The Center for Endometriosis Research and Treatment (CERT) is an innovative program for women suffering from endometriosis. Dr. Agarwal is a Clinical Professor and Director of Fertility Services in the UC San Diego Department of Reproductive Medicine, as well as a Director of CERT. He agreed to take a few minutes out of his busy schedule to answer the following questions, inviting us to peer into his perspective, and ongoing work, on this disease.
As a sidenote to any of our Southern California or San Diego-based readers, you may be interested in checking out CERT’s facilities, treatment, studies, etc. Contact information will be at the end of this interview.
A little personal and professional history of Dr. Agarwal:
I grew up in England and moved to Duke University, NC in 1989 to do an Ob/Gyn residency. Thanks to my Professors, Dr. Claude Hughes and Dr. Haney, I became fascinated by Reproductive Endocrinology and Infertility (REI) and so did an REI fellowship from 1993 – 1995 at UCLA and Cedars-Sinai. In 2003 I was recruited to work at UC San Diego in La Jolla. My main clinical and research interests remain in the areas of infertility and endometriosis. A few years ago I set up the UC San Diego Center for Endometriosis Research and Treatment (CERT, www.CERT.ucsd.edu) which has provided a venue for clinical care and research. I don’t believe any of us have all the skills necessary to take care of all the needs of women with a complex disease such as endometriosis and so CERT is a unique multidisciplinary center. We have gynecologists, pain specialists, psychologists, bowel and bladder doctors, robotic surgeons, dietary specialists, acupuncture…. It’s great and highly unusual. I think I learn as much from my patients as I teach them.
What got you interested in the study, treatment, and research of Endometriosis?
During my time at UCLA and Cedars-Sinai, I happened to stumble upon and help with an endometriosis study that was being performed by Dr. Howard Judd comparing lupron to synarel. I realized that there was a lot of work to be done in the world of endometriosis and that women with endometriosis were motivated to help make a difference. This is where my interest began.
There are so many theories regarding the cause of Endometriosis. Which theories has your work led you to focus on as the cause?
When there are so many theories, you know we need better insights! The most important is Sampson’s theory of retrograde menstruation. When women have periods, some tissue goes backwards, through the fallopian tubes and into the pelvis. This happens in all women but only 5-10% develop endometriosis. The big question is what’s different about these women that develop endometriosis as compared to to those that do not develop endometriosis? To help find an answer to this question and with colleagues from UCSD bioengineering and others, we are about to study the bowel in endometriosis.
Do you feel that Endometriosis symptoms can be controlled by diet and supplements?
YES. As time goes by, I hear from more and more patients that a low carb diet has helped them. This is one of the things I have learnt from my patients. I am writing a grant application to start studying this to 1) better understand what causes endometriosis and 2) learn how to better treat endometriosis.
How do you feel about hysterectomies as a cure for Endometriosis?
It often works but I don’t like it. I try very hard to avoid surgeries in my patients. This takes more effort on their part and on my part but I think it is usually better for them than repeat surgeries.
Where do you see medical care and treatment headed for Endometriosis over the next 10-20 years?
I think we will have new treatments that have less side effects than current options. Dr. Warren Foster and I are also working on a blood test (BDNF) to diagnose endometriosis. This will prevent the need for surgery to diagnose the disease and will hopefully allow quicker and safer diagnosis. Women typically suffer for over a decade prior to being diagnosed with endometriosis, which is a tragedy. The BDNF data look really encouraging and much better than previous markers for endometriosis. My hope is that women will not need to be on long term medicines to prevent endometriosis flare ups. But rather, they will test themselves periodically with their smartphone and if the test indicates that a flare up is likely, they will start their endometriosis medicine for a short time to prevent the flare. This way, they would be on pulsed therapy when necessary rather than long term treatment, month after month and year after year!
Any words of advice for Endometriosis sufferers who may be reading this?
Get together with local and national support groups. Realize that surgery can help but that there are also other options.
What can we do to help you and the medical community?
Do what you are doing. Increase awareness and where possible support research.
Anything else you would like to add?
We can’t make a difference in isolation. So, I am extremely grateful to those that have contributed to our research and clinical endometriosis programs over the years. We have a lot of exciting new studies planned for the next year or two! I think we are going to be learning a lot about endometriosis that will make real differences to women around the globe. It’s a very exciting time.
If you would like to follow CERT’s efforts (or contact them to participate in their research), you may do so by the following
Appointments Telephone: 858-657-8745
Clinical Research Telephone: 619-940-4377
I would like to personally thank Dr. Agarwal for taking the time to thoroughly review and respond to these questions. Together, we can help spread awareness, education, and moral support. We are not alone. We are a mighty force! And, it’s because of the efforts like Dr. Agarwal’s and his team, and other medical and scientific members across this globe, that one day we will have better tests and treatment for endo…and one day a cure!