Dr. Nanette SantoroDr. Nanette Santoro

Title: Professor and Chair
Primary Location: Denver

Dr. Nanette Santoro has been an active clinician and researcher in Reproductive Endocrinology since 1986. She has directed the Division of Reproductive Endocrinology at two medical schools: New Jersey Medical School and the Albert Einstein College of Medicine, both of which provided full-service care for women with reproductive problems of all kinds. At New Jersey Medical School, Dr. Santoro directed one of the nation’s first oocyte donation programs. She is the author of over 120 scientific publications and two books.

Dr. Santoro’s major research interests include the reproductive endocrinology of premature, peri-, and postmenopausal infertility, and the physiology of gonadotropin-releasing hormone secretion. She has been involved with numerous industry- and government-supported clinical trials, including the Study of Women’s Health Across the Nation (SWAN), the Kronos Early Estrogen Prevention Study (KEEPS), and the Reproductive Physiology of Ovarian Failure, and is a co-editor of the Textbook of Perimenopausal Gynecology and the upcoming textbook Amenorrhea: A Clinician’s Guide. She has also held a K24 grant, Establishment of Regular Ovulation in Normal Menarche, for the past nine years.

Education:

M.D. – Albany Medical College
Residency – Beth Israel Medical Center, New York
Fellowship – Massachusetts General Hospital, Harvard Medical School

Research:

Dr. Santoro’s laboratory has specialized in the development and measurement of urinary metabolites of reproductive hormones. In this way, field studies can be performed that allow for daily hormone assessments without the inconvenience of blood drawing. Urine sampling has been used to characterize the irregular hormone and bleeding patterns seen during puberty and across the transition into menopause. In collaboration with Dr. Lubna Pal, Dr. Santoro has recently assessed the daily urinary hormonal profiles of women in their 30s who have diminished ovarian reserve (DOR), a fertility problem in which the egg supply in the ovary is prematurely low. Such women are at risk for early menopause, but prior to their menopause they go through a variable period of time when they have somewhat regular menstrual cycles, yet a lower chance of pregnancy compared to other women their age without this condition. Dr. Pal’s study has shown that the expected change associated with natural menopause – elevated follicle stimulating hormone or FSH – is elevated in women with DOR, but other, unexpected changes in hormones were observed that are not typically seen in the normal transition into menopause. In these younger women, there was evidence that both estrogen and progesterone, as measured in the urine, were significantly lower in the women with DOR. This is an important clinical finding because such women may be at high risk for occult bone loss and may not have their bone density checked for many years.

Turning to another problem, the Santoro lab has recently been awarded a Project in the Center for Reproductive Biology’s Specialized Centers Program for Research in Reproduction (U54) Program Grant from the NIH. This project will follow up on intriguing findings from past work examining how obesity affects the reproductive axis in women. Initial studies found evidence for suppression of hypothalamic or pituitary function in obesity that is not due to known feedback mechanisms. Current studies will tease out the site of the defect and help clarify the relationship between fertility and body mass. To demonstrate the impact of BMI on fertility, Dr. Santoro worked with Dr. Alex Polotsky on a secondary data analysis of SWAN, the Study of Women’s Health Across the Nation. In this study, Dr. Polotsky asked whether or not obesity in adolescence could be linked to infertility later in life. Indeed, the data bore out the hypothesis in this study, in which 30.9 percent of women with a BMI greater than 30 kg/m2 were found to have never delivered a child. This striking effect of obesity cannot be accounted for by less exposure to sexual encounters, and was also independent of other reproductive disorders, such as polycystic ovary syndrome, that also tend to be more common in obese women.

Selected Publications:

Traub ML, Santoro N. Reproductive aging and its consequences for general health. Ann N Y Acad Sci. 2010 Aug;1204:179-87.

Harman SM, Brinton EA, Naftolin F, Merriam GR, Cedars MI, Freeman RG, Santoro N. Menopausal hormone therapy and risk for cardiovascular disease in the WHI trial. Ann Intern Med. 2010 Jul 6;153(1):60-1.

Green R, Polotsky AJ, Wildman RP, McGinn AP, Lin J, Derby C, Johnston J, Ram KT, Crandall CJ, Thurston R, Gold E, Weiss G, Santoro N. Menopausal symptoms within a Hispanic cohort: SWAN, the Study of Women’s Health Across the Nation. Climacteric. 2010 Aug;13(4):376-84.

Nejat EJ, Santoro N. Exercise and quality of life: which comes first? Menopause. 2010 Jan-Feb;17:8-9.

Kuokkanen S, Chen B, Ojalvo L, Benard L, Santoro N, Pollard JW. Genomic profiling of microRNAs and messenger RNAs reveals hormonal regulation in microRNA expression in human endometrium. Biol Reprod. 2010 Apr;82(4):791-801.

Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009 Aug;6(8):2133-42.

Traub ML, Van Arsdale A, Pal L, Jindal S, Santoro N. Endometrial thickness, Caucasian ethnicity, and age predict clinical pregnancy following fresh blastocyst embryo transfer: a retrospective cohort. Reprod Biol Endocrinol. 2009 Apr 22;7:33.

Santoro NF, Dicken CL. Hot flashes: a rose is a rose is a rose. Menopause. 2009 May-Jun;16(3):432-3.

Green R, Santoro N. Menopausal symptoms and ethnicity: the Study of Women’s Health Across the Nation. Womens Health (Lond Engl). 2009 Mar;5(2):127-33.

Pal L, Zhang K, Zeitlian G, Santoro N. Characterizing the reproductive hormone milieu in infertile women with diminished ovarian reserve. Fertil Steril. 2010 Mar 1;93(4):1074-9.