As a young girl, Michelle Valenti always wanted to be a doctor. She was interested in science from an early age, but it was watching family members struggle with health issues that inspired a deep-seeded desire to become a physician.

"I lost my grandpa when I was really young, and I spent a lot of time in the hospital with him – always wishing there was something I could do," she said. "I remember feeling like everything could have been prevented. By the time I went to college, I wanted to be one of the folks who could help others."

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What began as a journey in pre-medicine at the University of Arizona soon shifted to public health at the Mel & Enid Zuckerman College of Public Health, where recently completed her Ph.D. in epidemiology. She previously earned a bachelor's and master's degrees in public health, and a second bachelor's degree in French.

If someone told an undergraduate Valenti she would cap off her Wildcat journey with a Ph.D. in epidemiology, she wouldn't have believed them. She fondly recalls her epidemiology courses, but always as fun asides to her focus in public health promotion.

But Valenti's academic career, and life, took a turn for the unexpected when lifelong issues with recurring pain progressed from acute to chronic. What began as painful menstruation grew to emergency room trips, sleepless nights and a growing sense of unease at the lack of answers to her concerns.

In December 2021, she was diagnosed with endometriosis, an inflammatory condition in which tissue similar to uterine lining grows throughout the body – often on the ovaries, fallopian tubes and pelvic lining. Symptoms can range from painful menstruation and pelvic pain to infertility. Previous research indicates that approximately 10% of reproductive-age women have been diagnosed with the condition, though the actual prevalence of the illness is likely higher due to the lack of a non-invasive, highly sensitive diagnostic measure. 

Valenti underwent surgery within a month and transitioned to a long recovery process. When it eventually came time to consider her academic future, she did so with years of medical crises – and recent relief – on her mind.

Valenti began investigating research surrounding endometriosis and was surprised at how little she found. Before long, she realized her true calling in epidemiology: the study of how diseases and health conditions spread in populations, and the means to control, prevent and manage those illnesses.

"I don't know if 'kinship' is the right word, but I feel as though I have a deeper understanding of gynecological conditions and can be more empathetic with other people who are trying to manage a chronic illness," Valenti said. "When it comes to the actual research, I am really interested in the pain aspect of endometriosis, because it was something I thoroughly experienced. I am interested in why people experience more pain, while others are totally asymptomatic. I know that everyone experiences illness differently, but there is always some overlap – and I want to know why."

From pain patient to publication

Now finished with her Ph.D., Valenti is celebrating a different academic milestone: the publication of her dissertation in the American Journal of Obstetrics and Gynecology. In her work, Valenti investigated the levels of anti-müllerian hormone present in women with and without endometriosis before the former undergo surgery for the condition.

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Also known as AMH, anti-müllerian hormone is a growth factor secreted in the granulosa cells of the ovary, the measurement of which can more accurately predict a woman's reproductive age – and the transition to menopause – than other tests. Clinically, the hormone is also used as an important biomarker in fertility treatments. Previous studies have shown that women with endometriosis tend to have lower levels of AMH compared to those without the condition, though some of those studies are limited due to the chosen focus group, sample size or specific goals of the research.

While scientists understand there is a link between endometriosis and infertility, the exact mechanism by which endometriosis contributes to infertility is not well understood. Hypotheses on the subject point to increased inflammation, anatomic distortion, implantation abnormalities and a reduction in ovarian reserve and function as possible contributing factors. Previous research has also shown that women with endometriosis have a 50% greater risk of early natural menopause, when compared to women without the condition, which could also result from a reduction in ovarian reserve and function.

Ovarian reserve is the number of healthy eggs in a woman's ovaries that could potentially be fertilized and is a measure of fertility.

Valenti and her colleagues evaluated presurgical AMH levels in women with and without endometriosis regardless of infertility history using the Eunice Kennedy Shriver Natural Institute of Child Health and Human Development-funded Endometriosis: Natural History, Diagnosis, and Outcomes Study from 2011. Their work assesses whether AMH levels differ by endometriosis surgical staging and typology in order to more precisely evaluate whether endometriosis is associated with diminished ovarian reserve prior to any surgical intervention and how this association may differ by specific disease characteristics.

"AMH is a biomarker that measures functional ovarian reserve in women, and our goal was to evaluate how endometriosis diagnosis and typology influence the amount of that biomarker that can be found," Valenti said. "A lot of previous work has shown lower levels of AMH, but typically in women after surgery. Is that an effect of surgery, or the disease? It's hard to disentangle."

Valenti and her colleagues found that people with more advanced forms of endometriosis, especially those with ovarian cysts called endometriomas, tended to have lower levels of AMH – lower than those of participants without endometriosis.

The team also noted that different types of endometrioses – deep, ovarian and superficial – were linked to lower AMH levels. However, this pattern seemed to be driven mainly by the presence of ovarian endometriomas across all types. Overall, the findings support earlier studies to show that endometriosis itself, even before any surgery, could affect AMH levels and play a role in reduced ovarian reserve.

Valenti worked alongside fellow U of A researchers Mellisa Furlong, assistant professor of environmental health science; Zelieann Craig, associate professor of animal and comparative biomedical sciences; and Leslie Farland, associate professor of epidemiology, as well as scientists from the University of Utah and George Mason University.

Valenti said that seeing her work published in an accredited journal is not only exciting as a researcher but validating as a woman who struggled with endometriosis for most of her life.

"I still get goosebumps thinking about the publication," she said. "It's the perfect moment to look back and see how far I've come. When I started this Ph.D., there were still days that I could barely walk because I was in so much pain. I always thought endometriosis was going to win – but here I am, close to graduating. And now I have a manuscript published in a journal I often read. I'm still in disbelief. I often have to tell myself, 'Wow, I actually did all that.'"

A future, with family

Despite nearing the end of her academic journey at the U of A, Valenti is far from finished in her pursuit of knowledge. She's interested in postdoctoral research that will develop her environmental epidemiology skill set, a continuation of other work she completed as a Wildcat.

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Valenti was part of the team that that uncovered a link between negative mental health conditions among women firefighters and reduced AMH levels. They found that clinical diagnoses of PTSD and anxiety among women firefighters were associated with reductions in anti-Müllerian hormone levels of 66% and 33%, respectively. That research included the Center for Firefighter Health Collaborative Research, where Valenti is a program coordinator.

In her dissertation, Valenti also investigated the impact of per- and polyfluoroalkyl substances – commonly known as PFAS – on AMH levels, endometriosis and reproductive health, and looks forward to continuing research in that vein.

No matter where she goes, Valenti's colleagues are sure she will find success.

"It's hard to articulate how large a role Michelle has played in my research group and on women firefighter research at the university," Farland said. "She is a true 'team scientist,' and is constantly engaging with other students, faculty and staff on research projects. When she joined our program, it was clear she was interested in endometriosis and women's health, but through her work on the health of women firefighters she has discovered a passion for understanding how environmental exposures impact reproductive and gynecologic health."

Whether her journey brings her back to the U of A or leads somewhere new, Valenti said she is excited for the future she shares with her husband, Alex Campmas, and their son, Owen, who was born in 2024.

"My parents and husband deserve a huge shoutout for all the support and inspiration they've provided me over the years," Valenti said. "Alex moved here from France to support me, and he's been absolutely amazing. Without them, I don't know how I would have survived the past 10-plus years of my studies."