Reproductive Endocrinology & Infertility
Reproductive Endocrinology & Infertility
Our REI three-year fellowship provides an intense educational experience for the clinical and research aspects of the subspecialty.
The fellowship in reproductive endocrinology has been fully accredited through the American Board of Obstetrics and Gynecology (ABOG) since 1977. At the program’s latest review in 2009, the fellowship earned a five-year approval rating, the maximum period granted.
The program trains a total complement of four fellows, accepting two fellows instead of one every third year. As of June 2012, the UofL REI fellowship has graduated a total of 34 fellows.
The division covers all endocrine (infertility, contraception, menopause) and surgical (operative endoscopy, laser and microsurgery) aspects of the subspecialty. Established in 1984, the assisted reproductive technology (ART) program offers micromanipulation and donor gametes.
We take pride in reporting Kentucky’s highest pregnancy rates culminating in the birth of a healthy baby.
The division maintains its major outpatient care facility at the University of Louisville HealthCare Outpatient Center (HCOC) where the REI attending and fellows see their private patients as part of the University of Louisville Physicians (ULP) group.
The fellow’s clinical activity is directly supervised by the attending faculty member for a majority of the faculty’s clinical teaching of the fellow is on an individualized “one-on-one basis”.
The Division’s Fertility Center is located within the Department of Ob-Gyn-WH’s office suite in the UofL HCOC. The close proximity of the Fertility Center to our clinical offices allows immediate access to our own self-contained outpatient operating room. A contract with the UofL Hospital anesthesiology group ensures reliable, convenient, and safe conscious sedation services for our patients.
The division is one of only two practices providing advanced ART procedures in the Louisville metropolitan area and the division is the dominant provider of ART services in the area. The Fertility Center has a long history of a successful ART practice. In addition to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), the division recruits their own oocyte donors for anonymous donation.
The Fertility Center staff includes a full-time Embryology Laboratory Director, one full-time embryologist, one part-time embryologist, and one ART coordinator. The Fertility Center is a large facility with approximately 1,600 square feet of patient care space and 700 square feet of laboratory space. The fellows are closely involved in the ART program and participate in the planning of a patient’s controlled ovarian hyperstimulation protocol and perform the oocyte retrieval procedures. Fellows gain embryo transfer experience through mock uterine transfers performed at the time of patient’s uterine mapping procedure. Fellows also are given formal lectures in embryology and various laboratory techniques, including ICSI.
The REI practice has a wide referral base, accepting patients from Kentucky, Indiana, Ohio, and West Virginia. In the immediate Louisville metropolitan area, the division draws from a geographical area of 1.3 million people within a 50-mile radius.
Patients have a wide range of medical conditions including infertility, amenorrhea, hirsutism, abnormal sexual development, premenstrual syndrome, and symptoms of the menopausal period.
The division has clinical patient care hour’s six-days-a-week and has an in-house andrology laboratory, clinical endocrinology laboratory, and ultrasound services on site.
The andrology laboratory operates the major artificial insemination (AI) program in the Louisville metropolitan area. Semen samples can be cryopreserved for men prior to chemotherapy or military service abroad and stored on site in our laboratories.
The division receives consults from colleagues for patients with developmental abnormalities of the reproductive organs, oocyte cryopreservation prior to beginning adjunctive radiation or chemotherapy, and adolescent menstrual cycle abnormalities.
The division works closely with a subspecialist in male infertility; fellows spend approximately four hours per week for eight weeks in this practice seeing patients in the private office.
Fellows see patients with a medical endocrinologist for approximately four hours per week for six weeks and with a pediatric endocrinologist for four hours per week for four weeks.
Each fellow spends a minimum of 18 months of their fellowship in basic or clinical research. Basic science research is conducted with departmental faculty members Zhenmin Lei, MD, PhD, and Amanda LeBlanc, PhD. The following techniques are available in these investigator’s laboratories: Northern, Southern, Western and ligand blotting, covalent receptor cross linking, nested RT-PCR, cell transfections, antisense gene expression, gel mobility shift, cloning cDNAs, light and transmission electron microscopy, immunocytochemistry, immunoassays, cell and tissue culture, and in situ hybridization.
Other mentors for basic science research include the Division of Pediatric Surgery, where our fellows benefit from the long-term research experience of Mary E. Fallat, MD, and Yong Siow, PhD, with the hormone anti-mullerian hormone (mullerian inhibiting substance).
The division also has an ongoing association with the Microsurgery Teaching Laboratory in the Department of Physiology (Gustavo Perez-Abadia, M.D). This relationship allows ample time for fellows to practice their microsurgical suturing in a formal, live animal laboratory.
A human cadaver laboratory and a dual console Intuitive daVinci Si unit are available to enhance knowledge of reproductive tract anatomy and to practice and refine clinical robotic endoscopic procedures, respectively.
Fellows may apply for the National Research Training Program in Reproductive Medicine. This is a two-year grant that provides for protected research time with less clinical responsibilities. The UofL REI fellowship is one of the founding programs participating in this joint research training initiative administered by the University of Pennsylvania and the Society of Reproductive Endocrinology and Infertility (SREI). This T32 grant is funded by the Reproductive Sciences Branch of the National Institute of Child Health and Human Development.
The CREST Program
Fellows may enroll in the Clinical Research Epidemiology and Statistics Training (CREST) program offered by the Department of Epidemiology and Clinical Investigative Sciences located within the School of Public Health at University of Louisville. During the research portion of the fellowship, fellows can complete the coursework which leads to an MSc degree in Epidemiology-Clinical Investigation Sciences.
The MSc degree program provides physicians an opportunity to acquire the clinical research skills necessary for a career in an academic medicine.
The CREST curriculum integrates biostatistic and epidemiologic methods in a problem-based learning format with additional instruction in bioethics, health economics, health services, outcomes research, and social-behavior science. CREST is supported by a Clinical Research Curriculum Award (K30) from the National Institute of Health.
20 days + 10 Continuing Health Science Education days
1.5 days per month
Most of the first year fellow’s time is spent with the division’s faculty in direct preceptorship learning diagnosis and therapy options for patients with problems related to reproductive endocrinology and infertility. With increasing experience and skill, the fellow assumes more clinical responsibilities while under direct supervision.
Some time is devoted to the development of a clinical and/or a basic science research project. The fellow spends the first year becoming acquainted with the research faculty and facilities and surveying the known literature for a possible research question.
During the second year, there is increased emphasis on research productivity; intramural and extramural sources support these endeavors. The fellow spends most of the time with the basic science faculty learning to master laboratory research. A medical biostatistics course is completed during the second year.
The fellow has some clinical responsibility and attends two external clinical rotations in urology/male infertility and medical endocrinology.
The third year is divided into two areas of emphasis: ART and research.
Fellows increase their responsibility for patient care and assist in all aspects of the ART program.
Fellows complete clinical and/or basic science thesis projects that are presented at the end of the third year. Fellows are mentored throughout the investigation, manuscript development, and submission process to ensure optimal outcomes.
A rotation in pediatric endocrinology offers additional training in this subspecialty.
How to Apply
Please check the appropriate box when completing the common application at the Society for Reproductive Endocrinology and Infertility website: www.socrei.org/
Faculty members of the Division of REI include Henry C.L. Bohler, Jr., MD (associate professor, interim division and fellowship director); Christine L. Cook, MD (professor); Marvin A. Yussman, MD (professor); and Greg Christensen, PhD (laboratory director of assisted reproductive technology [ART] and andrology laboratories).
Research members of the department who have direct contact with the fellows through laboratory studies include Zhenmin Lei, MD, PhD (professor), and Amanda LeBlanc, PhD (assistant professor).
Others involved in fellowship education include Christopher G. Schrepferman, MD (urology, male infertility); Mary E. Fallat, MD (pediatric surgery); Yong Siow, PhD (pediatric surgery); Michael B. Foster, MD (pediatric endocrinology); Stephen J. Winters, MD (medical endocrinology); Joseph H. Hersh, MD, and Kara Goodin, MD (geneticists, Child Evaluation Center); Dennis O’Connor, MD (gynecologic pathology); and Gustavo Perez-Abadia, MD (microsurgery teaching laboratory).