. While on rotation in the clinical reproductive service the first-year fellow is primarily responsible for the clinical management (with close supervision) of patients typically encountered in a reproductive endocrine/infertility clinic. This is a busy clinical service with approximately 800 new patients and 2400 return visits annually. The fellow is directly involved in all facets of patient care including the evaluation and treatment of reproductive endocrine/infertility disorders. The fellow participates as "primary surgeon" on all operative cases of the service under supervision and guidance of program faculty. In addition, fellows perform transvaginal sonography for detection of early pregnancy, controlled ovarian stimulation, and hysterosaplingography. The fellow is instructed in the current evaluation and treatment of common reproductive endocrine/infertility disorders such as anovulation, hirsutism, pituitary dysfunction, amenorrhea, recurrent abortion, contraception, and pubertal disorders. In addition, on rotation at WRAMC the first year fellow receives extensive operative training in current methods of surgical treatment of infertility including LASER and video-laparoscopy, advanced pelviscopy, diagnostic and operative hysteroscopy including resectoscope techniques, microsurgical methods including tubal reanastomosis, and medical and surgical management of ectopic pregnancies.

During the four 6 week rotations on the ART service, the first year fellow is intimately involved in all aspects of assisted reproduction. The ART experience and training encompasses: patient selection which is performed at weekly clinical/preoperative meeting, ovarian monitoring, evaluation of sperm and laboratory values, ovum retrieval, and embryo/gamete transfer techniques, and intrauterine inseminations. During the first year, the fellow is responsible for the management of any cases requiring hospitalization for complications of infertility treatment such as ovarian hyperstimulation syndrome or pelvic inflammatory disease. Through close supervision and guidance the first year fellow is expected to become competent in the diagnosis and treatment of most, but not all, problems relating to the practice of reproductive endocrinology.

Second Year Fellow
The second year fellow will spend the first eight weeks as a fellow on the fully accredited adult and pediatric endocrine service at the NIH Clinical Center (see http://www.cc.nih.gov). During this intense eight-week experience, the fellow will be primarily responsible (under direct supervision of adult and pediatric endocrine faculty) for the evaluation and treatment of common endocrine disorders such as hyper- and hypothyroidism, premature thelarche, diabetes mellitus, and growth disorders. Furthermore, due to the truly unique environment of the NIH, the fellow will gain invaluable exposure to rare endocrine disorders such as Cushings' syndrome, McCune-Albright syndrome, precocious puberty of many etiologies, acromegaly, pituitary tumors, and varied syndromes of multiple endocrine neoplasias. It is this experience which permits the reproductive endocrine fellow to collaborate with faculty from other disciplines on the most challenging of endocrine cases and deepens the fellow's understanding of complex endocrine disorders.

Following this rotation, the second-year fellow will have the option of spending two weeks in the laboratory of Dr. Paul Driggers at USUHS, or a two-week elective laboratory experience. The objective of this two-week experience is to introduce the fellow with ongoing research particularly suited to the interests of the fellow. It is expected that the fellow will use this time to develop skills needed for future projects, in particular the fellowship thesis.

The second-year fellow then selects a laboratory within the intramural research program of the National Institute of Child Health and Human Development (see http://www.nichd.nih.gov/) for the conduct of the research thesis. During the remaining nine months of the second year, the fellow will be primarily responsible for the research thesis and the performance of basic or clinical duties related to the thesis.

Fellows are required to take two formal graduate level courses during their training which have been arranged through the fully accredited sponsoring medical school, the Uniformed Services University of the Health Sciences. These courses (course description is included as Addendum #1) are administered to graduate and medical students of the university and will be taken for a letter grade with an exam on which the fellows are expected to perform well. The required statistical course is Statistics (PY0801). As a second course, fellows may choose to take Advanced Mammalian Reproduction (PYO512) or Recent Progress in Molecular and Cellular Endocrinology (PHO508). Other choices for a second graduate level course are available, but will require prior approval in advance by the American Board of Obstetrics and Gynecology. Due to the heavy clinical demands of the first year, it is expected that the fellow will take the courses in the second or third years of the fellowship.

Third Year Fellow
The third year fellow will be primarily responsible for the completion of a research project relating to the chosen thesis. It is expected that the fellow will devote 90% of time to the completion of a thesis project that will be published in a peer-reviewed journal. Rather than simply a prolonged two-year fellowship, the program is structured to allow the fellow to focus research effort (20 months of protected time) on a particular problem in order to achieve a depth of understanding which will serve as a foundation for a future independent research program.

The only clinical responsibilities of the third year fellow will be a four week participation in the ART program at which time the senior fellow will assume "acting attending" level of responsibility for the execution of an ART cycle (see below). During the four week ART experience which will occur in the latter half of the senior year, the fellow will be expected to be familiar with all aspects of patient selection, ovarian stimulation, ovum retrieval and gamete/embryo transfer. The fellow will answer questions and deal with all problems/dilemmas faced in the performance of ART. During this experience the faculty will closely observe the fellow, but the emphasis will be on permitting the fellow to make decisions and function at an attending level. This experience represents the final step in a graduated level of responsibility, and will also assure that program graduates are up-to-date with the most recent advances in the changing field of assisted reproduction.

Diddactic Instruction
There are many opportunities for instruction, both formal and informal during the fellowship. All faculty and fellows of all years are expected to attend the weekly Pre-operative and Fellows’ conference. In addition, fellows attend weekly research conferences sponsored by the Pediatric and Reproductive Endocrinology Branch of NICHD, NIH grand rounds, and NIH Endocrine Grand Rounds. Regular attendance at a monthly Journal club is expected. Fellows regularly attend weekly ART clinical meetings.

In addition to larger groups, mentors of individual laboratories to which the fellow affiliates generally meet on a weekly basis to review research progress. Furthermore, fellows are encouraged to participate in didactic training offered at national meetings, such as the American Society for Reproductive Medicine, the Society for Gynecologic Investigation and the Society for the Study of Reproduction. Moreover, fellows are encouraged to attend specialty meetings in their chosen interest areas, such as a Keystone meeting on hormone action or a microsurgical course.

• James H. Segars, M.D., Molecular Biology of Nuclear Hormone Receptors
• Ruben Alvero, M.D., Peptide Growth Factors
• Mark Leondires, M.D., Assisted Reproduction
• Rhonda Hearns-Stokes, M.D., Endometriosis
• Lawrence M. Nelson, M.D., Autoimmune Premature Ovarian Failure
• Mark Bush, M.D., Assisted Reproduction
• Alicia Armstrong, M.D., Endometrial Growth Factors
• Paul Driggers, Ph.D., Molecular Mechanisms of Steroid Action
• John Wu, Ph.D., GnRH and Reproduction

Medical Endocrinology

• Lynnette Nieman, M.D., Progesterone Action in Reproduction, Selective Estrogen Receptor Antagnoists
• Carolyn Bondy M.D., Growth factors in reproduction

Pediatric Endocrinology

• George P. Chrousos, M.D., Physiology and Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis, Endocrinology of Pregnancy

Embryologist/Andrologist

• Lynette Scott, Ph.D., Assisted Reproduction, Zygote and embryo assessment

Adjunct Faculty

• Craig Winkel, M.D., Surgical Treatment of Endometriosis

John Frattarelli (2000)

• Frattarelli JL Leondires MP, Miller BT. Intracytoplasmic sperm injection increases embryo fragmentation without affecting clinical outcome. J Asst Reprod Genet 17:207-12, 2000
• Frattarelli, JL, Bergh PA, Sable DB, Drews MR, Sharara FI, Scott RT. Evaluation of the prognostic significance of day 3 estradiol levels in assisted reproductive technology cycles. Fertil. Steril. 74:512-517, 2000.
• Frattarelli JL, Miller BT, Lauria-Costa D, Bergh PA, Scott RT. Basal antral follicle number an dmean ovarian diameter predict cycle cancellation and ovarian responsiveness in assisted reproduction cycles. Fertil. Steril. (in press).

Rhonda Hearns-Stokes (2000)

• Hearns-Stokes, R.M., Santoro, N.F., Simon, J.A. Surgically induced endometriosis attenuates accrual of bone mineral density in growing rats. Am. J. Obstet. Gynecol. 184:331-335, 2001.
• Hearns-Stokes, R, Miller B, Scott L, Cruess D, Chakraborty P, Segars J. Pregnancy rates following embryo transfer depend upon the provider at embryo transfer. Fertil. Steril. 74:80-86, 2000
• Papageorgiou, T., Hearns-Stokes, R., Peppas, D., Segars, J.H. Clitoroplasty with preservation of neurovascular pedicles. Obstet. Gynecol. 96:821-823, 2000.
• Sutton MY, Santoro N, Hearns R. Gynecologic Health and Disease. Med Clin North Am 82:223-247, 1998.

Mark Leondires (1999)

• Zhang-Zhi Hu, Li Zhuang, Jianping Meng, Mark Leondires, and Maria L. Dufau. The human prolactin receptor gene structure and alternative promoter utilization: The generic promotoer hPIII and a novel human promoter hPn. J Clin Endocrinol Metab, (in press).
• Leondires MP, Ernst SD, Miller BT, Scott RT. Triplets: outcomes of multifetal pregnancy reduction versus expectant management for 127 IVF pregnancies. Am J Obstet Gynecol 183:454-459, 2000.
• Scott, L., Alvero, R., Leondires, M., Miller, B. The morphology of human pronuclear embryos is positively related to blastocyst development and implantation. Hum. Reprod. 15:2394-2403, 2000.
• Leondires MP, Escalpes M, Segars J, Scott RT, Miller BT. Microdose follicular phase gonadotropin-releasing hormone agonists (GnRH-a) compared with luteal phase GnRH-a for ovarian stimulation at in vitro fertilization. Fertil Steril 72:1018-23, 1999.
• Leondires MP, Segars JH, Walsh BW. Antiestrogens in the postmenopausal woman. In Menopause: Endocrinology and Management. Ed. Seifer, & Kennard, E.A., Humana Press, Totowa, NJ, pp 197-207, 1999.
• Leondires MP; Berga SL Role of GnRH drive in the pathophysiology of polycystic ovary syndrome.
• J Endocrinol Invest 1998 Jul-Aug;21(7):476-85.
• Miller BT, Leondires MP. The fallopian tube in health and disease. In: The Physiologic Basis of Gynecology and Obstetrics. Ed Seifer, Samuels, and Kniss. Williams and Wilkins, Baltimore, MD, 1998.

Bradley Miller (1996)

• Deering S, Miller BT, Kopelman J, Reed M. Recurrent leiomyomatosis peritonealis disseminata exacerbated by in vitro fertilization, A case report and review of the literature. Am. J. Obstetrics and Gynecology 182:725-726, 2000.
• Leondires MP, Ernst SD, Miller BT, Scott RT. Triplets: outcomes of multifetal pregnancy reduction versus expectant management for 127 IVF pregnancies. Am J Obstet Gynecol 183:454-459, 2000.
• Miller BT, Rubino DM, Driggers PD, Haddad B, Cisar M, Gray K, Segars JH. Expression of the brx proto-oncogene in normal ovary and in epithelial ovarian neoplasms. Am J Obstet Gynecol 187:286-295, 2000.
• Rubino D, Driggers P, Arbit D, Kemp L, Miller BT, Cosco O, Pagliai K, Gray K, Gutkind S, Segars J. Characterization of BRX, a novel protein that modulates estrogen receptor action. Oncogene 1998;16:2513-2526.
• Opsahl MS, Miller BT, Klein TA. A comparison of the diagnostic accuracy of suspiciously abnormal hysterosalpingograms with laparoscopy in the evaluation of infertility. Fertil Steril 60:444-8, 1993.
• Miller BT, Opsahl MS, Klein TA. The effect of vaginal lubricants on the in vivo sperm penetration of cervial mucus. Fertil Steril 61:1171-3, 1994.
• Miller BT, Kim TJ, Hofmann GE, Navot D, Scott RT. Low LH:FSH ratios in women with normal ovarian reserve screening are predictive of decreased pregnancy rates. Proceedings of the 10th World Congress on In vitro Fertilization and Assisted Reproduction, 343, 1997
• Miller BT, Leondires MP. The fallopian tube in health and disease. In: The Physiologic Basis of Gynecology and Obstetrics. Ed Seifer, Samuels, and Kniss. Williams and Wilkins, Baltimore, MD, 1998.

Thomas Kim (1996)

• Kim TJ, Anasti JN, Flack MR, Kimzey LM; Defensor RA; Nelson LM Routine endocrine screening for patients with karyotypically normal spontaneous premature ovarian failure. Obstet Gynecol 1997 May;89(5Pt 1):777-9.

Oluyemisi Adesanya (1995)

• Adesanya OO, Colie C. Evaulating oral contraceptive use at 6 months and at 12 months. Journal of Reproductive Medicine, in press.
• Adesanya OO, Zhou J, Bondy CA. Sex steroid regulation of IGF system gene expression and proliferation in primate myometrium. Journal of Clinical Endocrinology and Metabolism, in press.
• Samathanam CA, Adesanya OO, Zhou J, Wang J, Bondy CA. Fibroblast growth factors 1 and 2 in the primate uterus. Biol Rerod 1998 Sep;59(3):491-6.
• Weil SJ, Vendola K, Zhou J, Adesanya OO, Wang J, Okafor J, Bondy CA. Androgen receptor gene expression in the primate ovary: cellular localization, regulation, and functional correlations. J Clin Endocrinol Metab 1998 Jul;83(7):2479-85.
• Vendola KA, Zhou J, Adesanya OO, Weil SJ, Bondy CA. Androgens stimulate early stages of follicular growth in the primate ovary. J Clin Invest 1998 Jun 15;101(12):2622-9.
• Ng ST, Zhou J, Adesanya OO, Wang J, LeRoith D, Bondy CA. Growth hormone treatment induces mammary gland hyperplasia in aging primates [see comments]. Nat Med 1997 Oct;3(10):1081-2.
• Zhou J, Adesanya OO, Vatzias G, Hammond JM, Bondy CA. Selective expression of insulin-like growth factor system components during porcine ovary follicular selection. Endocrinology 1996 Nov;137(11):4893-901.
• Adesanya OO, Zhou J, Bondy CA. Celllular localization and sex steroid regulation of insulin-like growth factor binding protein messenger ribonucleic acids in the primate myometrium. J Clin Endocrinol Metab 1996 Jul;81(7):2495-501.
• Adesanya OO, Colie CF. Evaluating oral contraceptive use at 6 and 12 months. J Reprod Med 1996 Jun;41(6):431-4.
• Adesanya OO, Zhou J, Bondy CA. Sex steroid regulation of insulin-like growth factor system gene expression and proliferation in primate myometrium. J Clin Endocrinol Metab 1996 May;81(5):1967-74.

Ruben Alvero (1994)

• Spong C, Lee S, McCune S, Gibney G, Abebe D, Alvero R, Brenneman D, Hill J. Maternal regulation of embryonic growth: the role of vasoactive intestinal peptide. Endocrinol (in press).
• Schifano M, Hoshaw N, Boushka R, Alvero R. Uterine artery embolization in a hemorrhaging post-operative myomectomy patient. Obstet Gynecol Survey 54:1-3, 1999.
• Hill J, McCune S, Alvero R, Glazner G, Brenneman D. VIP regulation of embryonic growth. Ann NY Acad Sci 805:259-268,1996.
• Hill J, McCune S, Alvero R, Glazner G, Henins K, Stanziale S, Keimowitz J, Brenneman D. Maternal vasoactive intestinal peptide and the regulation of embryonic growth in the rodent. J Clin Invest 97:202-208, 1996.
• Alvero R, Kimzey L, Sebring N, Reynolds J, Loughran M, Nieman L, Olson BR Effects of fasting on neuroendocrine function and follicle development in lean women. Clin Endocrinol Metab Jan;83(1):76-80, 1998.
• Chudacoff RM, Alexander J, Alvero R, Segars JH. Tissue expansion vaginoplasty for treatment of congenital vaginal agenesis. Obstet Gynecol May;87(5Pt2):865-8, 1996.

The Reproductive Endocrinology Program is accredited by the American Board of Obstetrics and Gynecology as a subspecialty program designed to lead to subspecialty certification in Reproductive Endocrinology. Upon completion of the program, fellows may sit for the American Board of Obstetrics and Gynecology examination in Reproductive Endocrinology. Qualified candidates must have completed an accredited residency in Obstetrics and Gynecology in the United States and be board eligible in this specialty. One position is available for each year for a total of three. Selection of candidates is processed through the National Resident Matching Program. Applications are accepted 18 months before the anticipated start date and interviews are typically held approximately 12 months before the start date.

Requests for applications must be made in writing to the address below. Interested candidates must submit a recent curriculum vita, three letters of reference, and medical school transcripts. Upon receipt of these materials, the applicant will be notified regarding an interview.

James H. Segars, M.D.
National Institute of Child Health and Human Development
National Institutes of Health
Building 10, Room 9D-42
Bethesda, MD 20892

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