Transdisciplinary Research in Transdisciplinary Research in Reproductive MedicineReproductive Medicine

Jeff Nisker MD PhD FRCSC

Schulich School of Medicine & Dentistry University of Western Ontario

Transdisciplinary ResearchTransdisciplinary Research

“multi-” “more than one”

“trans-” “across”

shift from unidisciplinary to interdisciplinary approaches, and from individualized projects toward collaborative team (JT Klien 1996, D Stokols 1996, National Academy of Sciences 2004)

growing interest and investment in promoting interdisciplinary collaboration is reflected in several large-scale research initiatives, including the establishment of the MacArthur Foundation (RL Kahn 1993)

CIHR’s Pillars of Health ResearchCIHR’s Pillars of Health Research

1. biomedical science

2. clinical science

3. health systems and services

4. social, cultural, environmental and other aspects that effect the health of populations

Projects should consider multiple pillars

Mixed Methods ResearchMixed Methods Research

1. laboratory methods

2. clinical science methods

a) RCT

b) cohort

c) n of 1

3. social science methods

a) survey research

b) qualitative research

(i) interviews

(ii) focus groups

(iii) audience discussions

4. humanities methods

Transdisciplinary Research CubeTransdisciplinary Research Cube

biomedical science

policy re

search

soci

al s

cien

ce clinical practice

Problem of High Order Multiple Pregnancy in CanadaProblem of High Order Multiple Pregnancy in Canada

• SOGC Initiative (Barrett, Bocking et al JOGC 2000)

• CIHR Conference (2002)

““Toward Single-Embryo Transfer” – CIHR (2004)Toward Single-Embryo Transfer” – CIHR (2004)

Tom Kennedy PhD - physiologist - implantation

Gerry Kidder PhD - developmental biologist - roles of gap junctional in intercellular

communication in gametogenesis and embryogenesis

Andy Watson - physiologist, oocyte researcher - molecular control of early

embryonic development

Chris Newton PhD - psychologist - psychological impact of infertility

Jeff Nisker MD PhD FRCSC - repro endo, scientist, ethicist - ethical issues in assisted

reproduction, genetics, cancer; and health policy

Robert Casper MD FRCSC (UofT) - repro endo, scientist-clinical IVF

Sue Varmuza (UofT) - zoologist, molecular geneticist-spermatogenesis and role of

sperm in preimplantation development

Derrick Rancourt (U Calgary) - molecular biologist, stem cell researcher

Co-PIs on projectsCo-PIs on projects

 Valt Feyles, MD PhD repro endo, scientist

Steve Power MD PhD repro endo, scientist

Francis Tekpetey PhD IVF scientist

Samantha Brennan PhD philosopher/ethicist

Carolyn McLeod PhD philosopher/ethicist

Françoise Baylis PhD (Dalhousie) philosopher/ethicist

Roxanne Mykitiuk HBA LLB LLM (Osgoode Hall, York U) legal scholar/ethicist

““Towards Single-Embryo TransferTowards Single-Embryo Transfer””

Project 1:  (Casper) Lowering E2 to physiologic range during COH and pregnancy rate

Project 2: (Varmuza) Mutations in human homologues of murine spermatogenesis genes among men with idiopathic non-obstructive azoospermia and ICSI.

Project 3: (Kidder) Gap junction communication within the follicle as indicator of oocyte and embryo “quality”; and whether connexin gene mutations underlie some female infertility.

Project 4: (Rancourt) Whether implantation serine proteinase gene (ISO1/strypsin), necessary for hatching and invasion of blastocyst in the mouse endometrium could be indicator of human embryo “quality”.

Project 5: (Watson) Effects of embryo culture conditions on the p38 MAPK signaling pathway and embryonic development

Project 6: (Kennedy) Markers of endometrial receptivity in the rat and human endometrium, and effects of COH protocols on their expression

Project 7: (Newton) Factors influencing patient’s attitudes towards single embryo transfer

Project 8: (Nisker) Ethical and legal issues in ARGTs, particularly regarding single embryo transfer, hESC research, and health policy

Cross-pollination among ProjectCross-pollination among Project

1. preparing grant

2. REB approval

3. informal meeting

4. formal meetings

5. papers

Project 8 - Ethical Issues: Team MembersProject 8 - Ethical Issues: Team Members

Jeff Nisker physician, scientist MD-patient relationship, hESC research, health policy

Francoise Baylis philosopher health policy, eligibility of embryos for donation to hESC research

Carolyn McLeod philosopher reproductive rights

Samantha Brennan philosopher children’s rights

Roxanne Mykitiuk legal scholar legal issues in ARGTs and rights of disabled people.

Project 8 – Ethical Issues: Research AreasProject 8 – Ethical Issues: Research Areas

1. ethical and legal concepts of a “healthy” embryo

2. informed choice regarding fertility conservation in children with cancer

3. ethical and legal considerations of embryo “donation” a. to hESC research

b. to other patients

4. ethical and legal considerations of oocyte “donation”

5. health policy development in ARGTs

6. stem cell research

7. other ethical and legal issues of ARGTs

Project 8 – PublicationsProject 8 – Publications1.  Nisker JA, White AD “The CMA Code of Ethics and the donation of fresh embryos for stem cell

research”. CMAJ Sept. 2005;173(6):621-2. 2. Ram N. Regulating Consent to Human Embryo Research: A Critique of Health Canada’s Proposal.

Health Law Review 2005; 14(2): 19-27.3.  Baylis F. Embryological Viability. American Journal of Bioethics 2005; 5(6): 17-18.4.  McLeod C. “’Embryo Autonomy? What about the Autonomy of Infertility Patients?” American

Journal of Bioethics 5(6), 2005: 25-26. 5.  McLeod C. Letter to editor of the Hastings Center Report on Rebecca Kukla’s “Conscientious

Autonomy: Displacing Decisions in Health Care” (HCR 35(2), 2005: 34-44), HCR 35(5), 2005: 5.6.  McLeod C, Baylis F. Feminists on the Inalienability of Human Embryos Hypatia 2006; 21(1): 1-14. 7. Nisker J “Compassion as Well as Clarity”, J Obstet Gynaecol Can ” [Let] Feb 2006; 28(2): 1218. Nisker J, Baylis F, and McLeod C. “Preserving the Reproductive Capacity of Girls and Young

Adolescent Women with Cancer: Informed Choice,” Cancer, in press.9. Daniels K, Feyles V, Nisker K, et al. “Semen donation: Implications of Canada’s Assisted Human

Reproduction Act, 2004 on recipients, donors, health professionals, and institutions” J Obstet Gynaecol Can in press 2006.

10.  Ram N. Britain's New Preimplantation Tissue-Typing Policy: An Ethical Defense. Journal of Medical Ethics in press.

11.  McLeod C. “For Dignity or Money: Feminists on the Commodification of Women’s Reproductive Labour” (11,063 words), Oxford Handbook of Bioethics, in press.

12.  White A, Nisker J, Tekpetey F, Feyles V “Donation of Embryos to Stem Cell Research in Canada: A Free and Informed Choice Process”, in preparation.

13. Mykitiuk R, Nisker JA, “Lenses and ‘Healthy’ Embryos”, in preparation.

Structural and Functional Annotation of the Human Structural and Functional Annotation of the Human Genome for Disease: R Hegele and M ShierGenome for Disease: R Hegele and M Shier

Theme 5 (Nisker): Ethical, legal, and societal implications of research into monogenic-related heart disease and breast cancerSub-themes:

Roxanne Mykitiuk HBA LLB LLM legal scholar York U - conceptions of health, disease, illness, normalcy and disability

Fiona Miller PhD McMaster University - socioeconomic issues of monogenic health services

Michelle Mullen PhD University of Ottawa - Informed choice to participate in monogenic research

Jeff Nisker MD PhD FRCSC UWO - Professional and educational issues in the conduct of monogenic research

Transdisciplinary Graduate Program in Transdisciplinary Graduate Program in Health Sciences, UWOHealth Sciences, UWO

begins September 2006

MHSc and PhD in Health Science

physicians and medical students, law students and lawyers, as well traditional health science professions (nursing, rehab, PT, OT, SP) and students having completed other undergraduate degree programs