From Endometriosis to Asherman’s: Ob/Gyn Chair Tackles the Toughest Cases

Like many obstetrician-gynecologists, Hugh Taylor, MD, was sold on his profession the moment he delivered his first baby.

Until then, Dr. Taylor, now chair of obstetrics, gynecology and reproductive sciences and chief of obstetrics and gynecology at Yale New Haven Hospital, had planned to focus on cancer research after he finished his medical training. But the sheer drama of childbirth—and all that must go right to make it happen—captivated him. Dr. Taylor set about finding a way to combine his love of biology with Ob/Gyn.

He started at the basic science level: by studying gene expression in fruit flies. His back-to-the-basics approach would pay off years later when his Yale lab discovered that Hox genes, which program the identity of developing organs, direct how the female reproductive system differentiates into the uterus, cervix, fallopian tubes, and vagina.

“It’s always been my philosophy that if you want to fix something, you must first understand it. Everything else is a temporary solution until we get to the bottom of it,” says Dr. Taylor, who specializes in reproductive endocrinology and infertility. “That’s what attracted me to cancer, the concept of understanding what makes cells cancerous. You can kill some cancer with chemotherapy, but you must understand the basic molecular biology and know what drives the disease in order to develop new, better and lasting treatments.”

Within Ob/Gyn, the root of many gynecologic and infertility problems stems from the uterus, including its lining, the endometrium. Dr. Taylor has long strived to understand how the endometrium, which he calls the “dynamic portion of the uterus that changes with pregnancy,” might get damaged in some women or why, as happens in endometriosis, endometrial-like tissue grows outside of the uterus.

As he got to know patients who have endometriosis, which is poorly understood and can be debilitating with symptoms including chronic pelvic pain, painful periods, pain during intercourse, and infertility, he was further motivated to connect his lab discoveries to patient care.

“Endometriosis is a fascinating, but troubling disease,” Dr. Taylor says. “It’s something that is often missed. On average, it takes women 10 years from the start of symptoms to having a diagnosis. We are trying to speed that up.”

An internationally known expert in endometriosis, and the most-cited author on it, Dr. Taylor’s work led to the current understanding that the condition can affect not just the reproductive system, but the whole body. For example, being thin, which is common in women with the condition, appears to be caused by endometriosis, rather than being a risk factor for having it—as was formerly thought.

“For women, it can be validating to learn all of their symptoms have an explanation and that we have effective treatments,” he says.

Dr. Taylor also has expertise in Asherman’s syndrome, a less well-known condition in which scar tissue forms in the uterus, leading to infertility and miscarriage. He is leading a clinical trial examining if a drug that stimulates bone marrow stem cell mobilization can treat the syndrome.

As he tackles this important research, he also balances seeing patients and his role as chair of the department, a position he has held since 2012. “When I’m not involved in patient care, the rest of my work hours are devoted to administrative work. And my laboratory staff know that I’ll come visit them in the evening before I go home,” says Dr. Taylor of his daily shuffle of duties. “It’s a juggle, to do everything and to do it well, but when you love what you do, it’s not a chore either. What else would I rather be doing?”

Dr. Taylor is a member of the National Academy of Medicine and former president of the American Society of Reproductive Medicine and the Society for Reproductive Investigation. His research has been continuously funded by the National Institutes of Health for more than 30 years. In the interview below, Dr. Taylor talks about his career and how the field of Ob/Gyn has evolved.

Since childhood, I’ve loved the natural world and being outdoors. That, combined with how I like to work with people, drove me to biological sciences and to medicine. I always knew I was going to do research and that I wanted to be a physician. At some point in college, I said, “I’m going to do both.” And I stuck to that. Luckily, being a physician-scientist is a wonderful career.

What really attracted me to Ob/Gyn is the long-term relationships you can form with patients. Plus, Ob/Gyn offers preventive medicine and primary care, but can also involve surgery. I’ve always loved that full spectrum of care and continuity with patients. I love to focus on what’s important to my patients. I love making people feel better, but I also have this desire to really understand things at a fundamental, molecular level.

I was drawn to reproductive endocrinology and infertility because of my interest in uterine development, fertility issues, and then later, endometriosis and related issues.

Yes, that is something I have championed—changing the paradigm to show that endometriosis affects multiple organ systems. People now describe endometriosis as a systemic disease. We were the first to use that term and to show that it is not just the lesions in the pelvis, but that it can also affect the heart, brain, and metabolism.

This helps us understand endometriosis better. Many women have had symptoms that were dismissed because we didn’t have that comprehensive understanding of the disease, and it is validating for them to have their diffuse symptoms all come together under a single diagnosis.

Directly as a result of our work, we now know the condition is a much bigger problem than just lesions in the pelvis. However knowing this, we can also find new ways to treat it. We aren’t focusing on surgical treatments, and we’re also moving away from hormonal treatments. Instead, we have discovered several other treatments for endometriosis that involve understanding what molecular pathways are active, and treating those.

We’ve published research that explore nonhormonal treatments including immune therapies and microRNAs, which are small RNA molecules that regulate gene expression. And our big push now is looking at the immunology of endometriosis and at how inflammation is involved. This has helped us understand why some people have a lot of pain and some don’t as well as develop new treatments.

We have a pilot clinical trial underway. It’s the only one in the country that can potentially help patients when surgery for this condition hasn’t been successful.

In Asherman’s syndrome, the lining of a woman’s uterus is scarred and very thin. The lining can’t grow into the nice, lush environment that supports an embryo.

In the general population, Asherman’s syndrome is rare. But among women who can’t get pregnant, it’s not uncommon. It’s heart-wrenching when someone can’t get pregnant or is having recurrent miscarriages because of Asherman’s. That’s why it’s so important for us to offer women treatment and new hope. And I believe we can!

Two of our faculty are doing basic research to try and understand Asherman’s and its causes. One of the ways the uterine lining heals when it gets severely damaged is by recruiting stem cells from other areas of the body. What we’ve shown in our animal models is that if we administer a drug that mobilizes one’s own stem cells from the bone marrow, and therefore more stem cells are in circulation where they can reach the uterus—the stem cells can repair the endometrium.

A generation or two ago, we didn’t talk about many gynecologic issues in public. We didn’t talk about menopause, about having periods, about things like endometriosis. And many of the gynecologic problems we weren’t discussing are very common. Endometriosis affects 10% of the population. A quarter of women in the general population have symptomatic, problematic uterine fibroids at some point in their life.

For too long, these topics were in the shadows and taboo. Thankfully, we are more open as a society now and we feel freer to talk about these things. If people don’t speak up about the issues they are having, they won’t get appropriate treatment, and it is more difficult to inspire research to make real progress in women’s health.

If your doctor's not listening it to you, find a new one. Get a second opinion, and find a specialist in whatever problem you have. Often that means going to an academic center that is studying your condition, where they have the most up-to-date information and latest technologies.