Curriculum Guidance

1. Neuro-endocrinology principles
2. Physiology and pathophysiology of female genital organs
3. Functionality of endocrine axes
4. Methods of analysis and interpretation of hormonal test results
5. Clinical pharmacology of hormonal medications
6. Diagnosis and treatment of menstrual disorders, including primary (delayed puberty) and secondary amenorrhea
7. Endocrine criteria of the normal menstrual cycle and the effects of sex steroids on the endometrium
8. Diagnosis and hormonal therapy for dysfunctional uterine bleeding and dysmenorrhea
9. Diagnosis and treatment of premenstrual syndrome
10. Diagnosis and treatment of complex gynecological endocrine diseases (e.g., hyperprolactinemia, PCOS)
11. Management of androgen excess, hirsutism, and related care
12. Understanding the endocrinology of pregnancy and the immunology of reproduction
13. Management of premature ovarian failure
14. Endocrinological measurement of hormones in biological fluids to evaluate the various endocrine systems: neuroendocrine anatomy and physiology, hypothalamic-pituitary dysfunction , hypogonadotropic hypogonadism o Kallmann syndrome , pituitary adenoma and hyperprolactinemia
15. Thyroid function and disease states
16. Disorders of growth hormone
17. Adrenal dysfunction especially congenital adrenal hypeplasia

1 – Evaluating female pelvic anatomy and ultrasound usage

• Female anatomy – abdomen and pelvis
• Normal ultrasound appearance of uterus, ovaries and adnexae
• Standardised terms and definitions to describe sonographic features of normal pelvis and pelvic pathology

2- Evaluating, describing, diagnosing, and planning therapy for female infertility causes :

2.1. Ovulatory disorders

• Physiology of ovulation and pathophysiology
• Classification of anovulatory disorders
• Diagnosis of anovulation and its causes (e.g., inappropriate prolactin secretion syndromes, CNS-hypothalamic-pituitary syndromes).
• The association of other medical conditions with anovulation, such as diabetes with polycystic ovaries and pituitary tumours with hypogonadotropic hypogonadism and psychiatric impact .
• Scoring system for hirsutism

2.2. Tubal disorders:

• Etiology of tubal factor infertility: infection, surgery, endometriosis and congenital abnormalities
• Classification of tubal disease relevant to natural and therapeutic prognosis
• Correct use and interpretation of tubal function studies (e.g., ultrasound, hysterosalpingography, laparoscopy).
• Indications for tubal reparative procedures (micro-surgery, laparoscopic surgery) versus assisted conception.

2.3 uterine disorders

• Classification of uterine disease
• Aetiology of uterine factor infertility: infection, surgery, tumours, congenital abnormalities, intrauterine adhesions, fibroids and polyps
• Diagnostic techniques available for assessing uterine and tubal disease, any associated risks and complications
• Pathological features of acute and chronic inflammation associated with infertility
• Indications, pre-requisites and complications of HyCoSy, sonohysterography and HSG

2.4. Endometriosis and other peritoneal disorders:

• The hypotheses on the pathogenesis of endometriosis and mechanism by which endometriosis may have an impact on fertility
• The relationship between stages of endometriosis and infertility (defective folliculogenesis, ovulatory dysfunction, distorted pelvic anatomy, altered peritoneal function, autoimmune disorders and impaired implantation)
• Diagnosis and staging of endometriosis and other peritoneal causes of infertility.
• Knowledge of management of endometriosis.

2.5. Cervical factors:
– Tests for sperm/cervical mucus interaction and potential therapy.

2.6. unexplained infertility

• The epidemiology and natural history, including prognosis for unexplained infertility
• An understanding of other investigations that could be carried out to arrive at a diagnosis of unexplained infertility and the scientific basis for them
• Management of unexplained infertility

• Selection of ovulation induction methods using anti-estrogens, gonadotrophins, dopamine agonists, GnRH, GnRH analogues, and other agents.

1. The male reproductive system – anatomy, physiology and the process of spermatogenesis including endocrinological control mechanisms, abnormalities, and effects of drugs.
2. Physiology and pathophysiology of sexual function.
3. Biosynthesis of estrogens, androgens, and progestogens by the human testis and the biological action of testosterone.
4. Coital dysfunction associated infertility
5. formation, content, and examination of seminal fluid.
6. Investigation, diagnosis, and therapy of male reproductive system infections.
7. Cryobiology of semen, counseling of donors and recipients of donor insemination, and sperm banking.
8. In vitro and laboratory tests of sperm function (e.g., mucus penetration, zona-free hamster egg penetration, biochemistry).
9. Value and limitations of testicular biopsy and endocrine assessment (e.g., plasma FSH).
10. Physiology of endocrine and gametogenic function of the testes and accessory glands.
11. Indications and methods of assisted fertilization, including intracytoplasmic sperm injection.
12. Surgical sperm retrieval methods.
13. Y chromosome microdeletion and when to discuss sperm DNA damage and aneuploidy
14.  Idiopathic male infertility

1. Identifying conditions suitable for IVF and related assisted reproduction techniques.
2. Determining the menstrual cycle for synchronization.
3. Conducting follicular stimulation and monitoring through ultrasound, steroid, and peptide assays.
4. Timing oocyte aspiration and performing ultrasound-guided procedures.
5. Understanding laboratory procedures and support needed for in-vitro gamete transport, maturation, and fertilization.
6. Utilizing surgical and non-surgical methods for sperm retrieval and their application in assisted fertilization.
7. Timing and techniques for embryo transfer.
8. Monitoring implantation progress.
9. Assessing genetic abnormalities and exploring potential treatments.
10. Understanding relevant aspects of cryobiology.
11. Conducting psychological assessments and managing gamete donors and recipients.
12. Indications and techniques for IUI
13. – Indications, recruitment, counseling, and preparation methods for ovum pickup for donors and recipients. ( if applicable)
14. Indications and appropriate counseling methods of surrogacy (if applicable )
15. Indications and complications of uterine transplantation
16. Ethical regulations of ART

1. The pathophysiology of amenorrhea, including nutritional and psychological aspects.
2. Structural abnormalities of the genital tract are associated with amenorrhea.
3. Amenorrhea in relation to puberty and menarche.
4. Clinical manifestations of conditions associated with amenorrhea (e.g., polycystic ovarian syndrome, hypopituitarism, gonadal dysgenesis).
5. The potential causes of amenorrhea including POI, congenital endocrine disorders (e.g. Turner syndrome, complete androgen insensitivity syndrome, ovarian agenesis, polyglandular endocrinopathy and fragile X syndrome) and iatrogenic (e.g. post-surgery, chemo/radiotherapy)
6. Physiology and pathophysiology of prolactin secretion. Management of patients with inappropriate prolactin secretion.
7. Physiology of menopause and its disorders.
8. Advantages and disadvantages, risks and benefits of hormone replacement therapy.
9. the indications for and choice of HRT o non-hormonal methods, including lifestyle and dietary advice on adverse effects and risks of HRT
10. The sequelae of long-term low oestrogen levels for primary ovarian insufficiency (POI)
11. The indications and principles of performing DEXA scanning
12. Premature menopause: o causes of premature ovarian failure, congenital endocrine disorders (e.g. Turner syndrome, complete androgen insensitivity syndrome, ovarian agenesis, polyglandular endocrinopathy and fragile X syndrome) and atrogenic (e.g. post-surgery and chemo/radiotherapy)
13. Treatment options for young women with ovarian failure, with a focus on future fertility o Advantages, disadvantages, risks and benefits of HRT

1. Embryology: the development of embryos and abnormalities which will have an influence on reproduction, in particular the development of the genital tract
2. The normal sequence of pubertal changes in females and males and their timing.
3. The impact of hormones on bone growth and epiphyseal closure.
4. Hormonal changes and gametogenesis in relation to the reproductive cycle from intrauterine life to the development of normal reproductive cycles.
5. Diagnosis and management of delayed puberty, including differential diagnosis and appropriate therapy.
6. Diagnosis and management of sexual precocity, including differential diagnosis and appropriate therapy.
7. Developmental abnormalities of the genital tract, including ambiguous genitalia, imperforate hymen and vaginal septa, uterine anomalies, Müllerian and Wolffian dysgenesis, Rokitansky syndrome and gonadal dysgenesis
8. Diagnosis and surgical of female genital malformations.
9. Early recognition and support for victims of sexual violence.
10. How hormonal changes and gametogenesis relate to the reproductive cycle, from intrauterine life to the development of normal reproductive cycles (e.g. gonadotropin secretion in the fetus and the neonate, sensitivity of the feedback system during fetal and neonatal life and childhood; and the role of adrenal androgen

1. The anatomy of the abdomen, female genital tract, bladder, ureters and lower bowel
2. Preoperative management.
3. Laparoscopic ergonomics.
4. Hysteroscopic anatomy and orientation.
5. Electrosurgical principles, including generator output and relative risks.
6. Operative Laparoscopy – Surgical Technique.
7. Hysteroscopic Procedures – Surgical Technique and Fluid Management.
8. Diagnosis and Management of Postoperative Complications – Hemorrhage, Gastrointestinal, Genitourinary.
9. Pathogenesis and aetiology of endometriosis
10. The mechanisms by which minimal and mild endometriosis may impair fertility, e.g. defective folliculogenesis, ovulatory dysfunction, hyperprolactinaemia, autoimmune disorders, and disturbances in the peritoneal fluid

1. Pharmacodynamics, metabolic effects, and complications of various oral and injectable contraceptive preparations.
2. Mechanism of action and complications of intrauterine contraceptive devices (e.g., inert, copper, and progestogen-containing).
3. Indications, advantages, disadvantages, side effects, complications, and efficacy of traditional contraceptive methods (e.g., barrier, vaginal spermicide, periodic abstinence) compared to non-utilization of contraceptives.
4. Male contraception and sterilization (also covered in Infertility – Male).
5. Female sterilization (also covered in Infertility – Female and Surgical Techniques).
6. Interruption of pregnancy, including estimation of gestational age, various techniques of pregnancy interruption (e.g., postcoital estrogen, menstrual extraction, medically induced methods, dilatation and evacuation, mid-trimester abortion with prostaglandins and other agents like antiprogesterones), and details of potential hazards and long-term fertility complications.
7. Potential techniques applicable to male and female contraception, with any relevant findings.

1. Normal genetics, including Mendelian inheritance, chromosome structure and identification, and gametogenesis.
2. Abnormal genetics, such as chromosome abnormalities and genetically transmitted abnormalities of sexual development (e.g., hermaphroditism, Turner’s syndrome).
3. Inherited non-reproductive disorders related to reproduction, such as congenital adrenal hyperplasia and diabetes mellitus.
4. Genetic studies, including pedigree analysis, karyotype analysis, antenatal diagnosis of genetic diseases, use of gene probes, fluorescent in-situ hybridization, array comparative genomic hybridization, and associated techniques like PGS/PGD. Understanding indications and arrangements for specialized genetic diagnosis and counseling.
5. Inherited causes of infertility and early pregnancy loss.
6. Genetic aspects of artificial insemination and assisted fertilization
7. Laboratory techniques for analysing parental and fetal samples, including quantitative polymerase chain reaction (qPCR), fluorescent in situ hybridization (FISH), karyotyping, microarray, mutational analysis, sequencing, enzymatic analysis, analyte genetic inheritance and transmission of genetic disease

1. Early pregnancy problems: Clinical competence and detailed understanding of the differences in etiology, diagnosis, and management of:
2. Sporadic miscarriage and complications such as hemorrhage, infection, uterine perforation, and the need for blood transfusion.
3. Knowledge of early pregnancy loss and appropriate management choices including expectant, medical, or surgical.
4. Recurrent pregnancy loss: Diagnostic criteria, investigation, management, and counseling.
5. Ectopic pregnancy and pregnancy of unknown location.
6. Thrombophilia, genetics, ultrasound imaging, and gestational trophoblastic disease.
7. The role of antiphospholipid syndrome (APS) in recurrent miscarriage
8. The role of pre-implantation genetic testing for aneuploidy (PGT-A) in relation to miscarriage
9. The available options on surgical correction of uterine abnormalities and impact on pregnancy outcome
10. The evidence for routine use of hormonal therapy or immunotherapy for recurrent miscarriage
11. The efficacy of thromboprophylaxis during pregnancy in women who have thrombophilia’s (inherited or acquired) with recurrent first-trimester miscarriage or second trimester miscarriage assessment
12. The role of cervical cerclage (transvaginal and transabdominal) to prevent second trimester miscarriage.
13. The role of infection, and microbiome, in pregnancy loss and subfertility

1. Legislation, particularly recent and relevant to their subspecialty practice.
2. Ethics of healthcare provision and resource allocation.
3. Medical confidentiality.
4. Consent:

4.a) Nature of consent:

1. Knowledge
2. Capacity

iii. Voluntary

4.b) Treatment of minors.

4.c) Treatment of the incapacitated patient.

5. Medical negligence.

6. Role and relevance of ethics committees.

7. Reproductive Medicine:

7.1. Assisted conception techniques.

7.2. Detailed knowledge of national legislation and its relevance to the practice of:

7.2.1. Gamete storage and donation.

7.2.2. Surrogacy.

7.2.3. Fertility control.

7.2.4. Termination of pregnancy.

7.2.5. Fetal reduction.

7.2.6. Pre-implantation diagnosis.

7.2.7. Gene therapy research on embryos.

7.2.8. Donation of fetal and ovarian tissue.

7.3. Role of the supervising Authority (if any), the code of practice, as well as the role and duties of the “person responsible.”

Reproductive endocrinology and infertility fellow should have a good observation and exposure to the following :

1. Awareness of quality control of IVF laboratory
2. Sperm preparation o oocyte culture
3. oocyte insemination and  oocyte sperm injection
4. embryo culture
5. embryo freezing and thawing
6. assisted hatching
7. Embryo transfer lab aspect
8. Ethical and regulatory guidelines of ART laboratory