Program
Clinical
The clinical facilities available for training in Reproductive Endocrinology include the UT Health Fertility Center, the University Health Center Downtown, University Hospital, Methodist Ambulatory Surgery Hospital, St. Luke’s Baptist Hospital, and the San Antonio Military Medical Center. The UT Health Fertility Center is located in the Medical Arts and Research Center Building (MARC).
The UT Health Fertility Center is a referral center for reproductive endocrinology and infertility patients in San Antonio and South Texas. The Fertility Center contains ancillary staffing and capital equipment sufficient for complete patient care, including dedicated procedure rooms, ultrasound machines with vaginal transducer and a full-service assisted reproductive technology (ART) and andrology laboratories. The Fertility Center functions for 10-12 half-day sessions per week, including weekends and holidays accommodating approximately 15-30 patients daily. Emphasis is placed upon treatment of difficult reproductive endocrine 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, robotic surgery, reconstructive surgery for external and internal reproductive tract abnormalities, and tubal microsurgery.
The University of Texas Health San Antonio (UTHSCSA) ART Program is located at the MARC Fertility Center. Approximately 410 embryo transfers are performed yearly. Gamete/embryo micromanipulation is performed, including intracytoplasmic sperm injection and assisted embryo hatching. Successful embryo and oocyte cryopreservation and donor oocyte and donor embryo programs are established. Preimplantation genetic testing procedures are also performed.
The Fellow in their first year of training will be primarily responsible for seeing patients at the Fertility Center. A designated faculty member is present at each session for supervision. Fellows also participate in reproductive surgery cases at University Hospital, MARC Ambulatory Surgical Center, Methodist Ambulatory Surgery Hospital, St. Luke’s Baptist Hospital. The third year fellow has a dedicated fellow’s clinic where they will diagnose and manage their own patients.
The Reproductive Endocrinology Clinic at the University Health Center Downtown meets one half-day per week (Monday afternoon) and is staffed by a faculty member in the Division. Fellows will supervise roughly one-fourth 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 and third years, fellows have the opportunity to attend the Medical and Pediatric Endocrine Clinics and gain additional Male Infertility experience with a Male Infertility specialist.
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
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, immunoassays, 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.
During the second year, fellows spend time in the basic science laboratory specific for their research interests and provides exposure and experience in molecular biology, cell biology, and ART laboratories.
In the Basic Science 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) molecular biology of reproductive tissues and the microbiome 3) mitogen mediated signal transduction during regulation of cell proliferation 4) Chlamydia and tubal factor infertility 5) Fibroid pathogenesis and 6) Recurrent Pregnancy Loss
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.
Also, the Division has participated in the Reproductive Medicine Network (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 (PPCOSII) trial was aimed at determining the efficacy of multiple medications designed to aid in the achievement of conception and a live birth outcome.
- For couples with unexplained infertility who undergo ovarian stimulation treatments, the RMN (AMIGOS) Multiple Gestations trial examined medications designed to reduce the occurrence of multiple gestational pregnancies.
Didactics
The educational component of the program includes didactics, weekly conferences and the options for formal courses in the Graduate School of Biomedical Science. Didactic instruction involves both basic science and clinical aspects of reproductive endocrinology.
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 American Board of Obstetrics and Gynecology 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 major areas of interest to reproductive biology: 1) molecular mechanisms of gene regulation, 2) reproductive physiology, 3) cell biology and 4) genetics 5) fertility evaluation and treatment. The Journal Club encourages fellows to keep abreast of new ideas and technical development, and often generates novel research investigations.
Graduate level courses in biostatistics and other graduate level course are optional. 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.
Winifred Mak MD, PhD
Associate Professor
Program Director
Patricia D. Gutierrez
Program Coordinator – Senior