12 Months Fellowship in Reproductive Medicine

Course Name: FELLOWSHIP IN REPRODUCTIVE MEDICINE

Syllabus:

Part 1 Basic Sciences:

Anatomy : Male and Female genital tract
Physiology : Menstrual cycle / ovulation
Endocrinology : Relevant to human reproduction – Pituitary hormones / Thyroid function / Control of reproduction
Embryology : Cell cycle, gametogenesis, Fertilization & cleavage structure of sperm and oocytes
Genetics : Nomenclature / Basic principles prenatal diagnosis
Laboratory equipment
Andrology : Spermatogenesis, Semen Analysis Components, Sperm function tests.

Part 2 Infertility:

Broad outlines of causes of male and female.
Causes and Evaluation of male and female infertility.

Part 3 Assisted Reproductive Technology:

Evolution
Different technologies

Part 4 Andrology Laboratory:

Semen analysis
Processing sperm for various procedures – intrauterine insemination
Processing samples –testicular / epididymal

Part 5 Embryology Laboratory (Only Theory):

Culture media Egg Identification
Insemination
Fertilization and cleavage check.
Embryo transfer technique
Blastocyst Culture
Embryo Hatching
Technique of ICSI
Cryopreservation: Semen freezing/ Embryo freezing

Part 6 Ethical principles in ART:

ART Act and Surrogacy Act

LECTURE TOPICS FOR FELLOWSHIP PROGRAMME

After completion of the course the reproductive medicine specialist will be proficient in the following areas of learning :

Minimally invasive surgery (Theory and Observation)

Proficient in the principles and practice of diagnostic and operative laparoscopy for infertility like release adhesions / cystectomy / endometriosis, etc.
Proficient in the principles and practice of diagnostic and operative hysteroscopy for infertility like removal of foreign body, polyps, biopsy / septum resection / adhesiolysis / cannulation of ostium

Reproductive Endocrinology including laboratory techniques

Attain expertise:

In the use of ovulation inducing agents and hormonal control of the menstrual cycle.
Follicular recruitment and retrieval procedures
Understand and be able to manage OHSS.
Trans Vaginal Ultrasonography with particular reference to follicular monitoring
Luteal Phase Support

Andrology

With reference, maintenance and trouble shooting.

Laboratory Technology

Familiarity with – Laboratory equipment, maintenance
QC & QA of laboratory
Detailed knowledge of ART procedures carried out like semen preparation, oocyte identificationand grading, embryo grading, micromanipulation, cell culture.

Log book

To be maintained to ensure practical exposure.

Suggested minimal requirements:

Minimally Invasive Surgery:
Observe

10 diagnostic laparoscopies
5 operative laparoscopies

Assist

5 diagnostic laparoscopies
3 operative laparoscopies

Andrology
Observe: 5 PESA, TESA, TESE
Assist: 2 PESA, TESA, TESE
IVF :

Observe : 25 Oocyte retrieval
Assist : 10 Oocyte retrieval
Perform : 5 oocyte retrieval

Laboratory:

Observe 15 semen analysis & 10 sperm preparation
Perform 10 semen analysis & 2 sperm wash procedures
Follow up : 5 cases of IVF / ICSI patient preparation to embryo transfer (written records)

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Counseling sessions : Observed 30 patients from initial visit/planning till OPU

Observed 30 patients from Embryo transfer plan till embryo transfer

Reproductive anatomy and physiology of the male and the female.
Reproductive endocrinology.
Gametogenesis.
Fertilization in vivo.
Implantation and early embryogenesis.
Pathology of infertility – Causes of infertility namely the ovarian, tubal, uterine, male factors, pathology that reduces fertility namely PCOS, endometriosis, fibroid, adenomyosis uterine anomaly etc.
Approach to investigate and diagnose sub-fertility.
Clinical decision making and choice of treatment.
9.Pharmacology – Pharmacological effects of the various drugs including the pharmacokinetics and pharmacodyanamics of the commonly used drugs.
Complication of ART procedure.
Ovulation induction during IUI and IVF procedures.
Ultrasound and other imaging modalities in infertility(only folliculometry)
Fundamental of the surgical procedures namely laparoscopy,hysteroscopy, myomectomy etc.(theory and observation)
Pre-conception evaluation and counseling.
Administration – Setting up the ART unit, quality control and assurance, creating protocol for management and organizing and coordinating of clinical meetings.
Counseling of the infertile couple Implicative, therapeutic, ethical and social.
Clinical Embryology. ∙ Principles and practice of semen analysis and cryopreservation of semen. ∙ Cytology of mammalian and human oocyte to identify stages of oocyte maturation accurately. ∙ All aspects of embryology including developmental itiology. ∙ Cell biological techniques used in cell and tissue culture. ∙ Molecular biology and genetics of human reproduction. ∙ Micromanipulation of sperm and oocytes for carrying out ICSI and single-cell biopsies of embryos for pre implantation genetic diagnosis. ∙ Principles and functioning of all the equipment used in the laboratory. ∙ In vitro fertilization of oocytes after processing the gametes. ∙ Principles and practice of embryo freezing
Research and Audit
Teaching

Components Of The Fellowship:

1. Ovulation induction protocols

The trainees work in the hospital out-patient unit where they share the responsibility with the consultant in the evaluation of the infertile couple, participate in the decision making depending on the couple’s need, formulate a plan of action, pre-procedure assessment, counseling, protocol selection, monitoring the patient for response and early detection of side effect, etc. The trainee receives instruction and is guided by the consultant in acquiring the cognitive and technical skills for the various diagnostic and therapeutic procedures.

Ultrasound and other imaging

The trainee acquires special competence in ultrasound imaging for folliculometry during stimulation, basic TVS

Observe : SIS , HyCoSY ( 10)

Clinical Embryology

15 days of observation of OPU/ICSI/Embryo transfer/Fertilization check/Embryo check

Surgical training

The trainee is required to participate in the pre-procedure assessment; observe surgical procedure and the post operative follow up the patients who undergo laparoscopy, hysteroscopy and laparotomy.

Research and Audit

The research project should be approved and should demonstrate the basic principles of the research. The trainee is required to participate in the audit of the ART procedure and should obtain knowledge in quality control and assurance.

1 research paper to be completed and published

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Specific Objective Of The Fellowship

The practice of reproductive medicine involves the following major subgroup of patients, namely

Infertile couple with female factor

Anovulation, namely WHO type 1, 2, 3, 4.
Tubal factor namely with tubal obstruction, hydrosalpinx.
Uterine cavity abnormality both congenital and acquired (Fibroid, adenomyoma, septum and uterine malformations).
Endometriosis.
Endocrine abnormality (hyperprolactinemia, hyperandrogenism, etc).
Recurrent pregnancy loss.

Infertile couple with male factor