12 MONTHS COURSE

Gunasheela Surgical & Maternity Hospital is conducting a one-year fellowship programme in Reproductive Medicine under the IAEHC Banner. The students will be taught all the theoretical and clinical aspects of Reproductive Medicine. There were be two streams for intake of the students – January & July.

FELLOWSHIP IN REPRODUCTIVE MEDICINE

(AFFILIATED TO RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES)

Name
Information
DURATION: 12 Months
COURSE COMMENCES: January & July
NO OF SEATS : 6 students per year
ELIGIBILITY: MBBS Degree from a University recognized by the MCI, M.D. / M.S. (or its equivalent recognised degree) in Obstetrics & Gynecology from a recognized University or DGO with 1 year experience.
COURSE FEE: Rs. 8 lakhs per student
COURSE TYPE: Full time course with hands on training lectures, seminars, visit to different labs to observe procedures related to Infertility.
LEARNING OBJECTIVES: Evaluation of infertile couples including history and physical examination, laboratory tests, hands on experience with procedures related to reproductive medicine. Providing surgical experience related to reproductive medicine (diagnostic and therapeutic laparoscopy / hysteroscopy surgery) Assessment and dealing with complex infertility problems Providing technical skills in handling gametes and embryos and management of laboratory in relation to human infertility programme
COURSE CONTENTS: The training program will include the following areas: Reproductive Surgery Management of Infertile Couple Assisted Reproductive Techniques Subspecialty Clinics
CERTIFICATION: Examination at the end of the course / programme, conducted by IAEHC
 

As you know, ours is also an obstetrics hospital and the students who are choosen for the above course would be required to take an Obstetric On Call for which a minimum stipend of Rs. 20,000/- will be paid to them.

After completion of the course, the students will be proficient in the the following areas of learning:

1. Assist in Operative gynecological open surgery

  • Microsurgical principles as applied to the treatment of tubal disease especially with regard todistal tubal obstruction, proximal tubal recanalization & mid tubal obstruction by end to endanastomosis.
  • Diagnostic laparoscopy and assisting for conditions like laparoscopic ovarian cystectomy/resection of endometriosis /myomectomy and repair of tubal blocks and adhesiolysis etc.
  •  Diagnostic and operative hysteroscopy for conditions causing infertility like removal of foreign body, polyps, IUCD, biopsy, septum resection, and cannulation of tubal ostium.
  • A clear understanding of the principles of reconstructive surgery as applied to Mulllerian duct abnormalities – vaginoplasty for vaginal agenesis, or unification of bicornuate uterus.
2. Reproductive endocrinology and its management.
3. Proficient in the etiology, pathophysiology, diagnosis and management of common gynecological problems related to infertility like – fibroids /endometriosis / pelvic infections/ectopic pregnancy and management of high order pregnancy.
4. Expertise in the use of ovulation inducing agents and hormonal control of the menstrual cycle and controlled ovarian stimulation.
5. Follicular recruitment, oocyte retrieval procedure and embryo transfer procedure.
6. Understand and be able to manage OHSS.
7. Trans Vaginal Ultrasonography with particular reference to follicular monitoring & early pregnancy scanning.
8. Andrology: Semen analysis and semen preparation
9. Laboratory Technology: Familiarity with ART laboratory equipment, maintenance & trouble shooting.
10. Oocyte identification and grading, embryo grading, micromanipulation, cell culture, freezing techniques etc
11. Medico legal and ethical aspect
  1. Third Party Reproduction
    i. Oocyte donation
    ii. Embryo donation
    iii. Sperm donation
    iv. Surrogacy
  2.  Ethical & medico-legal aspects of infertility management- ICMR guidelines
12. Miscellaneous
  •  Biostatics & Data management.
  • Research Methodology
  • Medical statistics
  • Writing and presenting a paper
13. Fertility preservation – Social & Onco- fertility
14. Monitoring & treatment of early pregnancy after ART treatment
Faculty of the course:
Full time :

  1.  Dr. Devika Gunasheela
  2.  Dr. Rajsekhar Nayak
  3.  Dr. Jyothi Menon
  4.  Dr. Vasanth Kumar
  5.  Dr. Rajeshwari M.V
  6. Dr. Raajam Murali S.R.
  7. Dr. Ashwini N
  8. Dr. Ashwini M
  9.  Dr. Manyam Indira - Radiologist
  10.  Dr. Radhakrishna - Radiologist
  11.  Dr. Sandesh - Sonologist
  12. Dr. Nagesh - Radiologist
After completion of the course, the students will receive Course Completion Certificate fromIAEHC, which is the educational wing of Gunasheela Hospital.

SYLLABUS
BASIC SCIENCES

1. Anatomy: Comprehensive knowledge of the regional anatomy of the pelvis, which includes female and male reproductive organs. Detailed knowledge of gross anatomy of hypothalamus, pituitary and adrenal glands. Comprehensive knowledge of the histology of the genital tract and endocrine glands related to reproduction. Detailed knowledge of cell structure in relation to function.
2. Physiology: Comprehensive knowledge of human physiology with particular reference to the female and male reproductive system.
3. Genetics and molecular biology: Detailed knowledge of sexual differentiation and common inherited disorders. Knowledge of the principles of inheritance of chromosomal and genetic disorders. Detailed knowledge of chromosomal abnormalities involve in reproduction.
4. Embryology: Comprehensive knowledge of gametogenesis, fertilization and early embryo development. Comprehensive knowledge of development of the reproductive organs and abnormalities associated with it. Knowledge of common fetal malformations.
5. Pathology: Detailed knowledge of the cytopathology and histology of the female and male reproductive tract.
6. Biochemistry: Knowledge of the metabolism and function of neurotransmitters receptors, autocrine and paracrine factors.
7. Pharmacology: Comprehensive knowledge of the properties, pharmacodynamics, actions, interactions and hazards of pharmacological agents, which are used in reproductive medicine and particularly the compounds, which could have a deleterious effect on the reproductive tract and adverse epigenetic influence.

CLINICAL SCIENCES

1. Infertility: Comprehensive knowledge of
  • Epidemiology
  • Aetiology of female infertility
  • Evaluation of female factor
  • Causes & Investigations in the female
  •  Determination of Ovarian reserve
  •  Treatment of female factor
  • Polycystic ovarian disease – Evaluation & management
  •  Endometriosis – Diagnosis & management
  •  Immune factors in fertility
2. Pharmacology related to Infertility
3. Comprehensive knowledge of gynaecological and andrological endocrinology including its application in reproductive medicine.
4. Reproductive Genetics
  • Detailed knowledge of genetic disorders related to female and male reproduction (infertility, recurrent abortions, etc)
  • Epigenetics in Infertility
  • Genetics of Infertility
  •  Recurrent implantation failure / Recurrent miscarriages
  •  PGS / PGD
5. Andrology
  • Comprehensive knowledge of normal and abnormal spermatogenesis, as well as of testicular, epididymal and accessory sex glands patho-physiology.
  • Comprehensive knowledge of erection and ejaculation, as well as their physiopathology.
  • Detailed knowledge of endocrine changes in spermatogenesis, seminogram and sperm function tests.
  • Spermatogenesis, ejaculation & spermatozoa
  •  Treatment of male factors
  • Evaluation of male factor
  •  Sperm Donation
6. Andrology laboratory:
  •  Semen analysis
  • Processing of semen for various procedures – IUI/IVF/ICSI, processing samples of testicular / epidydymal sperms for ICSI.
7. Assisted reproductive technology:
  • Evolution of different technologies in ART.
  •  Controlled ovarian stimulation, oocyte retrieval and embryo transfer techniques.
  •  Comprehensive knowledge of endocrine therapy, especially ovarian stimulation and its complications.
  • Comprehensive knowledge of the ART: IUI, IVF, ICSI.
  • Comprehensive knowledge of gamete and embryo donation.
  • Comprehensive knowledge of pre-implantation genetic screening (PGS) / Preimplantation genetic diagnosis (PGD)
  •  Uterine Receptivity
  •  Success rate with different treatment modalities for infertility
  • Complications of ART & its management
  •  Ethical aspects of infertility management
  • Oocyte donation
  •  Embryo donation
  •  Invitro maturation of Oocytes
8. Embryology laboratory:
  • Culture media,
  •  Oocyte identification
  •  Insemination,
  •  Fertilization and cleavage check
  •  Blastocyst culture
  •  Cryopreservation and its principles.
  •  Setting up of an ART Lab
  •  Equipments required for setting an ART Lab
  •  Quality Assurance & quality control in ART laboratory
  • Vitrification as a method of embryo freezing
  •  Preservation of fertility on cancer patient
  •  Oocyte freezing
9. Comprehensive knowledge of reproductive surgery and competence in common fertility enhancing endoscopic and open surgeries.
10. Ultrasound: Detailed knowledge and competence in ultrasound in all aspects:-
  • Pelvic ultrasound in women and ability to diagnose pathological conditions of female genital tract
  •  Follicular monitoring
  •  Ultrasound guided invasive procedures.
11. Biochemistry –
  •  Hormones – definition, role in human body, importance of hormones and its function
  •  Summary and explanation of hormones
  • Principle of Hormones (Assay)
  •  Instrument – types of chemiluminescence
12. Statistics and epidemiology:
  • Detailed knowledge of statistical analysis.
  •  Collection of data in reproductive medicine as well as the knowledge of calculating effectiveness of infertility treatments.
  •  Detailed knowledge of setting up and interpreting clinical trials.
  • Knowledge of evidence based medicine pertaining to human reproduction as well as the knowledge of meta-analysis or guidelines on diagnosis or management of various conditions given by important medical bodies such as RCOG, ASRM, ESHRE or Cochrane
13. Ethics and law:
  •  Detailed knowledge of ethical and national legal issues involved in reproductive medicine and ART and the resources required in providing adequate health care in hospital and wider community.

DETAILED SYLLABUS

1.Menstrual & ovarian cycles
  • Regulation of menstrual cycle
  • Follicular growth in humans
  • Autocrine & paracrine factors regulating follicular growth
  • Physiology & biochemistry of follicular rupture
  • Function of follicle after ovulation _ Corpus luteum
  • Structure & function of fallopian tubes
  • Uterus – structure, anomalies, physiology, endometrial structure, importance of dating  endometrium
  • Cervix & cervical canal & its function
2.Spermatogenesis, ejaculation & spermatozoa
  • Sexual differentiation
  • Structure & Physiology of testis & seminiferous tubules
  • Mode of steroid hormone action
  • Spermatogenesis & spermiogenesis
  • Collecting ducts & Epididymis
  • Vas deferens
  • Male accessory gland & ejaculation
  • Normal semen profile
  • Changes in sperm for & at fertilisation
  • Sperm-oocyte interaction
3.Treatment of male factors
  • Medical treatment for male factor
  • Surgery for varicocele
  • Treatment of endocrine deficiencies
  • Treatment of obstruction in epididymis, vas deferens, or ejaculatory duct
  • Congenital absence of seminal vesicles
  • Retrograde ejaculation & failure of emission
  • Deficient or abnormal spermatozoa
  • Infection
  • Autoimmune cause
  • Genetic disorder
  • Use of assisted reproductive techniques – IUI, IVF, ICSI
  • Necessity for PGD
4.Endometriosis – Diagnosis & management
5.Polycystic ovarian disease – Evaluation &management 6.Intrauterine Insemination
  • Indications
  •  Ovarian stimulation
  •  Monitoring
  • hCG for ovulation induction
  • Timing of IUI
  • Sperm preparation techniques
  • Procedure of IUI
  • Post IUI precautions
  • Luteal phase support
  • Diagnosis of pregnancy after IUI
7.Assisted Conception
  • Types of ART techniques
  • Evaluation & preparation of infertile couple for ART
  • Testing of ovarian reserve
  • Natural cycle & ovulation Induction for ART
  • Use of GnRh agonist & Antagonist for ovulation induction
  •  Use of USG in ART – Monioring, OR, Cyst aspiration, ET
  • Oocyte retrieval
  • Sperm preparation for IVF & ICSI – Ejacualte, Epididymal aspiration,testicular biopsy/aspiration
  • Fertilization – IVF, ICSI
  • Analysis of fertilization
  • Embryo development & assessment
  • Embryo culture systems
  • Preimplantation genetic diagnosis
  • Assisted Hatching
  • Embryo transfer techniques
  •  Oocyte & embryo cryopreservation
8. Uterine Receptivity
9. Epigenetics in Infertility
10. Genetics of Infertility
11. Immune factors in fertility
12. Recurrent implantation failure
13. Setting up of an ART Lab
14. Equipments required for setting an ART Lab
15. Quality Assurance & quality control in ART laboratory
16. Success rate with different treatment modalities for infertility
17. Monitoring & treatment of early pregnancy after ART treatment
18. Complications of ART & its management
19. Ethical aspects of infertility management
20. Aetiology of female infertility
  • Ovulatory dysfunction
  • Cervical factor
  • Uterine facor
  • Tubal factor
  • Tuboperitoneal factor – Endometriosis, infection, adhesions
  • Immunological factor
  • Ovarian mass
  • Infertility of unknown aetiology
21. Evaluation of female factor
  • Importance of detailed history & physical examination
  • Disorders of menstrual cycle & ovulation
  • Other endocrine disorders affecting menstrual cycle & ovulation
  • Polycystic ovarian syndrome
  • Primary & secondary amenorrhea
  •  Luteal disorders
  • Ovarian dysfunction
  • Tubal & peritoneal factors
  •  Uterus & endometrium
  • Cervical factor
  •  Immunity to spermatozoa
  • Infection of the genital tract
  • Subtle factors in idiopathic infertility
  • Genetic evaluation
22. Investigations in the female
  •  Hormone assays in early follicular phase
  •   Assesment of ovulation by BBT, USG & urinary LH
  • Postcoital test
  • Progesterone in mid or late luteal phase
  • Endometrial biopsy & hysteroscopy for evaluation of endometrium
  • Hystrosonosalpingography (HSG) / Sonosalpingography (SSG)
  • Laparoscopy
  • PAP smear with cervical &/or vaginal swab culture
  • Sperm antibody test
  • Need of routine blood profile
  • ACL, ANA, LA, APTT, PTT, PT
23. Evaluation of male factor
  •  Evaluation for retrograde ejaculation
  • Karyotyping
  • Sperm Maturation Index
  • Sperm DNA fragmentation
  •  ‘Y’Deletion
24.Treatment of female factor
  • Ovulation induction – Protocols, monitoring
  • Luteal phase support
  •  Ovarian hyperstimulation syndrome – diagnosis & treatment
  • Treatment of poor & hyper responders
  • Treatment of premature ovarian failure
  •  Treatment of cervical factor
  • Treatment of tubal factor
  • Treatment of uterine factor
  • Treatment of peritoneal factor
  • Treatment of genital infection – Tuberculosis, chlamydia, bacterial, others
25. Treatment of Male factor – medical / surgical
26. Recurrent pregnancy loss – Evaluation & management
27. Oocyte donation
28. Sperm Donation
29. Embryo donation
30. Endometrial blastocyst interaction for Implantation
31. Determination of Ovarian reserve
32.  Invitro maturation of Oocytes
33  Vitrification as a method of embryo freezing
34.  Preservation of fertility on cancer patients
35.   Oocytes freezing
36. PGS / PGD
PLEASE NOTE : IF FOR ANY REASONS, THE CANDIATE HAS TO GO ON LONG LEAVE, SHE / HE WILL BE EXPECTED TO COMPLETE THE COURSE WITHOUT WHICH SHE / HE CAN NEITHER TAKE THE EXIT EXAMS NOR CAN BE GIVEN THE COURSE COMPLETION CERTIFICATE.
ALSO PLEASE NOTE THAT APPLICATION FOR REFUND OF FEES WILLNOT BE ENTERTAINED.
After completion of the course, the students will receive Course Completion Certificate from IAEHC, which is the educational wing of Gunasheela Hospital.