A nonprofit group called R.I.P. Medical Debt has relieved Americans of $11 billion in hospital bills. But that did not improve their mental health or their credit scores, a study found.Over the past decade, R.I.P. Medical Debt has grown from a tiny nonprofit group that received less than $3,000 in donations to a multimillion-dollar force in health care philanthropy.It has done so with a unique and simple strategy to tackling the enormous amounts that Americans owe hospitals: buying up old bills that would otherwise be sold to collection agencies and wiping out the debt.Since 2014, R.I.P. Medical Debt estimates that it has eliminated more than $11 billion of debt with the help of major donations from philanthropists and even city governments. In January, New York City’s mayor, Eric Adams, announced plans to give the organization $18 million.But a study published by a group of economists on Monday calls into question the premise of the high-profile charity. After following 213,000 people who were in debt and randomly selecting some to work with the nonprofit group, the researchers found that debt relief did not improve the mental health or the credit scores of debtors, on average. And those whose bills had been paid were just as likely to forgo medical care as those whose bills were left unpaid.“We were disappointed,” said Ray Kluender, an assistant professor at Harvard Business School and a co-author of the study. “We don’t want to sugarcoat it.”Allison Sesso, R.I.P. Medical Debt’s executive director, said the study was at odds with what the group had regularly heard from those it had helped. “We’re hearing back from people who are thrilled,” she said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Published2 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, SABRINA KHANBy Monika PlahaBBC PanoramaA woman died when a major private healthcare provider failed to transfer her to NHS intensive care quickly enough after she became critically ill.Sabrina Khan said Spire Healthcare staff “should have known something was wrong” with her mother, Nafisa.The BBC also obtained testimony from doctors – contracted by the company to work up to 168 hours a week – who say long hours could put patients at risk.Spire Healthcare has apologised for failings in Nafisa Khan’s care.The death of Mrs Khan from east London is one of several deaths following surgery at Spire Healthcare, looked at by BBC Panorama.Spire Healthcare, which runs 39 private hospitals across the UK, is one of the biggest private hospital chains. All surgery, wherever it’s carried out, comes with some risk and things can go wrong. Spire has received three Prevention of Future Deaths reports from coroners calling for action in the past two years. In one case in Norwich, the coroner issued a warning about Spire’s continuing reliance on ambulance transfers to NHS hospitals in the event of emergencies, after three patients had died following long waits.In England alone, there are more than 6 million people on NHS waiting lists. In some cases the NHS will pay for patients to be treated in private hospitals to help reduce the backlog. Since 2021, Spire Healthcare has treated more than half a million NHS patients. Last year its profits rose by more than 30% to £126m.While most NHS hospitals have intensive care units, most private hospitals do not. BBC Panorama has found evidence that some patients treated in Spire hospitals were unaware there were no intensive care facilities. Dr Nick Woodier at the Health Services Safety Investigations Body said that “there is a risk to patient safety”, particularly where the NHS does not understand the capabilities of a particular private hospital.Following Panorama’s questions to Spire, the company has now updated its hospital websites, informing patients they may need to be transferred to the NHS for intensive care.When ambulance staff eventually arrived to take Nafisa Khan to an NHS hospital, daughter Sabrina says Spire Healthcare’s east London hospital had so few staff on duty that the cleaners let them in. After having been referred to Spire, Mrs Khan underwent a routine gallbladder operation in September 2021. She had been told it would be quicker for the NHS to pay for the procedure to be done privately.The morning after her surgery, Mrs Khan deteriorated and her condition became critical. Spire has five hospitals with critical care units, but Spire East London does not have one. Mrs Khan’s family say the ambulance to take her to an NHS hospital did not arrive until about 22:00 that night.”Why did they wait that whole Saturday while she was deteriorating, while she was vomiting, to transfer her to the NHS hospital?” said Sabrina.Mrs Khan died shortly after being taken into NHS intensive care. Spire Healthcare has admitted it failed to fully appreciate the seriousness of Mrs Khan’s deteriorating condition and has apologised.It said she should have been transferred earlier to an NHS hospital for critical care.In 2023, Spire Healthcare was warned about another death as part of a coroner’s Prevention of Future Deaths report. These are issued when someone has died and action needs to be taken to reduce the risk of further deaths occurring in the future.At another Spire Hospital, in Leeds, a woman had developed sepsis – a life-threatening reaction to an infection – after a routine hernia operation.The hospital was late in identifying the complications and the woman died. The coroner concluded her death had been avoidable and highlighted the role of the on-call doctor, known as the resident medical officer (RMO).”The RMO was called twice during the night but failed to appreciate that the deterioration in her condition necessitated an escalation to the surgeon or anaesthetist,” the coroner said.Resident medical officers, now called resident doctors, provide 24-hour cover at private hospitals. In some private hospitals, including Spire, these doctors are contracted to work up to 168 hours a week.Panorama – NHS Patients Going Private: What Are the Risks?With more than six million people in England alone waiting for an operation on the NHS, Monika Plaha investigates patient safety at one of the UK’s biggest private healthcare providers.Watch now on BBC iPlayer (UK Only)This may mean they work from 09:00 to 17:00 and then are on call until the following morning, when they work a day shift again and then repeat the pattern across a week.Since 2009, the NHS has said its doctors should not work on average more than 48 hours a week.Panorama has obtained the testimony of 28 resident medical officers who worked at Spire until 2022 and who want to remain anonymous. Almost all of them expressed concern about their workload and the potential safety implications for patients.One said: “I was working round the clock, being the only doctor at night. Feeling constantly burnt out. And this obviously is not safe for the patients, nor for me as a doctor.””I constantly had concerns about patient safety in the Spire hospital,” said another.Spire Healthcare told Panorama the wellbeing of all its staff is of “paramount importance” and said it has since updated its working practices.The company said it has “robust safeguards to ensure that resident doctors are well supported” and are “only working when adequately rested”.Spire Healthcare was previously caught up in a major medical scandal when rogue surgeon Ian Paterson – who worked mostly in the NHS as well as for Spire – was jailed in 2017 for carrying out more than 1,000 unnecessary operations on women.Then in 2018, another Spire surgeon, Michael Walsh, was suspended after dozens of patients complained about him. Spire referred Walsh to the regulator, the General Medical Council. Walsh denied any wrongdoing and later took himself off the medical register before his case was completed.After three deaths in less than a year at the Spire Norwich Hospital, a coroner raised concerns about the company relying on NHS ambulance services in the event of medical emergencies. In 2022, Geoffrey Hoad, 85, was in severe pain and needed a hip replacement. He decided to pay for surgery at Spire Norwich because of the two-year NHS waiting list.Image source, ANNE MCDOWELLThe operation appeared to go well. Mr Hoad had diabetes and coronary artery disease. Though he was a higher-risk patient, Spire says he was well enough to be treated at its hospital. Over the next couple of days his condition deteriorated.His wife, Anne McDowell, said she had “no idea at all” that the hospital did not have its own intensive care unit. An ambulance to take him just a mile down the road to the Norwich and Norfolk University Hospitals NHS Trust took 14 hours to arrive.After he was eventually transferred to the NHS, Mr Hoad suffered a heart attack. The consultant told Ms McDowell her husband would not recover.At an inquest last September, while the coroner didn’t say the delay had contributed to Mr Hoad’s death, she did issue a Prevention of Future Deaths report. She found that by continuing to rely on the NHS ambulance service, Spire had not learned the lessons from Mr Hoad’s death and two previous deaths. In 2021, two patients undergoing routine operations at Spire Norwich died after their conditions deteriorated. They also faced long ambulance delays to transfer them to the Norfolk and Norwich University Hospitals NHS Trust.East of England Ambulance service has apologised to the three families for the delayed transfers. It said response times have improved significantly since these tragic cases.Spire Healthcare said transferring patients after operations is “an extremely rare occurrence, and long delays are even rarer”.It said it continues to “work closely with the ambulance service and local NHS trusts on ways to ease delays”.The company said that “ensuring patients are safe is at the heart” of what it does, and that 98% of its hospitals are rated “good” or “outstanding”.The Department of Health and Social Care says since the Paterson Inquiry “key actions have been taken to strengthen protections for patients receiving care from independent sector providers”.More on this storyNHS to expand private sector use to tackle waitsPublished4 August 2023Use private sector more for NHS patients – LabourPublished19 May 2023Surgeon wounded hundreds amid ‘culture of denial’Published4 February 2020Surgeon facing ‘serious’ allegations quits medical registerPublished6 December 2023

Published23 hours agoShareclose panelShare pageCopy linkAbout sharingBy Paul O’HareBBC Scotland NewsMolly Cuddihy realised how ill she was when the radiographer started crying during her scan.Later that day a consultant told the then 15-year-old that she had a rare form of bone cancer.Time was critical and she had to start chemotherapy at the Royal Hospital for Children in Glasgow the following week. Molly, who was preparing for her National 5 exams, had mapped out her life and planned to study medicine.She said: “That was all taken away from me in less than a minute. Everything falls away. “There are so many parts of your life that it reaches into and affects.”It is so much more than just a cancer diagnosis.”Teenage cancer patients raise £250k to improve servicesThe friends who want to help other young cancer patientsThe maths student, who now has no active cells, is one of eight women who share their stories in a candid new podcast.Radio Therapy is aimed at young people and covers themes including mental health, body image and mortality.The six-part series, produced by Glasgow-based Go Radio, has proved cathartic for the contributors and illuminating for their loved ones.Molly, 21, told BBC Scotland News: “There’s things that I have said on the podcast that they have never heard me say before and they have lived it with me.”It is almost like letting people in on a secret.”Image source, Molly CuddihyThe student, from Gourock, Inverclyde, felt something was wrong for about six months before she was finally diagnosed with metastatic Ewing’s sarcoma on 16 January 2018.That day, the radiographer chatted and got to know her beforehand in a bid to calm her nerves.But what happened next took them both by surprise.Molly said: “The woman who was doing my scan started crying. “If that was not a tell-tale sign then I don’t know what was.”The teenager was transferred to A&E where she was given another scan and then admitted to the hospital’s Schiehallion ward, which cares for children and young people with blood-borne diseases and cancers.Molly said: “All my consultant said to me was ‘we are treating to cure it’ and that’s all I needed to know.”Mental health is one of the main themes of the podcast and Molly speaks with remarkable honesty about her own experiences.She said: “I was going through it for two years and I was fine and then I had a stem cell transplant in 2020 and I totally broke down. “I really couldn’t cope with it any more and I struggled for a long, long time.”Molly said admitting she needed help was the “hardest part” and she wished more support was available six years ago.She added: “The podcast lets people hear that they are not on their own, that this is how someone else experienced it, without actually having to leave the comfort of their room. “They can access it all on their phone in hospital.”Molly compared the experience of many cancer survivors to soldiers returning from a war zone.She added: “You don’t just expect them to be ok when it’s all finished and they are home.” The student admitted she still has trouble sleeping and often gets flashbacks to times when she wasn’t sedated.Molly said: “There was a lot of things that I was awake for that I’m constantly remembering. That’s hard to cope with.”I think I have come to terms with the fact that I had it and, to be quite blunt, I almost died from it.”It is more that I am struggling with everything I have been left with.”While undergoing chemotherapy Molly also experienced “frightening” shivers that were linked to a hospital-acquired infection.In 2021 she recalled her ordeal when she gave evidence before the Scottish Hospitals Inquiry.Although she has completed her cancer treatment, she has been left with irreparable liver damage and needs a kidney transplant.Julie Cain, Teenage Cancer Trust national lead nurse for Scotland, came up with the idea for the podcast.She said: “We forget how shocking it is to hear young people talking so openly about being given a cancer diagnosis and having to ask ‘am I going to die?'”For me what shone through is that it is completely unscripted and completely authentic.”It is a group of young people having a chat and saying ‘me too’.”The women reflect on living with disabilities, fears they may never hold down a job and “scanxiety” around check-ups.Molly said: “Living and surviving are two different things. A lot of us are not really living.”‘Body neutrality changed my perspective’ Mairi MacLean, 24, also features on the new Radio Therapy podcast.She was first diagnosed at the age of eight and is currently receiving her seventh treatment for acute lymphoblastic leukaemia.For years Mairi struggled with the “tiresome and defeating” body positivity that filled her social media feeds.But the concept of “body neutrality” changed her perspective. She explained: “To be at peace with your body, not consuming energy in loving or hating it. “It is a vessel that is trying hard to survive each day, whether you have an illness or not, and that is truly remarkable. “My body will fluctuate and change over and over again but I am at peace with that because I admire the strength and perseverance of it.”The podcast also deals with the side-effects of gruelling treatment, including hair loss and dramatic weight changes.It was funded by Every Thank You Counts, a charity set up by Molly and her friend, Sara Millar, in 2019.Since then, it has raised more than £300,000 for a new pre-teen common room in the Schiehallion ward and ongoing improvements, such as new loungers.Each episode features three women talking frankly about their experiences.Dana Maitles reveals her father kept a detailed journal of all the positive things she said after she was diagnosed with blood cancer on her 18th birthday.When Dana, now 20, was struggling he read back her own words in a bid to lift her spirits.Molly said people often find it difficult to talk to cancer patients or say the wrong thing.She added: “A lot of people asked me if I was going to die? You don’t want to hear that. Or say ‘my gran died of cancer’.”Another challenge is being asked incredibly personal questions, on issues such as fertility.Molly said: “People forget you are a person and you very much become the illness, especially when you are young.”The podcast highlights the need for patients to “be selfish” when it comes to talking about their condition.And Molly said a simple statement from well-wishers, such as “I am thinking of you” or “I am here”, goes a long way.She added: “Sometimes it’s all you want and that is such a comforting and amazing message to read.”Last month the Princess of Wales announced in a video message that she is undergoing cancer treatment.Molly described the news as “sad and horrible” but believes her words will help others.She said: “You can say to a wee girl who is going through treatment ‘you can be like Princess Kate’.”She is doing something very powerful by telling her story.”

A private-equity-backed firm has helped drive down payments to medical providers, drive up patients’ bills and earn billions for insurers.Large health insurers are working with a little-known data company to boost their profits, often at the expense of patients and doctors, a New York Times investigation found. A private-equity-backed firm called MultiPlan has helped drive down payments to medical providers and drive up patients’ bills, while earning billions of dollars in fees for itself and insurers.To investigate this largely hidden facet of the health care industry, The Times interviewed more than 100 patients, doctors, billing specialists, health plan advisers and former MultiPlan employees, and reviewed more than 50,000 pages of documents, including confidential records made public by two federal judges after petitions from The Times.Here are five takeaways.The smaller the payout to doctors, the bigger the fees for insurers and MultiPlanWhen patients see medical providers outside their plans’ networks, UnitedHealthcare, Cigna, Aetna and other insurers often send the bills to MultiPlan to recommend a payment amount.MultiPlan and the insurers have a powerful incentive to keep the payments low because their fees get bigger as the payments get smaller.Here’s how it works.The most common way Americans get health coverage is through an employer that pays for workers’ medical care itself and uses an insurance company to administer the plan. Providers in the plan’s network have agreed-upon rates, but out-of-network providers often must negotiate payments.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.Weeks after undergoing heart surgery, Gail Lawson found herself back in an operating room. Her incision wasn’t healing, and an infection was spreading.At a hospital in Ridgewood, N.J., Dr. Sidney Rabinowitz performed a complex, hourslong procedure to repair tissue and close the wound. While recuperating, Ms. Lawson phoned the doctor’s office in a panic. He returned the call himself and squeezed her in for an appointment the next day.“He was just so good with me, so patient, so kind,” she said.But the doctor was not in her insurance plan’s network of providers, leaving his bill open to negotiation by her insurer. Once back on her feet, Ms. Lawson received a letter from the insurer, UnitedHealthcare, advising that Dr. Rabinowitz would be paid $5,449.27 — a small fraction of what he had billed the insurance company. That left Ms. Lawson with a bill of more than $100,000.“I’m thinking to myself, ‘But this is why I had insurance,’” said Ms. Lawson, who is fighting UnitedHealthcare over the balance. “They take out, what, $300 or $400 a month? Well, why aren’t you people paying these bills?”Gail Lawson faced more than $100,000 in bills after a complex surgery. Her insurance paid out $5,449.27.Bryan Anselm for The New York Times

As medical practices owned by private equity firms fuel overbilling, a payment tool also backed by such investors helps insurers boost their profits.Insurance companies have long blamed private-equity-owned hospitals and physician groups for exorbitant billing that drives up health care costs. But a tool backed by private equity is helping insurers make billions of dollars and shift costs to patients.The tool, Data iSight, is the premier offering of a cost-containment firm called MultiPlan that has attracted round after round of private equity investment since positioning itself as a central player in the lucrative medical payments field. Today Hellman & Friedman, the California-based private equity giant, and the Saudi Arabian government’s sovereign wealth fund are among the firm’s largest investors.The evolution of Data iSight, which recommends how much of each medical bill should be paid, is an untold chapter in the story of private equity’s influence on American health care.A New York Times investigation of insurers’ relationship with MultiPlan found that countering predatory billing is just one aspect of the collaboration. Low payments have burdened patients with unexpectedly large bills, slashed pay for doctors and other medical professionals and left employers that fund health plans with high, often unanticipated fees — all while making the country’s biggest health insurance companies a lot of money.Often, when someone gets insurance through an employer and sees a doctor outside the plan’s network, the insurer routes the bill to MultiPlan to recommend an amount to pay. Both MultiPlan and the insurer receive processing fees from the employer, usually based on the size of the final payment: the smaller the payout, the bigger the fees.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

When Diane Scheig’s father, Bill, came home from work at the Mallinckrodt factory in St. Louis, he would strip down in their garage and hand his clothes to her mother to immediately wash, not daring to contaminate the house with the residue of his labors.Mr. Scheig, an ironworker who helped build the city’s famous arch, never told their family exactly what he was doing at the plant, where scientists first began processing uranium for the Manhattan Project in 1942. But by the age of 49, he had developed kidney cancer, lost his ability to walk, and died.Decades later, Diane’s older sister Sheryle, who years earlier had given birth to a baby boy born with a softball-sized tumor in his stomach, died of brain and lung cancer at 54. Her neighbor two doors down died of appendix cancer at 49. So many of her classmates have died of cancer that a large round table covered with their pictures is now a staple of her high school reunions.“I know for myself, I was thankful when I passed the age of 49,” Ms. Scheig said. “And I was thankful when I passed the age of 54.”The Mallinckrodt plant processed the uranium that allowed scientists at the University of Chicago to produce the first man-made controlled nuclear reaction, paving the way for the first atomic bomb.But the factory — and the program it served — left another legacy: A plague of cancer, autoimmune diseases and other mysterious illnesses has ripped through generations of families like Ms. Scheig’s in St. Louis, and other communities across the country that were exposed to the materials used to power the nuclear arms race.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The New England Journal of Medicine published an article condemning its own record during World War II.A new article in the New England Journal of Medicine, one of the oldest and most esteemed publications for medical research, criticizes the journal for paying only “superficial and idiosyncratic attention” to the atrocities perpetrated in the name of medical science by the Nazis.The journal was “an outlier in its sporadic coverage of the rise of Nazi Germany,” wrote the article’s authors, Allan Brandt and Joelle Abi-Rached, both medical historians at Harvard. Often, the journal simply ignored the Nazis’ medical depredations, such as the horrific experiments conducted on twins at Auschwitz, which were based largely on Adolf Hitler’s spurious “racial science.”In contrast, two other leading science journals — Science and the Journal of the American Medical Association — covered the Nazis’ discriminatory policies throughout Hitler’s tenure, the historians noted. The New England journal did not publish an article “explicitly damning” the Nazis’ medical atrocities until 1949, four years after World War II ended.The new article, published in this week’s issue of the journal, is part of a series started last year to address racism and other forms of prejudice in the medical establishment. Another recent article described the journal’s enthusiastic coverage of eugenics throughout the 1930s and ’40s.“Learning from our past mistakes can help us going forward,” said the journal’s editor, Dr. Eric Rubin, an infectious disease expert at Harvard. “What can we do to ensure that we don’t fall into the same sorts of objectionable ideas in the future?”In the publication’s archives, Dr. Abi-Rached discovered a paper endorsing Nazi medical practices: “Recent changes in German health insurance under the Hitler government,” a 1935 treatise written by Michael Davis, an influential figure in health care, and Gertrud Kroeger, a nurse from Germany. The article praised the Nazis’ emphasis on public health, which was infused with dubious ideas about Germans’ innate superiority.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Dr. Nora Volkow, who leads the National Institutes of Drug Abuse, would like the public to know things are getting better. Mostly.Historically speaking, it’s not a bad time to be the liver of a teenager. Or the lungs.Regular use of alcohol, tobacco and drugs among high school students has been on a long downward trend.In 2023, 46 percent of seniors said that they’d had a drink in the year before being interviewed; that is a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national poll of youth substance use. A similar downward trend was observed among eighth and 10th graders, and for those three age groups when it came to cigarette smoking. In 2023, just 15 percent of seniors said that they had smoked a cigarette in their life, down from a peak of 76 percent in 1977.Illicit drug use among teens has remained low and fairly steady for the past three decades, with some notable declines during the Covid-19 pandemic.In 2023, 29 percent of high school seniors reported using marijuana in the previous year — down from 37 percent in 2017, and from a peak of 51 percent in 1979.There are some sobering caveats to the good news. One is that teen overdose deaths have sharply risen, with fentanyl-involved deaths among adolescents doubling from 2019 to 2020 and remaining at that level in the subsequent years.Dr. Nora Volkow has devoted her career to studying use of drugs and alcohol. She has been the director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss changing patterns and the reasons behind shifting drug-use trends.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A new “atlas” of the human ovary provides insights that could lead to treatments restoring ovarian hormone production and the ability to have biologically related children, according to University of Michigan engineers.
This deeper understanding of the ovary means researchers could potentially create artificial ovaries in the lab using tissues that were stored and frozen before exposure to toxic medical treatments such as chemotherapy and radiation. Currently, surgeons can implant previously frozen ovarian tissue to temporarily restore hormone and egg production. However, this does not work for long because so few follicles — the structures that produce hormones and carry eggs — survive through reimplantation, the researchers say.
The new atlas reveals the factors that enable a follicle to mature, as most follicles wither away without releasing hormones or an egg. Using new tools that can identify what genes are being expressed at a single-cell level within a tissue, the team was able to home in on ovarian follicles that carry the immature precursors of eggs, known as oocytes.
“Now that we know which genes are expressed in the oocytes, we can test whether affecting these genes could result in creating a functional follicle. This can be used to create an artificial ovary that could eventually be transplanted back into the body,” said Ariella Shikanov, U-M associate professor of biomedical engineering and corresponding author of the new study in Science Advances.
The majority of the follicles, called primordial follicles, remain dormant and are located in the outer layer of the ovary, called the cortex. A small portion of these follicles activate periodically and migrate into the ovary, to a region known as the growing pool. Only a few of those growing follicles go on to produce mature eggs that get released into the fallopian tube.
With the ability to guide follicle development and tune ovarian environment, the team believes that engineered ovarian tissue could function for much longer than unmodified implanted tissue. This means that patients would have a longer fertility window as well as a longer period in which their bodies produce hormones that help regulate the menstrual cycle and support muscular, skeletal, sexual and cardiovascular health.
“We’re not talking about utilizing a surrogate mother, or artificial insemination,” said Jun Z. Li, associate chair of U-M’s Department of Computational Medicine and Bioinformatics and co-corresponding author of the study. “The magic we’re working toward is being able to trigger an immature cell into maturity, but without knowing which molecules drive that process, we’re blind.”
U-M’s team utilized a relatively new technology, called spatial transcriptomics, to track all of the gene activity — and where it occurs — in tissue samples. They do this by reading strands of RNA, which are like notes taken from the DNA strand, revealing which genes are being read. Working with an organ procurement organization, U-M researchers performed RNA sequencing of ovaries from five human donors.

“This was the first time where we could target ovarian follicles and oocytes and perform a transcription analysis, which enables us to see which genes are active,” Shikanov said.
“The majority of ovarian follicles, already present at birth, never enter the growing pool and eventually self-destruct. This new data allows us to start building our understanding of what makes a good egg — what determines which follicle is going to grow, ovulate, be fertilized and become a baby.”
U-M’s work is part of the Human Cell Atlas project, which seeks to create “maps of all the different cells, their molecular characteristics and where they are located, to understand how the human body works and what goes wrong in disease.”
Shikanov, Li and U-M collaborators such as Sue Hammoud, U-M associate professor of human genetics and urology, are mapping other parts of the female reproductive system, including the uterus, fallopian tubes and ovaries. Other contributors include Andrea Suzanne Kuliahsa Jones, formerly of U-M and now at Duke University, and D. Ford Hannum, a U-M graduate student research assistant in bioinformatics.
The research was partially funded by the Chan Zuckerberg Initiative. Additional financial support was provided by the National Institutes of Health.