WEBVTT

NOTE duration: "00:04:16.213"


NOTE Confidence: 0.998727

00:00:04.640 --> 00:00:06.080
The endometrium are those cells

NOTE Confidence: 0.998727

00:00:06.080 --> 00:00:07.040
in the center of the

NOTE Confidence: 0.998727

00:00:07.040 --> 00:00:09.059
uterus that normally support pregnancy.

NOTE Confidence: 0.9991562

00:00:10.240 --> 00:00:12.080
They're there to receive an

NOTE Confidence: 0.9991562

00:00:12.080 --> 00:00:12.580
embryo

NOTE Confidence: 0.952652

00:00:12.960 --> 00:00:14.480
where the embryo will initially

NOTE Confidence: 0.952652

00:00:14.480 --> 00:00:15.620
grow within the uterus,

NOTE Confidence: 0.9874531

00:00:15.975 --> 00:00:17.175
And each month, they build

NOTE Confidence: 0.9874531

00:00:17.175 --> 00:00:18.215
up to a point where

NOTE Confidence: 0.9874531

00:00:18.215 --> 00:00:19.675
they can accommodate that embryo,

NOTE Confidence: 0.9874531

00:00:19.895 --> 00:00:21.015
and then they're shed with

NOTE Confidence: 0.9874531

00:00:21.015 --> 00:00:22.775
menses and regrown in every

NOTE Confidence: 0.9874531

00:00:22.775 --> 00:00:23.675
menstrual cycle.

NOTE Confidence: 0.9622611

00:00:24.375 --> 00:00:26.375
It's evolved to protect, support,

NOTE Confidence: 0.9622611

00:00:26.375 --> 00:00:27.994
and nourish that early embryo,

NOTE Confidence: 0.9997241

00:00:28.615 --> 00:00:30.135
so it is the basis

NOTE Confidence: 0.9997241

00:00:30.135 --> 00:00:30.955
for all pregnancy.

NOTE Confidence: 0.96472305

00:00:34.909 --> 00:00:36.590
Asherman syndrome is a condition

NOTE Confidence: 0.96472305

00:00:36.590 --> 00:00:37.950
where that lining of the

NOTE Confidence: 0.96472305

00:00:37.950 --> 00:00:40.030
uterus is scarred or very

NOTE Confidence: 0.96472305

00:00:40.030 --> 00:00:41.390
thin and won't grow to

NOTE Confidence: 0.96472305

00:00:41.390 --> 00:00:43.070
that nice lush environment that

NOTE Confidence: 0.96472305

00:00:43.070 --> 00:00:44.210
supports an embryo.

NOTE Confidence: 0.9824419

00:00:45.114 --> 00:00:46.315
The most common time to

NOTE Confidence: 0.9824419

00:00:46.315 --> 00:00:47.434
see it is after a

NOTE Confidence: 0.9824419

00:00:47.434 --> 00:00:48.954
pregnancy. The hormone levels are

NOTE Confidence: 0.9824419

00:00:48.954 --> 00:00:49.854
down from pregnancy,

NOTE Confidence: 0.9857478

00:00:50.234 --> 00:00:51.515
and maybe somebody has some

NOTE Confidence: 0.9857478

00:00:51.515 --> 00:00:52.734
bleeding after pregnancy.

NOTE Confidence: 0.99806935

00:00:53.754 --> 00:00:55.675
Some sort of inflammation or

NOTE Confidence: 0.99806935

00:00:55.675 --> 00:00:56.894
insult to the endometrium

NOTE Confidence: 0.9612117

00:00:57.195 --> 00:00:58.394
causes it to scar, and

NOTE Confidence: 0.9612117

00:00:58.394 --> 00:00:59.620
the walls of the uterus

NOTE Confidence: 0.9612117

00:00:59.620 --> 00:01:01.060
may even attach to one

NOTE Confidence: 0.9612117

00:01:01.060 --> 00:01:03.700
another that prevents that uterine

NOTE Confidence: 0.9612117

00:01:03.700 --> 00:01:05.720
lining, that endometrium from growing.

NOTE Confidence: 0.9746685

00:01:06.740 --> 00:01:08.660
The first sign that somebody

NOTE Confidence: 0.9746685

00:01:08.660 --> 00:01:10.180
may have Asherman syndrome is

NOTE Confidence: 0.9746685

00:01:10.180 --> 00:01:11.800
often that their period becomes

NOTE Confidence: 0.9746685

00:01:12.100 --> 00:01:14.145
either absent or very light.

NOTE Confidence: 0.9746685

00:01:14.145 --> 00:01:16.625
There's less endometrial lining, or

NOTE Confidence: 0.9746685

00:01:16.625 --> 00:01:17.825
sometimes it may be more

NOTE Confidence: 0.9746685

00:01:17.825 --> 00:01:19.105
subtle. They may continue to

NOTE Confidence: 0.9746685

00:01:19.105 --> 00:01:20.385
get bleeding at the time

NOTE Confidence: 0.9746685

00:01:20.385 --> 00:01:21.825
of their period, but the

NOTE Confidence: 0.9746685

00:01:21.825 --> 00:01:23.105
lining may just not be

NOTE Confidence: 0.9746685

00:01:23.105 --> 00:01:24.865
thick enough or appropriate enough

NOTE Confidence: 0.9746685

00:01:24.865 --> 00:01:26.145
to support a pregnancy. So

NOTE Confidence: 0.9746685

00:01:26.145 --> 00:01:27.285
we may have infertility

NOTE Confidence: 0.9145492

00:01:27.910 --> 00:01:29.430
as the first sign, or

NOTE Confidence: 0.9145492

00:01:29.430 --> 00:01:31.610
unfortunately miscarriage may be another,

NOTE Confidence: 0.9312148

00:01:31.990 --> 00:01:33.610
sign of an Asherman syndrome.

NOTE Confidence: 0.9736472

00:01:34.069 --> 00:01:35.910
And this is, just such

NOTE Confidence: 0.9736472

00:01:35.910 --> 00:01:36.890
a heart wrenching,

NOTE Confidence: 0.98991555

00:01:37.670 --> 00:01:39.190
condition when somebody can't get

NOTE Confidence: 0.98991555

00:01:39.190 --> 00:01:39.690
pregnant

NOTE Confidence: 0.94630367

00:01:40.150 --> 00:01:41.290
or is having

NOTE Confidence: 0.9321837

00:01:41.685 --> 00:01:43.625
miscarriages, often recurrent miscarriages,

NOTE Confidence: 0.9990768

00:01:44.165 --> 00:01:45.365
it's so important to be

NOTE Confidence: 0.9990768

00:01:45.365 --> 00:01:46.744
able to offer them some

NOTE Confidence: 0.9990768

00:01:46.805 --> 00:01:47.945
treatment and hope.

NOTE Confidence: 0.97639585

00:01:53.045 --> 00:01:54.564
The mainstay of treatments right

NOTE Confidence: 0.97639585

00:01:54.564 --> 00:01:55.545
now are surgical,

NOTE Confidence: 0.99069995

00:01:56.270 --> 00:01:57.310
and we have a clinical

NOTE Confidence: 0.99069995

00:01:57.310 --> 00:01:58.509
trial going on, the only

NOTE Confidence: 0.99069995

00:01:58.509 --> 00:01:59.869
one in the country that

NOTE Confidence: 0.99069995

00:01:59.869 --> 00:02:01.950
can potentially help patients when

NOTE Confidence: 0.99069995

00:02:01.950 --> 00:02:03.570
surgery hasn't been successful.

NOTE Confidence: 0.9592116

00:02:04.590 --> 00:02:06.110
To repair the Aschterman syndrome,

NOTE Confidence: 0.9592116

00:02:06.110 --> 00:02:07.229
of course, we wanna open

NOTE Confidence: 0.9592116

00:02:07.229 --> 00:02:08.989
up the uterine cavity, so

NOTE Confidence: 0.9592116

00:02:08.989 --> 00:02:10.034
we wanna take care of

NOTE Confidence: 0.9592116

00:02:10.034 --> 00:02:11.234
that scar tissue that may

NOTE Confidence: 0.9592116

00:02:11.234 --> 00:02:12.375
be holding it together.

NOTE Confidence: 0.9960554

00:02:12.754 --> 00:02:14.915
So this procedure involves a

NOTE Confidence: 0.9960554

00:02:14.915 --> 00:02:15.415
hysteroscopy

NOTE Confidence: 0.8574226

00:02:15.715 --> 00:02:16.594
where we're gonna go in

NOTE Confidence: 0.8574226

00:02:16.594 --> 00:02:17.954
with a little telescope, and

NOTE Confidence: 0.8574226

00:02:17.954 --> 00:02:18.454
we

NOTE Confidence: 0.98833185

00:02:19.234 --> 00:02:21.814
cut apart those scarring adhesions

NOTE Confidence: 0.98833185

00:02:21.875 --> 00:02:23.234
that hold the uterine cavity

NOTE Confidence: 0.98833185

00:02:23.234 --> 00:02:24.754
closed to remove the scar

NOTE Confidence: 0.98833185

00:02:24.754 --> 00:02:25.254
tissue.

NOTE Confidence: 0.99829775

00:02:25.690 --> 00:02:27.450
Just before the surgical procedure,

NOTE Confidence: 0.99829775

00:02:27.450 --> 00:02:28.190
we also

NOTE Confidence: 0.9987694

00:02:28.490 --> 00:02:29.370
give a shot of a

NOTE Confidence: 0.9987694

00:02:29.370 --> 00:02:30.750
medication that mobilizes

NOTE Confidence: 0.99931526

00:02:31.050 --> 00:02:31.790
stem cells.

NOTE Confidence: 0.9919552

00:02:33.130 --> 00:02:34.169
One of the ways which

NOTE Confidence: 0.9919552

00:02:34.169 --> 00:02:36.090
this uterine lining heals when

NOTE Confidence: 0.9919552

00:02:36.090 --> 00:02:38.169
it's severely damaged is by

NOTE Confidence: 0.9919552

00:02:38.169 --> 00:02:40.250
recruiting stem cells from other

NOTE Confidence: 0.9919552

00:02:40.250 --> 00:02:41.389
areas of the body.

NOTE Confidence: 0.99419385

00:02:41.985 --> 00:02:43.185
So stem cells are these

NOTE Confidence: 0.99419385

00:02:43.185 --> 00:02:43.685
undifferentiated

NOTE Confidence: 0.98900574

00:02:44.065 --> 00:02:45.665
cells that can travel to

NOTE Confidence: 0.98900574

00:02:45.665 --> 00:02:47.105
an organ and help repair

NOTE Confidence: 0.98900574

00:02:47.105 --> 00:02:48.245
and heal that organ.

NOTE Confidence: 0.99517226

00:02:50.145 --> 00:02:51.825
There aren't usually enough stem

NOTE Confidence: 0.99517226

00:02:51.825 --> 00:02:52.885
cells in the circulation

NOTE Confidence: 0.99977815

00:02:53.840 --> 00:02:54.500
to overcome

NOTE Confidence: 0.9887914

00:02:54.960 --> 00:02:56.400
a large injury to the

NOTE Confidence: 0.9887914

00:02:56.400 --> 00:02:56.900
uterus.

NOTE Confidence: 0.99696016

00:02:57.280 --> 00:02:59.120
So by simply administering a

NOTE Confidence: 0.99696016

00:02:59.120 --> 00:03:01.680
drug that mobilizes one's own

NOTE Confidence: 0.99696016

00:03:01.680 --> 00:03:02.500
stem cells

NOTE Confidence: 0.9668572

00:03:02.800 --> 00:03:04.160
into their blood, at the

NOTE Confidence: 0.9668572

00:03:04.160 --> 00:03:05.440
time we're doing a procedure

NOTE Confidence: 0.9668572

00:03:05.440 --> 00:03:07.540
to the uterus, they'll naturally

NOTE Confidence: 0.9668572

00:03:07.680 --> 00:03:10.014
home towards that area to

NOTE Confidence: 0.9668572

00:03:10.014 --> 00:03:11.775
help repair it and, allow

NOTE Confidence: 0.9668572

00:03:11.775 --> 00:03:13.794
that endometrial lining to grow.

NOTE Confidence: 0.97658706

00:03:18.655 --> 00:03:20.755
We have a really comprehensive

NOTE Confidence: 0.97658706

00:03:20.975 --> 00:03:22.720
approach to patients with infertility.

NOTE Confidence: 0.97658706

00:03:22.780 --> 00:03:23.660
Not only do we have

NOTE Confidence: 0.97658706

00:03:23.660 --> 00:03:25.340
a great IVF program, but

NOTE Confidence: 0.97658706

00:03:25.340 --> 00:03:26.959
we have people involved

NOTE Confidence: 0.99488145

00:03:27.739 --> 00:03:29.599
in research and clinical care

NOTE Confidence: 0.95813125

00:03:30.060 --> 00:03:31.980
covering the spectrum of special

NOTE Confidence: 0.95813125

00:03:31.980 --> 00:03:33.919
conditions that often lead to

NOTE Confidence: 0.95813125

00:03:33.980 --> 00:03:34.480
infertility.

NOTE Confidence: 0.940279

00:03:35.145 --> 00:03:36.605
We have within our infertility

NOTE Confidence: 0.9428479

00:03:36.905 --> 00:03:39.084
program people with surgical expertise

NOTE Confidence: 0.951438

00:03:39.465 --> 00:03:40.745
in treating this, which aren't

NOTE Confidence: 0.951438

00:03:40.745 --> 00:03:42.584
always coupled, that surgical expertise

NOTE Confidence: 0.951438

00:03:42.584 --> 00:03:44.285
within an infertility center.

NOTE Confidence: 0.9498535

00:03:44.985 --> 00:03:46.905
Plus, we have some active

NOTE Confidence: 0.9498535

00:03:46.905 --> 00:03:48.825
ongoing research to try and

NOTE Confidence: 0.9498535

00:03:48.825 --> 00:03:50.444
understand Asherman syndrome.

NOTE Confidence: 0.993387

00:03:51.700 --> 00:03:52.680
Twenty years ago,

NOTE Confidence: 0.9653689

00:03:53.060 --> 00:03:54.340
we here at Yale first

NOTE Confidence: 0.9653689

00:03:54.340 --> 00:03:55.780
describe the role of stem

NOTE Confidence: 0.9653689

00:03:55.780 --> 00:03:57.300
cells in the uterus, and

NOTE Confidence: 0.9653689

00:03:57.300 --> 00:03:58.580
it's so nice now twenty

NOTE Confidence: 0.9653689

00:03:58.580 --> 00:04:00.100
years later to finally bring

NOTE Confidence: 0.9653689

00:04:00.100 --> 00:04:01.300
this to the patient that

NOTE Confidence: 0.9653689

00:04:01.300 --> 00:04:03.620
that basic science discovery we

NOTE Confidence: 0.9653689

00:04:03.620 --> 00:04:04.600
made in the laboratory

NOTE Confidence: 0.9657168

00:04:04.975 --> 00:04:06.015
has come all the way

NOTE Confidence: 0.9657168

00:04:06.015 --> 00:04:08.015
to a actual practical approach

NOTE Confidence: 0.9657168

00:04:08.015 --> 00:04:09.295
where we're helping people because

NOTE Confidence: 0.9657168

00:04:09.295 --> 00:04:10.195
of that discovery.