Departments

Yale’s Department of Obstetrics, Gynecology and Reproductive Sciences is dedicated to helping women at all stages of life. A global leader in women’s health, Yale is known for its innovative contributions to diagnosis and treatment, including: Developing the first fetal echocardiography Pioneering the first obstetrical ultrasound Developing the first fetal blood sampling and first fetal transfusion Offering the first chorionic villus sampling in New England Co-authoring the first U.S. study for first-trimester risk assessment Developing the first comprehensive first-trimester risk assessment program in New England Inventing fetal monitoring and many prenatal diagnostic and treatment techniques Our physicians tap into the broad expertise of our entire institution to provide compassionate, customized care for all of our patients, from adolescence through adulthood. Through eight subspecialty areas, we offer the most advanced diagnostics and therapies that harness the latest advances in technology. Recent clinical research includes a new emphasis on therapeutic vaccines in gynecologic oncology, novel treatments for endometriosis and menopause, a comprehensive patient safety program in maternal-fetal medicine, and an advanced fetal therapy program. Specialized care is offered in the following areas: Family planning Gynecologic oncology Gynecologic specialties Maternal-fetal medicine Obstetric specialties & midwifery Pediatric & adolescent gynecology Reproductive endocrinology & infertility Urogynecology & reconstructive pelvic surgery Maternal-fetal medicine service offers 24-hour on-site dedicated space for complex pregnancies and fetal care First in Connecticut to perform in-utero laser therapy in pregnancies complicated by twin-to-twin transfusion syndrome Outstanding survival outcomes for all types of gynecologic surgery, from open to robotic Pioneer in caring for patients with sexual intimacy issues after cancer surgery Fetal therapy program Midwifery and birthing center

Providing patient-centered, compassionate gynecologic care is our priority. Our diverse team of gynecologists offers consultative and treatment services for a comprehensive range of gynecologic conditions. Our clinical expertise in prevention, screening, and diagnosis of gynecologic cancers, prevention and treatment of gynecologic infections, fibroid management, management of endometriosis and pelvic pain, contraceptive services, and gynecologic care for patients with HIV are just a few examples of areas in which we are proud to be making a difference in our community. We offer state-of-the-art approaches to individualize the care of women with complex gynecologic conditions, including those that are precancerous, require minimally invasive surgery, or other advanced medical or surgical treatments. We care for patients of all ages across the entire community, including those who are underserved. We offer expertise in treating a variety of conditions including: Abnormal pap smears Abnormal uterine bleeding Chronic pelvic pain Complex surgical histories Endometriosis Fibroids Menopausal symptoms Ovarian cysts Pelvic infections Precancerous changes in the vulva, vagina, cervix (dysplasia), or uterus (hyperplasia) Sexual dysfunction Additionally, we provide the following specialty services: Minimally Invasive Gynecologic Surgery (MIGS) . We offer an array of advanced laparoscopic, robotic, vaginal, and hysteroscopic surgical techniques to manage benign and precancerous gynecologic conditions. Office-based procedures. We offer several in-office procedures including colposcopy and LEEP, contraceptive implant and IUD insertion and removal, diagnostic hysteroscopy, endometrial and vulval biopsies, and trigger point injections in a safe, comfortable, and convenient setting. Transgender care. We offer surgical consultation for women transitioning to men. Pre-invasive gynecology care. We provide multidisciplinary evaluation and management of abnormal pap tests and precancerous conditions of the uterus, cervix, vagina, and vulva using the most up-to-date practice guidelines, in collaboration with gynecologic pathologists. Chronic Pelvic Pain. We provide a comprehensive, patient-centered approach to pelvic pain. We work with a multidisciplinary team (colorectal, urology, interventional radiology, social work, physical therapy, and vascular surgery) to address pelvic pain, which often has multiple causes. We are committed to working closely with local practices, community-based health centers, and colleagues in other medical specialties to ensure coordination of timely and appropriate gynecologic care for our patients. Our multidisciplinary approach includes partnership with primary care, other surgical specialties, pathology, radiology, social work and care coordination. We are committed to serving the community and providing access to care. Our collaborative care model includes working with the Connecticut Veterans Administration Health Care System, Corn

During a woman’s lifetime, she might face a reproductive problem that requires evaluation and possible surgery. Some gynecologic conditions that may require surgery are endometriosis, ovarian cysts, fibroids, abnormal bleeding, intrauterine scarring, damaged fallopian tubes, pelvic pain or abnormal development of the reproductive tract. Minimally invasive and robotic surgery have transformed the field of surgery, radically reducing trauma and recovery. In this approach, small skin incisions (less than an inch in size) and specialized tools are used. Our program utilizes the following methods for women’s reproductive conditions requiring surgery: Hysteroscopy. A small, narrow telescope (a hysteroscope) allows for visualization of the inside of the uterine cavity without incisions. This is often performed when evaluating abnormal uterine bleeding. Laparoscopy. A small telescope inserted through small abdominal skin incisions is used to evaluate the pelvic anatomy (uterus, ovaries, fallopian tubes, etc.). The laparoscope (camera) sends live pictures to a video monitor, which allows the surgeon to see the anatomy and perform complex surgeries with minimal trauma to the patient. Robotics. Robotic surgery was approved for gynecological conditions in 2005 and has since opened up the option of minimally invasive surgery for women who otherwise would not have been eligible for vaginal surgery or traditional laparoscopic surgery. Surgeons are trained in using the daVinci Robot for select laparoscopic surgeries. “Open“ surgery, or surgery performed through traditional large incisions (similar to a cesarean section), is associated with longer hospitalizations, increased pain, increased surgical risk, and longer postoperative recovery times. With a surgery performed using a minimally invasive approach, patients are often able to go home on the day of surgery or the next morning with less postoperative pain.

Endometriosis, a common gynecological disease, affects one in 10 women in the U.S., and is diagnosed in up to half of women who experience infertility . Due to its nonspecific symptoms, endometriosis often goes undetected for years. Many individuals attribute their chronic pelvic pain to menstrual cramps rather than recognizing it as a symptom of endometriosis. Additionally, some may remain unaware of their condition due to silent symptoms. It can take up to a decade for some patients to receive a proper diagnosis. Normally, the uterine lining (endometrium) grows along the interior walls of the uterus, providing a cushioned and receptive environment for embryo implantation during pregnancy. However, in endometriosis, the endometrium grows outside the uterus, commonly on the exterior of the uterus, ovaries, fallopian tubes, bladder, intestines, or other pelvic structures. This displacement frequently leads to chronic pelvic pain and may cause secondary symptoms, such as irritability, difficulty sleeping , anxiety , depression , or low self-esteem. Over time, endometriosis induces inflammation, bleeding, and scar tissue formation within the pelvic cavity, regardless of whether the patient experiences pelvic pain. The presence of scar tissue can hinder fertility. Early diagnosis of endometriosis, before the formation of scar tissue, can help preserve fertility. A delayed diagnosis may pose challenges for conception, even with assisted reproductive procedures like in vitro fertilization (IVF) . To confirm endometriosis, clinicians biopsy a small sample of uterine tissue and examine it under a microscope for signs of the condition. For patients diagnosed with endometriosis, the news may bring emotional relief after years of pelvic pain without a clear cause. Our providers offer treatments to alleviate chronic pain and related physical and emotional symptoms, and assess whether endometriosis has contributed to infertility. Treatment options for endometriosis include medications and/or surgical procedures, such as excision surgery, to relieve pain, remove scar tissue, and improve organ function. These treatments may also prevent a recurrence. In cases of endometriosis-related infertility, clinicians may recommend IVF or other assisted reproductive therapies to enhance pregnancy chances. Many patients with endometriosis benefit from therapy alongside medical treatments. Additionally, we conduct various research projects, offering patients access to medication and testing at no cost. Throughout the infertility journey, our counselors support patients with endometriosis, explaining different assisted reproductive technologies and helping patients understand their options fully.

Urologic diseases affect more than 20 million men, women, and children in the United States. Yale Medicine Urology, named one of the nation’s best urology programs by U.S. News & World Report, cares for adults and children with conditions that affect the bladder, kidneys, pelvic floor, penis, testicles, and urinary tract. Some urologic conditions are present at birth, and others develop over time. Whether for a routine checkup or highly specialized care, our urologists and caregivers provide the most advanced treatment, grounded in research. Our urologists are leaders in the fields of female pelvic medicine and reconstructive surgery, as well as men’s health. Our oncology team has made key research breakthroughs in the treatment of metastatic bladder cancer and kidney cancer. In addition, we offer specialized care for kidney disease, incontinence, stone disease, sexual medicine, neurogenic bladder, transgender care, and reconstructive surgery after trauma. We use the most advanced technology and procedures to give our patients the best care available. Our urologists offer Artemis MRI-ultrasound fusion for prostate biopsy, advanced imaging, laparoscopic and daVinci Si robotic surgery, Holmium Laser Enucleation of the Prostate (HoLEP), as well as UroLift and GreenLight laser procedures. Our doctors and the hospitals where we provide care rank among the best in the country. In addition to providing treatment at Yale New Haven Hospital, Smilow Cancer Hospital, Yale New Haven Children’s Hospital, Greenwich Hospital, and Lawrence + Memorial Hospital, we also have offices located in communities across Connecticut. Above all, at Yale Medicine Urology, we believe in the importance of the patient-doctor relationship. It is the cornerstone of what we do—provide compassionate, quality urologic care to every patient, every day. A multidisciplinary team of urologists, specialty-trained nurses, caregivers, and support staff will take care of patients and their families. The urologist leads the care team, providing a diagnosis and treatment recommendations, as well as performing surgery, if needed, and overseeing the patient’s recovery and postsurgical care. The nurse coordinator is the patient’s advocate and care manager throughout care. Studies show that using nurse coordinators can reduce the length of hospital stays and enhance patient outcomes. Practice nurses provide the day-to-day care during clinical appointments or hospital stays. They administer medications, track vital signs, review general test results, respond to patients’ specific needs, and report to other members of the team. They are available around the clock to answer questions and to help patients through their care. The intake specialist helps to ensure patients are ready in advance of their appointment and have all forms and records completed and sent in advance. Intake specialists are experts at understanding the patient appointment and transfer process. If faced with a diagnosis o

Patients often hesitate to discuss miscarriages, or spontaneous pregnancy losses. While one miscarriage might prompt a doctor's visit, experiencing two or more losses warrants a thorough examination for underlying reproductive issues. Yale Medicine’s Recurrent Pregnancy Loss Program assembles experts from various fields to provide comprehensive and compassionate care to patients facing this condition. We utilize cutting-edge technologies for diagnosis and tailor individualized treatments to address the root cause. Recurrent pregnancy loss is defined as two or more failed pregnancies, including those confirmed via pregnancy blood test or ultrasound. Miscarriage is relatively common, affecting 15% to 20% of known pregnancies within the first 20 weeks. However, experiencing two or more consecutive losses, which affects 1%-3% of pregnancies, may indicate underlying genetic, physiological, or anatomical issues. Anatomic abnormalities in the uterus, such as fibroids , polyps, adhesions, or the presence of a septum dividing the uterine cavity, can lead to pregnancy complications. Hormonal disorders, like uncontrolled diabetes or thyroid issues , can also contribute to recurrent pregnancy loss. Additionally, chromosomal abnormalities in embryos, autoimmune conditions, infections, and lifestyle factors, such as smoking, drug use, caffeine and alcohol consumption, toxin exposure, and obesity, may play a role. Our multidisciplinary team works closely with patients to identify potential contributing factors while offering emotional support during this challenging time. Initial assessments include a thorough review of medical history, physical examinations, specialized ultrasounds, and consultations with specialists, such as reproductive endocrinologists, maternal-fetal medicine specialists, reproductive immunologists, geneticists, and pathologists. We employ advanced diagnostic techniques, including genetic testing and analysis of fetal tissue, to pinpoint underlying causes. Our team includes psychological counselors, dietitians, and experienced nurses who provide comprehensive support throughout diagnosis and treatment. At Yale Medicine, our Recurrent Pregnancy Loss Program combines compassionate care with state-of-the-art genetic analysis. Following a definitive diagnosis, we offer customized treatment options, which may include surgical interventions to address anatomical abnormalities, in vitro fertilization (IVF) , or a genetic screening of embryos. Even in cases where a specific cause cannot be identified, the outlook remains positive, with the majority of subsequent pregnancies proceeding normally. Throughout the process, we remain dedicated to understanding the root cause of difficulties and providing empathy and reassurance to patients facing recurrent pregnancy loss.

Although perimenopause and menopause represent natural stages in a woman’s life, some women may find the common symptoms of this stage burdensome to the point of affecting their quality of life. On average, women experience menopause at age 51. Approximately 1% of women experience “premature” menopause, which occurs before age 40. (Menopause is considered “early”—but not premature—when it happens after age 40 but before 45.) Some medical conditions, such as autoimmune disorders, and some treatments, such as chemotherapy, radiation therapy, and ovarian surgeries, may increase the risk of early or premature menopause. Both premature and early menopause can be particularly burdensome—not only are the physical symptoms (hot flashes, night sweats, and vaginal dryness) more severe, but the psychological distress that accompanies an early onset of menopause can be particularly stressful, especially for women who may not have met their fertility goals. Our team of clinicians is equipped to help optimize the quality of life and health of the reproductively aging population of women by addressing their symptom burden, as well as identifying and minimizing their long-term health risks (such as osteoporosis or fractures). Our team is equally responsive to the reproductive needs and goals of our patients. Our Fertility Preservation Program addresses the needs of those who require treatments that may result in ovarian compromise or early ovarian failure. Our Third-Party Reproduction Program is committed to helping women with premature and early menopause meet their fertility goals through the use of donor eggs or gestational surrogacy . Our clinicians strive to serve our perimenopausal and menopausal patients’ immediate medical needs while also anticipating and reducing the risk of health problems that may arise in the future.

We treat women with urogynecological disorders, which arise from pelvic floor dysfunction, such as urinary and bowel incontinence, pelvic organ prolapse, interstitial cystitis, and related sexual dysfunction. These symptoms are caused by damage to the muscles of the pelvic floor. Our specialists help women understand their condition, recognize their symptoms, and match them with the treatment that best suits their comfort level and lifestyle. Many people assume pelvic floor disorders only affect a small number of elderly or disabled women, or are an unavoidable consequence of aging. However, they are actually very common—one in three adult women suffer from incontinence or prolapse—and are treatable. Our patients receive care and treatment at our Pelvic Medicine and Continence Center. The center offers a wide range of treatment options, both surgical and nonsurgical. Our doctors are active researchers working to further advance understanding of pelvic floor dysfunction. One of our primary research goals is to develop minimally invasive treatment options so that our patients are the first to benefit from these advances.

We use local anesthetics in surgical procedures to block sensations of pain from such areas of the body as the arms, legs, and abdomen. Regional anesthesia is increasingly used in such surgical areas as orthopaedics, vascular, and gynecology due to the development of ultrasound-guided placement techniques, and the use of catheters for delivery of continuous local anesthesia. Our specialists are trained in ultrasound, nerve stimulation, and landmark-guided peripheral nerve blocks using both single injection and continuous catheter techniques. We offer pain management and care in two areas: an inpatient Acute Pain Service (APS) and the outpatient Center for the Assessment and Management of Pain (CAMP). Our APS specialists offer care for postsurgical pain, pain from chronic medical conditions, cancer pain, and various chronic pain syndromes in adults and children. Our CAMP team focuses on the assessment and management of a wide variety of painful conditions not related to the spine or cancer. For patients with chronic pain, we incorporate primary care, psychiatry, pain psychology, neurology, neurosurgery, and physical and occupational therapy services into our treatment. For patients in the hospital, we utilize a variety of pain relief medication approaches and delivery pathways (including oral, topical, transdermal, patient-controlled analgesia [PCA], and intravenous), as well as interventional therapies, such as regional anesthetic blocks, to optimize pain control. We also strive to incorporate alternative methods in treating pain whenever applicable, such as the use of transcutaneous electrical nerve stimulation (TENS). For outpatients, we specialize in the management of pain related to: Spinal stenosis Disk disease Radiculopathy Facet arthropathy Spondylosis, spondylolysis and spondylolisthesis Post-laminectomy syndrome Cervicogenic headaches Sacroiliac joint dysfunction Piriformis syndrome Hip dysfunction Neuropathic and myofascial pain syndromes For spine-related pain, our comprehensive and multidisciplinary approach to treatment includes a wide variety of oral, topical, and transdermal medications; TENS units; and advanced interventions carried out in our procedure suite. At this facility, which is equipped with fluoroscopy and ultrasound, we offer epidural steroid injections, sacroiliac and other joint injections, bursa injections, piriformis injections, trigger point injections, facet medial branch blocks, radiofrequency ablation procedures, peripheral nerve injections, sympathetic blocks, and spinal cord stimulation. For patients with cancer, we offer a cancer pain treatment program atSmilow Cancer Hospital. These treatments include the latest interventions, such as various types of nerve blocks using advanced image guidance and implantable drug delivery systems to treat patients with a variety of cancers at different stages in their cancer care.

The Yale Medicine Department of Anesthesiology is a national leader in its field, and is dedicated to providing the highest quality anesthesia care to both children and adults. We provide pain management care to patients before, during, and after surgery, and work in a variety of clinical and specialty areas. We care for patients undergoing a wide range of procedures, whether they are healthy or gravely ill. We are committed to providing cutting-edge, safe, and short-acting anesthetic medications to patients. Our expert care teams include certified registered nurse anesthetists (CRNAs), APRNs, PAs, RNs and technicians, and specialist physicians. In our clinical research, we focus on developing technologies to improve patient safety and reduce perioperative care costs. Our translational research efforts are particularly strong in areas of regenerative medicine and vascular engineering. Our comprehensive care includes: Consulting with surgeons, providing pain control, and monitoring life functions during surgery Ambulatory care anesthesia Anesthesia for procedures outside the operating room (catheterization, CT scan, MRI, interventional radiology, neuroradiology) Cardiac anesthesia (including assist devices) Presurgical evaluation Supervising care after surgery Comprehensive inpatient and outpatient pain management Pediatric anesthesia and pain management Regional (local) anesthesia Adult pre-admission testing facilities Pediatric pre-admission testing service 24/7 in-house obstetrics coverage, and outpatient high-risk consultations

For patients in our care during labor and delivery, we work in close collaboration with Yale’s Obstetrics, Gynecology, and Reproductive Sciences team. We also offer consultative services and management for high-risk obstetric patients. We provide different types of regional (local) anesthesia for vaginal and cesarean deliveries, tubal ligations, fetal surgeries, and EXIT procedures (for babies who have airway compression). We also have expertise in regional blockade for postoperative pain relief, and the use of ultrasound for regional analgesia and epidural placements. Along with our colleagues in maternal-fetal medicine, we provide anesthesia consultation for patients with complex medical issues such as congenital and acquired heart disease, neurological conditions, and clotting disorders. As a tertiary care center, Yale New Haven Hospital is equipped with facilities to care for patients with significant risk of peripartum hemorrhage, such as those with placenta accreta, which occurs when blood vessels and other parts of the placenta grow too deeply into the uterine wall.

Our providers are dedicated to providing anesthesia care to patients in the following subspecialty surgical areas: Pre-admission testing:We review what testing is necessary for patients prior to surgery. Our section collaborates with biomedical imaging specialists and the Department of Laboratory Medicine to reduce the costs of unnecessary tests. Ear, nose, and throat (ENT) anesthesia:We provide state-of-the-art care for our patients and perform preoperative endoscopic exams. Orthopaedic anesthesia:We routinely care for patients undergoing orthopaedic surgery, as well as elderly adults suffering from severe co-existing cardiovascular or pulmonary diseases. As an alternative to a general anesthetic, many procedures for orthopaedic patients may be better managed with regional (local) anesthesia or with combined regional/general anesthetic techniques. Our anesthesiologists are familiar with such regional anesthetic procedures as spinal, epidural, and major nerve blocks, as well as other anesthetic techniques, such as fiber optic intubation for complex airway problems and special patient positioning to avoid intraoperative nerve injury. Transplant anesthesia:Our specialized group works closely with the multispecialty transplant team to care for pediatric and adult cardiac, liver, and kidney transplant recipients.