Fellowship in Reproductive Endocrinology and Infertility

Program Description

Clinical ProgramResearch TrainingDidactic

Clinical Program

 

The clinical facilities available for training in Reproductive Endocrinology include the UT Medicine Fertility Center, Methodist Ambulatory Surgery Hospitals, St. Luke's Baptist Hospital, the University Health Center Downtown, University Hospital, and the San Antonio Military Medical Center.

 

The UT Medicine Fertility Center is a referral center for reproductive endocrinology and infertility patients in San Antonio. The Fertility Center contains ancillary staffing and capital equipment sufficient for complete patient care, including a dedicated procedure room, ultrasound machine with vaginal transducer and a full-service assisted reproductive technology (ART) and andrology laboratories. The Fertility Center functions for 6 half-day sessions per week, including weekends and holidays accommodating approximately 15-20 patients daily. UT Medicine Fertility CenterNew patient visits at the Fertility Center number over 300 per year. Emphasis is placed upon treatment of difficult infertility cases. Fellows will gain experience in basic evaluation of the infertile couple, ultrasonography, office hysteroscopy and sonohysterography, ovulation induction techniques, artificial insemination, diagnostic and therapeutic laparoscopy and hysteroscopy, laser surgery, reconstructive surgery for external and internal reproductive tract abnormalities, and tubal microsurgery.

 

The University of Texas Health Science Center at San Antonio (UTHSCSA) ART Program is located at the Fertility Center. Approximately 150 embryo transfers are performed yearly. Gamete/embryo micromanipulation is performed, including intracytoplasmic sperm injection and assisted embryo hatching. Successful embryo cryopreservation and donor oocyte programs are established.

 

The Fellow in their first year of training will be primarily responsible for seeing patients at the Fertility Center five half-days per week. A designated faculty member is present at each session for supervision. Fellows also participate in reproductive surgery cases at Methodist Ambulatory Surgery Hospital - Northwest and St. Luke's Baptist Hospital.

 

The Reproductive Endocrinology Clinic at the University Health Center Downtown serves approximately 900 patient visits yearly. It meets one half-day per week (Monday afternoon) and is staffed by a faculty member in the Division. Fellows will supervise roughly one-third of the sessions during their second and third years, and will assist residents with any surgical cases generated by this activity. Approximately 54 major surgical procedures and 76 minor procedures are performed yearly from this clinic. During the second year, fellows have the opportunity to attend the Medical and Pediatric Endocrine Clinics.

 

A weekly clinical conference is held by the Division. The agenda includes review of all current ART participants (as well as a monthly review of the summary data from the program), review of hysterosalpingograms, review of interesting or challenging cases, and presentation of all potential surgical cases. The first-year Fellows, in conjunction with the residents and a designated faculty member, are responsible for presenting these conferences.

 
 

Research Training

 

The academic facility of the Department of Obstetrics and Gynecology houses over 12,000 square feet of laboratory space. Specific laboratories are dedicated to molecular biology, cell biology, neuroendocrinology, reproductive immunology, electron microscopy, radioimmunoassays, and infectious disease. The Fellows may utilize any or all of these facilities, in order to acquire specific laboratory skills.

 

The laboratory experience begins soon after entry into the program. Individualized training is designed to teach Fellows research techniques, experimental design, data evaluation, and manuscript submission for publication of their research project. Laboratory experience in microsurgery and endoscopy is an integral part of the training during the first year. Models, extirpated specimens, and animals are used in the laboratory training in microsurgery and endoscopy. During the second year, fellows spend time in the radioimmunoassay (RIA), molecular biology, cell biology, and ART laboratories.

 

In the RIA/Cell and Molecular Biology laboratories, Fellows are exposed to the technical aspects of measuring steroid and protein hormone levels in biological specimens. This training involves methods of extraction and isolation of hormones, preparation of standard curves for the assay and the quantification of unknown amounts of hormones/proteins in the specimens. In addition, methods of data analysis and trouble shooting various assay problems are presented. Complementary training in the detection, measurement and assay techniques for hormone receptor proteins may be acquired. Fellows will also learn standard molecular biology techniques including in situ hybridization, RNA/DNA isolation and Northern and Southern blotting, polymerase chain reaction (PCR), RNA estimation using reverse transcription PCR and other methods. Procedures for studies of mitogen signal transduction and preparation of transfected cell lines useful for these analyses are presented. Training in the ART laboratory includes methods of semen analysis, preparation of semen samples for intrauterine insemination, gamete/embryo in vitro culture techniques, and micromanipulation techniques including intracytoplasmic sperm injection and assisted hatching.

 

During the basic laboratory training, the Fellow will participate in a specific research project(s). Major research areas include: 1) cell biology of endometriosis and endometrium, 2) neuroendocrinologic aspects of reproduction (hypothalamic-hypophyseal axis, pineal, pituitary), 3) gamete and embryo development and cryopreservation, 4) molecular biology of reproductive tissues, 5) mitogen mediated signal transduction during regulation of cell proliferation 6) genetics of polycystic ovary syndrome and 7) placental function.

 

In addition to these opportunities, experience has shown that some fellows are capable of, and benefit from, developing a project of their own initiation. This opportunity will also be available. We have found that this decision is best made by the fellow and the Program Director.

 

There are also numerous ongoing clinical studies involving treatment of infertility, endometriosis, polycystic ovary syndrome and menopause. Some of these studies involve patients being seen in the Fertility Center. We are also a clinical center for the Women's Health Initiative (WHI). The WHI is an NIH-funded study that is the largest study ever conducted for women's health. It focuses on health issues of menopausal women. Approximately 15 WHI participants are seen daily at the medical school. Fellows have the opportunity to participate in this activity to learn how large complex clinical research projects are conducted. The WHI clinical center also affords interested fellows the opportunity to implement ancillary studies related to various aspects of menopause and aging.

 

The Division also participates as a Clinical Site of The Reproductive Medicine Network (RMN), which was established in 1989 and funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The RMN is a cooperative effort of seven clinical sites, a data coordinating center, and the Reproductive Science Branch of the NICHD, and is charged with conducting and publishing high quality clinical studies in reproductive medicine.

 

Since 2009, the Division has participated in RMN clinical trials that address important aspects of reproductive medicine, namely, female infertility, male infertility, and multiple gestations as a result of ovulation induction.

  • For infertile women diagnosed with Polycystic Ovary Syndrome (PCOS), the RMN Pregnancy in PCOS (PPCOS) trial is aimed at determining the efficacy of several medications designed to aid in the achievement of conception and a live birth outcome. For more information on the study please go to http://clinicaltrials.gov/ct2/show/NCT00719186.
  • For couples with unexplained infertility who undergo ovarian stimulation treatments, the RMN Multiple Gestations trial will examine medications designed to reduce the occurrence of multiple gestational pregnancies.
 

Additional projects being conducted by the RMN are a Pregnancy Registry to examine pregnancy outcomes in the RMN protocols and a biospecimen and data repository for future use by investigators within and outside the Network.

 

Fellows may also take advantage of the clinical research infrastructure available at the Frederic C. Bartter General Clinical Research Center. This N.I.H. funded facility is located on the 7th floor of the South Texas Veterans Health Care System Audie Murphy Division Hospital, which is immediately adjacent to University Hospital. The Center serves both local veteran and non-veteran patients and provides support in laboratory studies, imaging, informatics, nursing and nutrition.

 
 

Didactic

 

The educational component of the program includes formal courses in the Graduate School of Biomedical Science and weekly conferences. Didactic instruction involves both basic science and clinical aspects of reproductive endocrinology.

 

A graduate level course in biostatistics and one additional graduate level course are required. The biostatistics course covers material germane to medical research: 1) descriptive statistics, 2) use of computers, 3) confidence intervals, 4) t-tests, 5) p values, 6) chi-square analysis, 7) analysis of variance, 8) regression and correlation analysis, 9) multiple regression analysis and 10) time series analysis. An ancillary computer workshop in statistics and statistical design of experiments is also available.

 

The graduate school offers several courses pertinent to Fellowship training. They include 1) Computer Science, 2) Developmental Genetics, 3) Methods in Cell and Molecular Biology, 4) Endocrinology of Reproduction, 5) Experimental Immunology and Immunopathology, 6) Immunobiology, 7) Neuroendocrinology, 8) Molecular Genetics and 9) Reproductive Physiology.

 

The Reproductive Endocrinology Didactic Conference is held each week and presentations on selected topics are given by the Faculty, Fellows and invited speakers. Topics are selected to review fundamental and current information on reproductive endocrinology as outlined by the Board publication, "A Guide to Learning in Reproductive Endocrinology." A Journal Club format is utilized periodically to discuss recently published articles of special significance. Topics and articles are selected from four major areas of interest to reproductive biology: 1) molecular mechanisms of gene regulation, 2) reproductive physiology, 3) cell biology and 4) genetics. Journal Club encourages fellows to keep abreast of new ideas and technical development, and often generates novel research investigations.

 
 

Weekly Schedule

 

The tables below illustrate the weekly schedule for the three years of fellowship training.

 
 

Schedule for Fellows - Year I

(Jan-June)

  Monday Tuesday Wednesday Thursday Friday Saturday **
7:30 am UTMFC UTMFC UTMFC UTMFC UTMFC UTMFC
 9:30 am ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery
11:00 am            
12:00 Noon     Grand Rounds, Dept of OB/GYN   REI Case Conference  
1:00 pm Research   Gyn Conference      
2:00 pm   Reproductive Endocrine Didactic RMN Meeting

 

   

 

4:30 pm Endocrine and Diabetes Conference   Genetics Course      

 

 

Schedule for Fellows - Year I

(July-Dec)

  Monday Tuesday Wednesday Thursday Friday Saturday
7:30 am UTMFC UTMFC UTMFC UTMFC UTMFC UTMFC
 9:30 am ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery ART or Infertility Surgery
11:00 am            
12:00 Noon     Grand Rounds, Dept of OB/GYN   REI Case Conference  
1:00 pm Endoscopy & Microscurgery Workshop Research Gyn Conference      
2:00 pm Research Reproductive Endocrine Didactic RMN Meeting

 

Research  

 

4:30 pm Endocrine and Diabetes Conference   Genetics Course      

** UTMFC - UT Medicine Fertility Clinic - coverage one weekend each month.

 

 

Schedule for Fellows - Year II

(Jan-June)

  Monday Tuesday Wednesday Thursday Friday Saturday **
7:30 am         UTMFC
8:00 am Graduate Course Research Graduate Course Research Graduate Course  
9:00 am RIA Lab/Molecular Biology       Research  
11:00 am Laboratory Meeting       Research  
12:00 Noon Research   Grand Rounds Dept of Ob/Gyn   Reproductive EndocrineConference  
1:00 pm Endocrine/Infertility Clinic with Residents# Reproductive Endocrine Didactic Gyn Conference      
4:30 pm Endocrine and Diabetes Conference          

 

 

Schedule for Fellows - Year II

  Monday Tuesday Wednesday Thursday Friday Saturday **

7:30 am

         
8:00 am Graduate Course Research Graduate Course Research Graduate Course  
9:00 am RIA Lab/Molecular Biology       Research  
11:00 am Laboratory Meeting       Reproductive Endocrine Case Conference
12:00 Noon Research   Grand Rounds Dept of Ob/Gyn          
1:00 pm Endocrine/Infertility Clinic with Residents # Reproductive Endocrine Didactic Gyn Conference    
4:30 pm Endocrine and Diabetes Conference          

 

** UTMFC - UT Medicine Fertility Clinic - coverage one weekend each month.

# Alternates coverage - averages one afternoon each month.

 

 

Schedule for Fellows - Year III

(Jan-June)

  Monday Tuesday Wednesday Thursday Friday Saturday **
7:30 am         UTMFC
8:00 am Research Research Medical Endocrine Clinic Research Research  
8:30 am         Pediatric Endocrine Rounds  
12:00 Noon     Grand Rounds Dept of Ob/Gyn   Reproductive Endocrine/Case Conference  
1:00 pm Endocrine/Infertility Clinic with Residents# Reproductive Endocrine Didactic Gyn Conference      
4:30 pm Endocrine and Diabetes Conference   Genetics Course      

 

 

Schedule for Fellows - Year III

(April-June)

  Monday Tuesday Wednesday Thursday Friday Saturday **
7:30 am         UTMFC
8:00 am Research Research Medical Endocrine Clinic Research Research  
8:30 am     Osteoporosis Clinic   Pediatric Endocrine Rounds  
11:00 am         Urology/Male Infertility  
12:00 Noon     Grand Rounds Dept of OB/Gyn      
1:00 pm Endocrine/Infertility Clinic with Residents# Reproductive Endocrine Didactic Gyn Conference      
4:30 pm Endocrine and Diabetes Conference   Genetics Course      

** UTMFC - UT Medicine Fertility Clinic - average one weekend each month.
# Alternates coverage with faculty - averages one afternoon each month.