But when the former collegiate long-distance runner struggled to conceive, she didn’t expect the journey to motherhood to become a grueling marathon.

“I was in my early 30s, and we’d been trying for about two years,” said Lagat-Fischer, a nurse in Tucson, Arizona. “I started thinking that something was not right and that we needed help.”

Rather than finding help, she said she endured two years of shuttling from one specialist to another, with visits to several OB-GYNs and fertility specialists who immediately wanted to start costly in vitro fertilization (IVF).

One physician erroneously told Lagat-Fischer that she had endometriosis. Another doctor told her that she had benign uterine fibroid tumors, a more common condition among Black women that often leads to higher rates of fertility issues. She later found out that her fibroids were small and not the cause of the couple’s fertility challenges.

“It was frustrating and discouraging. My husband and I are both healthcare professionals, and we felt the care we received was all over the map. I didn’t feel like our difficulty conceiving was being fully assessed, and there was never a deeper conversation about what might be causing it in my individual case,” Lagat-Fischer said.

Her experience as a Black woman seeking fertility care is common, according to recent studies.

Difficulty conceiving among Black women and men has been understudied. But research published in Fertility & Sterility found that Black women in the U.S. are significantly less likely to seek or receive a fertility evaluation or treatment compared with white women. Despite having a higher or equivalent prevalence of infertility, Black women appear to face barriers that result in delayed care and lower utilization of services.

Lagat-Fischer also noticed that when her husband, Keith, who is white, started accompanying her to every visit, whether he was having tests or not, there was more focused attention from the specialists. When her husband asked the questions, she felt the information they were given was clearer and more direct.

“I felt like I was being heard differently when he was there,” she said. “That was very difficult for me to experience, and the emotional toll was significant. There were times I would be driving and just crying.”

The emotional toll their fertility journey was taking on his wife was very difficult for Irine’s husband.

“We struggled to conceive, which was stressful,” said Keith Fischer, a physical therapist. “Then, when we sought help, we were met with incomplete answers, a lack of attention to our needs and poor guidance from the medical experts.”

“It was hard to navigate a situation where you have a partner that is sad, frustrated and fearing she’ll never have a family. It was gut-wrenching for me,” Fischer said.

After two years of frustration and $20,000 of unsuccessful IVF attempts, a friend in Arizona suggested the couple go to Los Angeles to seek fertility care at Cedars-Sinai.

“Even though Irine had already been through IVF, I took a step back and tried to evaluate from the beginning, with a fresh perspective. Every couple deserves an individualized plan that is tailored to their specific health needs,” said Jessica Chan, MD, a reproductive endocrinologist and clinic director of the Fertility and Reproductive Medicine Center at Cedars-Sinai.

Chan said that after reviewing all of their testing, she recommended they try a less invasive option before returning to IVF. After discussing the options, the Fischers and Chan agreed upon a treatment plan.

“When we came to Cedars-Sinai, it was a completely different experience. From the moment we walked into the clinic, I felt like someone was really listening and taking the time to understand the full picture,” Lagat-Fischer said. “Two weeks after treatment, I found out I was pregnant. I honestly couldn’t believe it after everything we had been through.”

Does Chan believe racial bias can play a role in the kind of fertility evaluation and treatment a patient might receive?

“Communication and building trust between the doctor and the patient are critical in the fertility care process, as is a thorough understanding of a patient’s medical and social history,” Chan said. “But we know that implicit bias is also a significant factor that can lead to disparities in care and outcomes.”

It was a very long journey, but the couple says that their now 3-year-old twins, Lily and Liam, were well worth the difficulties they had.

“I would go through that journey again to have my children. It was all worth it,” Lagat-Fischer said. “My advice to other Black women is to advocate for yourself. Ask questions, seek thorough answers, and if you feel like you’re not being heard, get care somewhere else.”

Read more from Cedars-Sinai Stories and Insights: How Cedars-Sinai Is Working to Improve Black Maternal Health

Cedars-Sinai maternal-fetal medicine specialists have developed a postpartum blood pressure monitoring program that is receiving high marks from patients and addressing health risks faced by women during and after childbirth.

Hypertensive disorders of pregnancy, including preeclampsia, are a leading cause of serious postpartum complications and hospital readmissions. The risk of serious cardiovascular problems can persist well beyond delivery, making structured follow-up during and after the postpartum period critical.

“The postpartum period is a vulnerable time for patients with pregnancy-related hypertension, and too often it’s when care becomes fragmented,” said program leader Sonya Fabricant, MD, a maternal-fetal medicine fellow at Cedars-Sinai. “This program was designed to provide structure, continuity and support when patients return home and still need close follow-up.”

Support Begins at Home in Postpartum Hypertension Program

Nearly 500 women have enrolled in the Postpartum Hypertension Program and have received blood pressure cuffs to use at home. For two weeks, patients record blood pressure readings through a secure patient portal integrated into their electronic medical record. This allows the care team to review results in a timely manner and respond when readings require attention.

“Our program isn’t just about numbers,” Fabricant said. “It’s about making sure patients understand what their blood pressure readings mean, feel supported and know someone is paying attention and ready to intervene if needed.”

Improving Long-Term Cardiovascular Follow-Up

A central goal of the Postpartum Hypertension Program is to improve follow-up with healthcare providers who can evaluate and manage long-term cardiovascular risk.

Among patients receiving care within the Cedars-Sinai system, 72% had a physician visit within six months after giving birth, and 83% of those enrolled in the program followed up with a specialist by 12 months.

“Hypertensive disorders of pregnancy are not limited to pregnancy itself—they are an early marker of future cardiovascular risk,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai, who oversaw the creation of the monitoring initiative. “Programs like this help ensure patients stay connected to care and prioritize their own health after childbirth when mothers are more likely to focus on the newborn and their families.”

High Marks From Patients

Patient surveys consistently highlighted the program’s impact on emotional wellbeing during the postpartum transition, according to Fabricant. Participants frequently reported feeling less anxious after discharge and more confident managing their blood pressure at home.

“What we heard repeatedly from patients was how reassuring it was to know their blood pressure was being closely followed during a stressful time,” Fabricant said. “That reassurance helped many patients stay engaged in their care during early postpartum recovery.”

Read more from Cedars-Sinai Stories and Insights: A High-Risk Pregnancy Lifeline

Suze Lopez, a nurse from Bakersfield, California, was scheduled to finally have a 22-pound ovarian cyst removed; one that had been growing for years. But the results of a routine pregnancy test that was required before the surgery would give her the shock of a lifetime.

“Because of the large ovarian cyst that had been growing for years, it could have been a false positive, even ovarian cancer,” Lopez said. “And I was used to very irregular periods and some abdominal discomfort. I could not believe that after 17 years of praying, and trying, for a second child, that I was actually pregnant.”

Three days after finding out she was pregnant, the 41-year-old emergency room nurse shared the good news with her husband, Andrew, during a date night at a Dodgers baseball game in Los Angeles. But during the trip Lopez started having pain in her abdomen and they headed to Cedars-Sinai.

When they arrived at the medical center, Lopez had dangerously high blood pressure. John Ozimek, DO, medical director of Labor and Delivery, and his team got to work, stabilizing her blood pressure and ordering an MRI, blood work and an ultrasound.

Ozimek was stunned by what the diagnostic images revealed: a very rare abdominal ectopic pregnancy.

“Suze was pregnant, but her uterus was empty, and a giant benign ovarian cyst weighing over 20 pounds was taking up so much space,” Ozimek said. “We then discovered a nearly full-term baby boy in a small space in the abdomen, near the liver, with his butt resting on the uterus. A pregnancy this far outside the uterus that continues to develop is almost unheard of.”

Ozimek said that as the baby grew inside Lopez’s abdomen, behind the mass, it pushed the very large cyst forward. “It makes sense that she just thought the tumor was getting bigger again, not that she could be pregnant.”

What Is an Abdominal Ectopic Pregnancy?

In an abdominal ectopic pregnancy, the fertilized egg implants outside the uterus, often on vital organs or major blood vessels. The placenta cannot safely grow there, creating an exceptionally high risk of catastrophic maternal bleeding and fetal death. A surviving infant is extraordinarily rare and often faces severe medical complications.

“It was profound to see this full-term baby sitting behind a very large ovarian tumor, not in the uterus. In my entire career, I’ve never even heard of one making it this far into the pregnancy,” said gynecological oncologist Michael Manuel, MD, of Providence Cedars-Sinai Tarzana Medical Center, who was called in to remove the giant cyst.

“We had to figure out how to deliver the baby with a placenta and its blood vessels attached in the abdomen, remove the very large ovarian mass and do everything we could to save mom and this child,” Manuel said.

Delivering a Medical Miracle

It took a team of about 30 experts to pull off a highly coordinated, complex delivery and surgery. Maternal-fetal medicine specialists, gynecological oncologists, nurses, anesthesiologists and a host of specially trained surgical technicians filled the operating room to near capacity. 

Manuel lifted the massive dermoid cyst out of the way so Ozimek and team could quickly deliver the baby and hand him off to the Neonatal Intensive Care Unit (NICU) staff. Then they got back to work.

“As soon as the baby was delivered, Lopez started hemorrhaging badly. We were a specially trained team of obstetric anesthesiologists and well prepared, but it was still intense,” said anesthesiologist Michael Sanchez, MD. “I had already powered up a special machine that delivers blood products fast because every second matters. We used 11 units of blood.”

Cedars-Sinai is the only Level IV Maternal Care hospital in California, a designation earned for its ability to provide comprehensive care for mothers before birth, throughout labor and delivery and after childbirth.

“The ability to provide this level of highly trained, coordinated and multidisciplinary care for extremely high-risk patients can make a critical difference in the health of both mother and baby, as we saw in this extraordinary case of Suze and Ryu Lopez,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology.

The medical team was elated to see that after such a rare and dangerous pregnancy, the little boy the Lopezes named Ryu came into the world with very few health problems, a full head of hair and weighing 8 pounds.

Sara Dayanim, MD, a neonatologist with Cedars-Sinai Guerin Children’s, said a critical concern was whether his lungs had developed properly and if they would be functioning.

“We were very prepared to handle any lung problems the baby might have. But he came out of anesthesia pretty quickly and he was feisty,” Dayanim said. “The following day we were able to remove the breathing tube, and over the course of his two weeks with us, Ryu quickly reached all of the important benchmarks for surviving well. He defied all the odds.”

The Nurse Angel

Like her newborn, Lopez was feisty and focused on recovering quickly so she could spend time in the NICU with Ryu, her husband and teenage daughter, Kaila. She especially remembers Carmen Chavez, MSN, RN, assistant manager of the Maternal-Fetal Care Unit, for coming alongside her before and after the challenging delivery and surgery. Lopez still refers to as her guardian angel through it all.

“She checked on me so often,” Lopez said. “She sat in on the consults with doctors to make sure we understood everything I was facing at a difficult time. She even helped us tell my daughter about the pregnancy. I’m a nurse myself, but what Carmen did was above and beyond. It meant everything.”

Chavez said she felt Lopez deserved all the support she could get.

“This was an exceptionally high-risk case, and we had to plan every detail,” Chavez said. “It was all hands on deck for our nursing team. Knowing the complexities of Suze’s situation, knowing the challenges she and her baby were about to face, I wanted to stay close.”

Ryu’s parents believe he is the answer to years of praying for a second child. Andrew Lopez said that is why they chose “Jesse” for Ryu’s middle name; it means “gift from God.” 

“He is our gift. And Ryu and Suze are my miracles,” Lopez said. “They let me in the operating room, and it was tough to watch what she was going through, and amazing to see Ryu delivered. So yes, many prayers have been answered.”

“I appreciate every little thing. Everything. Every day is a gift and I’m never going to waste it,” Suze Lopez said. “God gave me this baby so that he could be an example to the world that God exists—that miracles, modern-day miracles, do happen.”

Read more from the Cedars-Sinai Newsroom: Cedars-Sinai Earns Highest Designation for Maternal Care

The scientific meeting brings together gynecologic experts from around the world to share the latest in complex benign gynecology and women’s health. Cedars-Sinai presentations span a range of topics including endometriosis, fibroids, pelvic pain, fertility preservation and surgical interventions that reduce bleeding and enhance recovery.

Cedars-Sinai MIGS Experts Available for Interviews

Kelly Wright, MD, director of the Division of Minimally Invasive Gynecologic Surgery and vice chair of Gynecology, is available to discuss MIGS research, innovation and gynecologic disorders. She is presenting findings about fertility-sparing treatment for a rare reproductive system disorder and sustainability in gynecologic operating rooms.

Liron Bar-El, MD, who specializes in complex gynecologic surgery and endometriosis care, can discuss methods to improve surgical team coordination in laparoscopic hysterectomy for efficiency and patient benefit. Bar-El will be honored at the meeting with an award from the Foundation of the AAGL (American Association of Gynecologic Laparoscopists) for innovative research in MIGS education and training.

Raanan Meyer, MD, director of Cedars-Sinai’s Minimally Invasive Gynecologic Surgery Research Program, is presenting a study that compared postoperative complication rates in traditional hysterectomy versus laparoscopic. Meyer will also share the results of a study that found patients with endometriosis-like pain, but no confirmed diagnosis, have a higher risk for depression than those with documented disease.

Kacey Hamilton, MD, who specializes in complex gynecologic surgery, ultrasound, and endometriosis, has done research evaluating outcomes of hysterectomy modalities. She will share a study of techniques for managing hemorrhaging during second-trimester pregnancy surgery that can be used in other gynecologic procedures.

Rebecca Schneyer, MD, has been honored for research that identified racial disparities in gynecological care. At the conference, she is available to discuss new population health research examining age-related trends in endometriosis disease severity and surgical complexity.

Camelita Thrift, MD, with the division of Minimally Invasive Gynecologic Surgery, and affiliated with the Cedars-Sinai Health Sciences University, is available to discuss her presentation on the role race and ethnicity play in endometriosis severity, delays in diagnosis and access to surgical care.

Media Contact

To arrange interviews, contact Laura Coverson at 310-562-1112 or Laura.Coverson@cshs.org.

A Level IV Maternal Care hospital, also known as a Regional Perinatal Health Care Center, provides comprehensive care before birth, throughout labor and delivery and after childbirth. The Joint Commission Maternal Levels of Care (MLC) Verification program operates in collaboration with the American College of Obstetricians and Gynecologists and recognizes the devotion to patient safety and quality of care.

Facilities with this top designation must be staffed with maternal-fetal medicine specialists and critical care physicians to deliver multidisciplinary and integrated treatment for patients with complex obstetric complications such as severe preterm preeclampsia or maternal heart disease.

Level IV medical centers also collaborate with other hospitals by providing medical education and easy access to consultations and transfers to Cedars-Sinai, if needed.  

“Access to this comprehensive level of specialty care can make a crucial difference in the health of both mother and baby and has been proven to reduce maternal morbidity,” said Sarah J. Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai and an expert in maternal-fetal medicine.

“This Level IV verification recognizes our ability to provide coordinated, multidisciplinary care involving obstetricians, maternal-fetal medicine specialists, anesthesiologists, cardiologists, neurologists and any other specialty needed to effectively care for these extremely high-risk patients,” Kilpatrick said.

Approximately 3.6 million babies are born each year in the United States, including about 6,000 at Cedars-Sinai, one of the busiest labor and delivery hospitals in California.

The only other hospital in California to be formally verified for any level of maternal care by The Joint Commission is Torrance Memorial Medical Center, an affiliate of Cedars-Sinai. In 2023, Torrance Memorial received verification as a Level III Maternal Care facility.

“The Joint Commission commends Cedars-Sinai for being named a Level IV Maternal Care verified facility and for its efforts to standardize maternal care and reduce maternal morbidity and mortality,” said Ken Grubbs, DNP, MBA, RN, executive vice president of Accreditation and Certification Operations and chief nursing officer at The Joint Commission.

Hospitals receive Level IV designation following an on-site evaluation and a thorough review of their maternal care services as well as other medical specialties.

“The Level IV verification affirms not only the advanced capabilities of our institution but also the unwavering dedication of our maternal care team—especially our extraordinary nurses, who bring a rare combination of clinical expertise, compassion and readiness to respond to even the most complex maternal-fetal challenges,” said David Marshall, JD, DNP, RN, Cedars-Sinai senior vice president, chief nursing executive and chair of the Department of Nursing.

The Maternal Levels of Care Verification program will also help strengthen awareness of a regionalized approach to care for mothers where needed.

“This prestigious recognition reflects the outstanding professionalism of our multidisciplinary clinical teams who care for these vulnerable patients. The comprehensive management of the highest level of obstetric care is a hallmark of Cedars-Sinai’s service to our community,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences, dean of the Medical Faculty and the Helene A. and Philip E. Hixon Distinguished Chair in Investigative Medicine.

When pregnant patients receive the right level of care for their unique needs, it leads to safer births and healthier moms and babies.

“Importantly, most women in the U.S. appropriately give birth at Level I and Level II facilities with excellent outcomes. But one of the keys to reducing maternal morbidity and mortality is matching the level of care a patient requires with the right hospital,” Kilpatrick said.

“This ‘triage’ approach means that most women can stay in their communities, closer to home, family and support. But if things do not go as planned, the highest level of care can be readily available to them.”

Read more on our Cedars-Sinai Blog: Keeping Time With the Baby Blues

In a special conversation to mark Women’s Health Month, maternal-fetal medicine specialist Melissa Wong, MD, spoke with the Cedars-Sinai Newsroom about specific AI applications developed at Cedars-Sinai and being used to improve maternal health outcomes and gynecological cancer screening. Wong is also director of Informatics and Artificial Intelligence Strategies for the Department of Obstetrics and Gynecology.

What are some significant results of using AI to improve pregnancy and childbirth outcomes?

Two important studies looked at the leading causes of death during pregnancy and childbirth: preeclampsia and postpartum hemorrhage.

We know that low-dose aspirin can reduce the risk of developing preeclampsia, a dangerous hypertensive complication of pregnancy that can cause serious illness or death. Black pregnant women are particularly vulnerable to being overlooked for aspirin treatment. Our study found that using artificial intelligence to identify patients at risk for preeclampsia—and then automate the decision-making about prescribing the aspirin—led to an increase in appropriate aspirin treatment and also eliminated the racial disparity in care.

In another study using an application of AI, machine learning, we developed an algorithm that can help predict which patients are at an increased risk for severe complications from bleeding after childbirth. The key was to analyze data at many different points of a patient’s labor and delivery—from underlying medical conditions to the kind of anesthesia the mother received. Our next step is to see if the algorithm can help predict hemorrhages in real time and allow for intervention and saving lives.

What future uses of AI for OB-GYN care are being considered?

In the area of gynecological care, we are wrapping up a study that could improve the evaluation of the Pap smear used to check for cervical cancer. We do hundreds of Paps a week in our health system. The results are most meaningful when you can put them in the context of the patient’s history. We’ve developed an AI application using ChatGPT that performs a contextual analysis of results, produces a recommendation for next steps, if needed, and even generates a letter to the patient about the results.

Gestational diabetes and hypertension during pregnancy are two conditions we believe could also benefit from AI interventions to identify trends and patterns in patient-submitted data and recommend interventions.

In the case of diabetes, about 80% of the patients submitting data from their glucose monitors are probably doing well or just need straightforward adjustments to their insulin. But our expert diabetes educator still has to analyze all of the data, even if only 20% of the patients will require direct intervention with medication or nutrition counseling to get them back on track. AI could help us focus on the smaller group of patients who need more complex and nuanced support, more expeditiously.

As for managing high blood pressure during pregnancy, this is often a new skill patients learn in pregnancy or postpartum. It’s also a complicated one. Trying to distinguish between a somewhat worrisome reading and one where you need to call your provider asap is not intuitive. A good AI model could send an alert when subtle pattern changes signal a need for medication modifications or urgent attention by the patient and provider.

What is the approach to AI innovation at Cedars-Sinai?

I feel incredibly fortunate to be here, not just because we are at the forefront of investigating the use of artificial intelligence across a wide variety of specialties and procedures, but because we do it with implementation in mind. There is a lot of AI research in the U.S. but not much that goes beyond the lab. At Cedars-Sinai, the goal is to research the myriad possible applications, and then when we’ve refined and tested them, to “turn it on,” so to speak. We are highly motivated to implement what we have developed and to help improve the delivery of care and the health of our patients.

What is the primary goal of harnessing AI for healthcare?

It’s about how AI can help healthcare providers free up their brains and their time to focus on delivering the best possible care. It can be a remarkable tool that brings us front and center with the patient again and moves us away from the kind of work that AI and machine learning do more effectively, quickly and accurately.

Whether a provider is in a healthcare desert with limited resources or at an academic medical center, the best applications of artificial intelligence will have a democratizing impact—reducing healthcare inequalities and providing care that could be more personalized across a broad spectrum of patient populations.

Read more from the Cedars-Sinai Blog: How Women Can Strengthen Their Health at Any Age

It is one of the most common and painful disorders, affecting more than 6 million women in the United States. Endometriosis is often difficult to diagnose and effectively treat. But Cedars-Sinai experts find patients can now benefit from minimally invasive procedures, medications and integrative medicine.

Endometriosis occurs when cells similar to the uterine lining are found growing in the wrong places, most commonly in the ovaries or fallopian tubes or in the abdominal cavity. Sometimes the errant endometrial tissue can migrate to the bladder, rectum and vagina. More than 11% of women have the disorder, according to the Office on Women’s Health in the U.S. Department of Health and Human Services.

Cedars-Sinai endometriosis experts Matthew Siedhoff, MD, a minimally invasive gynecological surgeon and vice chair, Department of Obstetrics and Gynecology, and Kelly Wright, MD, director of Minimally Invasive Gynecological Surgery, answer some of the most common questions about the condition and offer guidance on finding effective treatment and support for the challenges many women face.   

Dr. Siedhoff, what are common, and uncommon, symptoms of endometriosis?

Classic symptoms of endometriosis include pain with periods, noncyclic pelvic pain, pain with intercourse, and infertility. Very painful periods in adolescence can be an early warning sign of the disease, and it is sometimes associated with other symptoms such as vomiting or loose stool. Bowel and bladder dysfunction, migraines, fatigue and pain throughout the body can also be associated with endometriosis. However, some patients are completely asymptomatic, and the condition is diagnosed almost accidentally when it can be seen on imaging done for other reasons, such as an infertility workup.

Dr. Wright, why is endometriosis so difficult to diagnose?

There are no good noninvasive tests for endometriosis, and it doesn’t always show up on imaging studies. Since the condition can present in a variety of ways, patients can be passed from specialist to specialist before it is finally considered as a possible diagnosis. It can then be hard for a patient to find a physician familiar with the nuances and complexities involved in effectively treating the disease. In too many cases, the road from initial symptoms to a diagnosis of endometriosis can take seven to 10 years.

The symptoms of endometriosis, such as pain, sexual dysfunction and infertility, can be difficult to talk about during medical visits. Some providers don’t actively inquire about these symptoms, relying on patients to volunteer them. Sometimes clinicians minimize the symptoms a patient shares telling them that what they are experiencing is normal for a woman. And sometimes they are told that their physical complaints are psychological or all in their head.

Dr. Siedhoff, what are the current best practices for effectively diagnosing and treating endometriosis?

Endometriosis can sometimes be diagnosed by imaging or physical exam, but most of the time, laparoscopic, or minimally invasive, surgery is required to definitively confirm the diagnosis. If a provider suspects endometriosis based on a patient’s clinical presentation, it is perfectly reasonable to start treatment without surgical confirmation. If initial nonsurgical treatments aren’t working, that’s often a sign it’s time to consider surgery.

It’s important that patients see a surgeon with considerable experience in endometriosis surgery. Less experienced surgeons sometimes superficially treat endometriosis lesions by burning them away, a procedure called fulguration. This approach may help the patient a little, but actually cutting out the tissue results in greater pain reduction, decreases the risk the endometriosis will recur and produces better fertility outcomes.

Dr. Wright, is minimally invasive surgical removal of endometriosis a complicated procedure?

Finding how far the disease has spread and removing it often requires working around delicate structures, such as the intestines, kidneys, bladder, blood vessels and nerves. The severity of the patient’s endometriosis—and where the lesions will be found—can be difficult to predict before surgery, so it’s important to have a skilled surgeon prepared to remove the tissue regardless the location. Also, in younger women, the appearance of endometriosis can be subtle and requires an experienced eye to identify it and remove it.

The good news is that minimally invasive gynecological surgery is associated with less postoperative pain, faster recovery and lower infection rates. Our team at Cedars-Sinai is highly experienced and dedicated to improving the health and quality of life for patients who have been suffering with endometriosis.

Dr. Siedhoff, what is the best advice you can give frustrated patients trying to get help and relief?

First of all, don’t give up. There is effective treatment available. Often their condition will be one that is managed rather than cured. It usually takes some time to find the right treatment plan, and it may involve a variety of specialists, including gynecological surgeons, urologists, reproductive endocrinologists, gastroenterologists and integrative medicine specialists. But our patients do improve, and sometimes dramatically.  

Endometriosis Patient Resources

Endometriosis can sometimes lead to feelings of isolation, hopelessness and depression. Emotional support and practical strategies for managing endometriosis can help people navigate the anxiety, stress, loneliness and pain. Here are support programs available to Cedars-Sinai patients.

Endometriosis Peer Support Network: Patients can connect directly with volunteers who have had their own extensive endometriosis journeys and understand the emotional, psychological and healthcare challenges women face. For more information, contact Caryn Lindsey, LCSW, at 310-423-2412 or by email at caryn.lindsey@cshs.org. There is no fee.

Endometriosis Support Group: Connect with others who are facing challenges living with an endometriosis diagnosis. Currently, the group meeting is virtual. Register here. The fee is $15.

Empowered Relief (chronic pain management class): A single-session, two-hour class providing patients with in-depth knowledge about chronic pain and effective pain management.  Register here. The fee is $30.

Read more on the Cedars-Sinai Blog: You’re Not Alone: Coping With Endometriosis

Formerly known as the California Pregnancy-Associated Mortality Review (CA-PARM), the committee conducts in-depth investigations of deaths during—and up to one year after— pregnancy. The goal is to identify the causes of maternal loss of life, and any contributing factors, in order to develop evidence-based recommendations for prevention.

CA-PARM was established in 2006 by the California Department of Public Health, in partnership with the California Maternal Quality Care Collaborative, where Gregory has also served.

“We couldn't be more excited about Dr. Gregory's appointment to lead CA-PARC. Her leadership experience with the state committee, a distinguished career as a maternal-fetal medicine specialist, and her critical research on maternal health outcomes and disparities make her perfectly suited for this role,” said Amanda Williams, MD, MPH, the Clinical Innovation Advisor at the California Maternal Quality Care Collaborative.

Gregory is the director of Maternal-Fetal Medicine and vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology at Cedars-Sinai.  

“Death associated with pregnancy is a tragic event, impacting families and communities. Each woman who died while pregnant, or in the postpartum period, deserves a thorough and respectful review of what contributed to their death. It is my honor to serve as chair of CA-PARC and to work with a team who is thoughtful and diligent with this sensitive review process. We are dedicated to work that may keep others from dying from preventable causes,” said Gregory, who holds the Helping Hand of Los Angeles–Miriam Jacobs Chair, Maternal-Fetal Medicine.

Gregory joined Cedars-Sinai in 1992, after receiving her medical degree from the Drew/UCLA Medical Education Program and completing her residency in obstetrics and gynecology at Beth Israel Deaconess Medical Center in Boston. She went on to earn a master’s degree in public health from Harvard University before completing a fellowship in maternal-fetal medicine at LAC+USC Medical Center.

A major focus of Gregory’s research over the past decade has been examining the hospital childbirth experience from the mother’s perspective. Her goal is for hospitals to provide a safer and more meaningful experience for women in their care, addressing concerns that range from better pain management to breastfeeding policies.

“Dr. Gregory has been steadfastly committed to improving obstetric outcomes for women for her entire career. She is a compassionate physician whose dedication to providing her patients the best possible care also drives her innovative research to identify and reduce racial and ethnic disparities that can impact the healthcare women of color receive. She wants every pregnant patient to receive the best possible care available,” said Sarah Kilpatrick, MD, PhD, the Helping Hand of Los Angeles Chair of Obstetrics and Gynecology at Cedars-Sinai.

Read more on the Cedars-Sinai Blog: Equitable, Personalized Care for Women and Children of Color

concluded that further research is needed to clarify the reasons for this disparity.

“We’ve known for years that Black women with endometrial cancer have lower survival rates than white women, largely because they are more likely to have an aggressive subtype and to be diagnosed at an advanced stage,” said Kristin Taylor, MD, assistant professor of Obstetrics and Gynecology at Cedars-Sinai and lead author of the study. “But our study found this disparity persists even when we compare patients with the lowest-risk form diagnosed at the earliest possible stage.”

Taylor and fellow investigators reviewed data on more than 23,000 Black and white women from the National Cancer Institute’s SEER database, which collects data from registries in 18 geographic areas in the U.S. All of the patients had the earliest-stage, least-aggressive endometrial cancer—a type called stage 1A low-grade endometrioid endometrial carcinoma.

“Low-grade endometrioid tumors account for about 80% of endometrial cancers, and most of these are stage 1 at diagnosis,” said Taylor. “For these patients, standard treatment is hysterectomy, and many should be cured without the need for radiation or chemotherapy.”

The SEER data showed that the vast majority of patients, both Black and white, were treated with hysterectomy and had high overall survival rates. However, while just 1% of white women did not receive hysterectomies, 3% of Black women in the study didn’t receive this lifesaving surgery.

“We had hoped that when we looked only at the lowest-risk patients, the disparity between Black and white women would disappear, but it did not,” Taylor said. “It’s disappointing.”

Residing in the South, being insured with Medicaid, and residing in a county with low median income were also associated with not receiving surgery.

Study investigators said doctors might recommend against hysterectomy for women—both Black and white—with underlying health conditions that increase risk of surgical complications. Doctors might also offer women of childbearing age a fertility-sparing hormone treatment that lets them temporarily postpone surgery, Taylor said.

However, a slightly higher—though not statistically significant—number of Black women than white women refused surgery when their doctors recommended it, the study found.

“Although there was no data collected on the reason for refusal,” Taylor said, “there is likely an element of mistrust of the medical community that contributes to this difference.”

One factor that might help account for this disparity is structural racism, Taylor said. She pointed to historical policies that caused more Black people to be of lower socioeconomic status, and thus more likely to be uninsured or underinsured and have less access to quality healthcare. She also noted prior medical experimentation on Black people (e.g., the Tuskegee syphilis study) as recently as a few decades ago.

“Even though they might not always be in our conscious memory, I think that the downstream effects of those insults from decades ago get passed on culturally, particularly in the South. Among my own family, I see geographical differences in how members perceive their relationships with their doctors,” said Taylor, who was born in the South but grew up in Illinois.

Taylor said that further studies should be conducted to delve into the roles of these social factors.

“Disparities in survival that persist even among patients with the same stage and subtype of cancer must be investigated and addressed,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE One Distinguished Chair. “Dr. Taylor’s work is an example of the many ways investigators at Cedars-Sinai Cancer are working to understand these disparities and bring the highest level of care to all of the diverse patient groups we serve.”

Going forward, Taylor and team plan to address some limitations of the current study by looking at a different dataset.

“One major limitation with the SEER database is that socioeconomic factors are recorded at the county level, which is so broad,” Taylor said. “We're essentially repeating this study using the California Cancer Registry, which gives information including median income, education level, insurance status, primary language and immigration status at the neighborhood level. We'll have a much richer, more granular view of the lives of these patients, which should be really informative.”

Another planned study goes in a completely different direction.

“Some data suggest that there are different genetic pathways, even within this narrow subset of tumors, that could be driving disparities between outcomes in Black and white women,” Taylor said. “We’re hoping to develop models in the lab derived from the tumors of Black and white women with this subtype of cancer to look for biologic differences that could help inform treatments for each population.”

Read more on the Cedars-Sinai Blog: Uterine Cancer: What Women Need to Know

Division of Gynecologic Oncology, providing care and clinical services for patients within the Department of Obstetrics and Gynecology. She also joins as director for the Gynecologic Oncology Fellowship Program.

"We are so pleased to have Dr. Liang back on our team, as she was one of the strongest fellows we had the opportunity to train and has been emerging as a leader in our field,” said Kenneth Kim, MD, division director for Gynecologic Oncology at Cedars-Sinai Cancer and the Board of Governors Endowed Chair in Gynecologic Oncology. “Dr. Liang’s commitment to providing the highest quality care for patients, combined with her passion, knowledge and expertise, make her an outstanding addition to our team.”

Liang earned her medical degree at The Ohio State University, where she also completed her obstetrics and gynecology residency. She completed a gynecologic oncology fellowship at UCLA and Cedars-Sinai. In addition, Liang earned a master of science in health policy and management at UCLA. She conducts health services research with an interest in developing interventions to address financial hardship among cancer patients due to out-of-pocket costs and reduced income earning ability.

“I’m excited to return to Cedars-Sinai because I know from personal experience that we offer patients access to cutting-edge treatments while ensuring that they experience compassionate and well-coordinated cancer care,” Liang said. “My clinical research aims to improve the affordability of cancer care from the patient perspective, and I hope this work will have a positive impact on the greater Los Angeles community and beyond.”

Liang added that she was pleased to have the opportunity to help mentor residents and fellow trainees.

“My mentors were invaluable when I completed my residency and fellowships, and I’m proud to help continue that for others,” she said.

Kim noted, “In addition to completing her fellowship training at Cedars-Sinai, Dr. Liang is a nationally recognized expert in our field, so she is perfectly suited to help lead and grow our program. I am excited to work with her to ensure we remain among the best in the country.”

Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, added, “Fellowship programs are very important to the educational mission of Cedars-Sinai Cancer. The Gynecologic Oncology Fellowship is joined this year by the new fellowship in hematology and oncology, led by Drs. Hendifar and Merchant.”

Cedars-Sinai Cancer, ranked #11 in the nation in U.S. News & World Report’s “Best Hospitals 2022-23,” is renowned for its groundbreaking strides in cancer prevention, treatments and precision medicine. The hospital is proud to serve the most diverse population in the country and is working to expand access for those who often lack quality care.

Read more on the Cedars-Sinai Blog: Cancer and Fertility | What You Should Know

The one-hour virtual program, Embracing Our Community: LIVE! Advancing Black Maternal Health, focused on why Black women are three times more likely to die from pregnancy-related causes than white women--a disparity that transcends education, socioeconomic status, and even pre-existing health conditions.

“The inequities around black maternal health in America are critical for us to keep at the forefront of our work,” said Christina Harris, MD, vice president and chief health equity officer at Cedars-Sinai, who moderated the discussion. “This issue embodies every challenge we face in healthcare today, from inequitable access to timely and high-quality care to disparate treatments and outcomes.”

Joining Harris was Kimberly Gregory, MD, MPH, vice chair of Women's Healthcare Quality and Performance Improvement in the Department of Obstetrics and Gynecology, and director of Maternal-Fetal Medicine at Cedars-Sinai; Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai; Sonya Young Aadam, CEO, California Black Women's Health Project; and Natalie Hernandez, PhD, executive director, Center for Maternal Health Equity at Morehouse School of Medicine.

Panelists identified living conditions and experiences that contributed to Black women’s high maternal mortality rate, such as access to healthcare and prenatal care, trauma, childhood abuse, racism, unconscious bias, and sexism.

The panelists also discussed the persistence of disparities in Black maternal health across different socioeconomic levels, emphasizing that economic circumstances alone cannot explain inequities. They also stressed the need to eliminate racism in healthcare as well as in the daily lives of Black families, because of racism’s negative impact on health outcomes.

Conditions such as diabetes, hypertension, and obesity have increased among Black women, leading to complications, including preeclampsia, higher cesarean rates, and an increased risk of bleeding disorders.

"What's happening is that many symptoms experienced by women during pregnancy are often considered typical, when in reality, some of them can be indicative of significant morbidity and mortality,” said Gregory. “As physicians, we must learn to listen and differentiate these symptoms over time.”

Panelists gave advice for pregnant women and their families, emphasizing the importance of open communication with healthcare providers, seeking immediate care for urgent warning signs, documenting pregnancy history, and maintaining healthcare and social support systems throughout the pregnancy journey.

“For years we've had guidelines make in-hospital care better, but most deaths are actually postpartum,” said Kilpatrick. “We need to do a better job of making, what’s now being called the fourth trimester, postpartum care for women after giving birth easier. Make it covered by insurance, provide accessible follow-up, whether virtual or in-person, to ensure mothers can receive care in their own environment.”

Panelists also identified changes in policy and the healthcare delivery system that are essential for improving Black maternal health in the United States. These changes include: 

• Reviewing the causes behind every maternal death
• Ensuring access to prenatal and maternal care
• Addressing social factors like housing, transportation, and food insecurity
• Increasing diversity among healthcare professionals.

“My hope is sort of echoing Martin Luther King's dream and that one day it won't matter what color your doctor is, that you're going to get the right care at the right time for your right condition,” Gregory said.

Read more on the Cedars-Sinai Blog: How Cedars-Sinai is Working to Improve Black Maternal Health