Yale Reproductive Endocrinology and Infertility (REI) Fellowship program offers an interdisciplinary clinical and research training in all aspects of the subspecialty. The depth and breadth of clinical experience and the expertise of the faculty in clinical and basic research attracts patients with clinical issues across the spectrum of REI. In addition, the state-of-the-art equipment and facilities available to the trainees within the Division, the Department and the institution ensures that our trainees are well prepared to meet the rigorous requirements for board certification by the ABOG Division of Reproductive Endocrinology and Infertility and for professional excellence in their chosen career paths (both as academicians and clinicians).
The three-year fellowship program is structured to ensure attainment of proficiency in clinical and research domains of the subspecialty through systematic exposure to the clinical challenges and concepts and through hands-on training under direct supervision and guidance by the faculty. The goal of our fellowship is to provide trainees with exposure to the breadth of reproductive endocrinology and infertility subspecialty, ranging from issues pertaining to adolescent population, reproductive age women, to concerns unique to the perimenopausal and postmenopausal women, while ensuring that the trainees gain exposure to the evolving technologies pertinent to the care of infertile couples. Education of fellows is accomplished through hands-on clinical experience gained through one-on-one interaction with faculty during outpatient clinics, in-patient rounds and surgeries, and through regularly scheduled teaching conferences, seminars, and didactic instruction in both basic science and clinical aspects of the subspecialty.
The program is so designed that the trainee progressively attains proficiency in clinical reproductive endocrinology and office practice (Year I), research (Year II) and assisted reproductive techniques (Year III). The goal of this fellowship program is to ensure that the trainee is exposed to the breadth of the field of REI, and these experiences will help the trainee evolve into a sensitive and empathetic clinician and a critical thinker equipped with the requisites that would facilitate his/her role as an effective leader in the field.
Education of fellows is accomplished through hands on clinical experience gained through one-on-one interaction with and under direct supervision of faculty during outpatient clinics, in-patient rounds and in the operating room.
The first year of fellowship focuses on clinical issues relevant to reproductive endocrinology and infertility. During the first year of training, the fellow becomes proficient in conducting gynecological ultrasound evaluation and endoscopic surgical techniques including operative laparoscopy, robotic procedures, and operative hysteroscopy. He/she participates in assessing patients presenting with a diverse array of conditions and complaints ranging from pubertal concerns (such as precocious or delayed puberty), to menstrual irregularities (absent, infrequent or too frequent or disrupted menses), to common clinical entities (infertility, uterine fibroids, endometriosis, mullerian anomalies), to hormonal imbalance-related concerns (polycystic ovary syndrome, premenstrual dysphoric disorder), to concerns pertinent to aging women (menopausal symptoms, osteopenia and osteoporosis); in addition to participating in outpatient care of faculty patients, the clinical fellow gains experience in critical thinking, systematic evaluation of clinical challenges and with autonomy in management decisions through providing direct care to “Fellow List Patients” for whom the fellow acts as the primary subspecialty provider under direct supervision of a faculty member. The first year fellow operates with the division faculty members as the primary surgeon on all procedures, and serves as the primary surgeon for all subspecialty intra-operative consults, under the direct supervision of a faculty member. While the first year focuses on clinical REI, the first year fellow is additionally expected to become familiar with the basic principles of clinical research and is encouraged to initiate/participate in clinical research projects. It is expected that the first year fellow will have direct experience in the interpretation of all imaging procedures pertinent to care of REI patients, and will familiarize herself/himself with all histopathological diagnoses on surgical specimens of patients he/she has operated on. The first year fellow plays a major role in all decisions affecting patient clinical management and is part of a program that ensures continuity of patient care. At the end of the first year of fellowship, the trainee is expected to be fully competent and capable of performing patient assessment and relevant diagnostic procedures (such as sonohysterogram, hysterosalpingogram), and to be capable of undertaking therapeutic procedures common to the REI subspecialty, with the exception of in vitro fertilization. The performance of the fellow is evaluated through periodic formal appraisals by all participating faculty.
The second year is almost exclusively devoted to research-related experience. The fellows are encouraged to collaborate with any faculty member of the Department or any faculty member of the University with an established mentorship track record. Each fellow has the option of selecting or being assigned a research mentor. Department of Obstetrics, Gynecology and Reproductive Sciences at Yale is widely acclaimed for its mentoring record and offers a breadth of possibilities of collaboration with, and training by, an outstanding group of clinical and basic science faculty. Fellows are strongly encouraged to consult with the Program Director no later than January of the first year of fellowship so as to identify a mentor, and are expected to have identified a research project by April of the first year. Fellows are encouraged to seek guidance from senior fellows, faculty, as well as visit http://www.yaleobgyn.org/ to help identify potential research mentors.
It is in the second year that the fellow gets exposure to and gains proficiency in a breadth of laboratory techniques pertinent to REI-related research. The goal for the second year is to equip the trainee with requisite tools for conduct of his/her own research, and to ensure that the trainee develops a fundamental knowledge to be able to critically evaluate published literature. Basic science techniques and concepts that a fellow is expected to become familiar with during the research year of fellowship include but are not limited to tissue culture, immunohistochemistry, Western analysis, DNA-RNA analysis including polymerase chain reaction (PCR), and microarray and proteomic analyses. It is expected that each fellow will acquire a thorough knowledge and understanding of the methodologies and analyses used in research protocols that relate to research in their subspecialty. An in-depth understanding of the statistical methods and research project-specific methodology is mandatory. It is required that the fellow perform the research. Fellows must also acquire a thorough understanding (through direct research or didactic learning) of the theory and special methodology used to perform hormonal assays, receptor assays, molecular biological procedures, chromosomal analysis, gamete manipulation, embryo culture and cryopreservation.
Statistical analysis and quality control is an integral part of the curriculum. The second year is structured to allow interaction with a wide cadre of researchers and clinical scientists, and improves the fellow’s understanding of the latest scientific techniques. Each fellow chooses a specific area of research that will be the basis of a published thesis. In addition, clinical research projects initiated during the first year are continued during this year. Finally, although the second year fellow has limited exposure to patient care, he/she is expected to participate in patient care review conferences and participates in performing early morning ultrasound monitoring and intrauterine inseminations. The fellow participates, as in the first year, in regular teaching seminars. The performance of the fellow is evaluated through periodic formal appraisals by all participating faculty.
The third year of fellowship aims at completion of research projects and attainment of proficiency in assisted reproductive technologies (ART).
Not only are all fellows expected to complete and submit their thesis work to the program director by the conclusion of the 3rd year of fellowship, each 3rd year fellow is required to defend his /her thesis at a formal presentation to the departmental scientific and clinical faculty prior to graduation.
The 3rd year fellow also learns to critically analyze and understand the rationale behind the treatment protocol individualized for each patient undergoing ART. He/she is responsible for critically evaluating each patient designated to proceed with ART. In addition to performing transvaginal (and occasionally transabdominal) ultrasound guided oocyte retrievals, mock transfers and transvaginal aspiration of ovarian cysts, the 3rd year fellow is the primary person for the evaluation and management of any ART-related complication and unanticipated event. The fellow is additionally expected to spend some time in the embryology and andrology laboratories to gain insight into gamete handling and evaluation. It is in the 3rd year that the fellow gains proficiency in all aspects of in vitro fertilization, from patient evaluation and management to laboratory techniques, including micromanipulation.
Why Choose the Yale REI Fellowship
- Diversity, depth and breadth of the experience of Yale REI faculty (10 REI board certified or eligible faculty) ensure trainee exposure to clinical concerns ranging from adolescent gynecology, to spectrum of problems of reproductive age women and couples (including male and female infertility), to aging related issues (menopause and osteoporosis), to common endocrine problems (such as thyroid and adrenal dysfunction) and metabolic disorders that are increasingly encountered in the reproductive age population (such as diabetes, insulin resistance and dyslipidemias).
- High clinical volume (>1,000 new and >10,000 return patients/year) allows the trainees’ exposure to the spectrum of scenarios in our sub-specialty and attainment of training goals and trainee comfort with relevant procedures.
- Our trainees gain hands on exposure and participate actively in all aspects of infertility management including the spectrum of ART procedures (IVF, ICSI, egg donation and gestational surrogacy, and established and experimental fertility preservation procedures including embryo, oocyte and ovarian tissue cryopreservation), and male infertility management related procedures (including TESE and PESA).
- Exposure to and attainment of expertise in minimally invasive and robotic surgical procedures (>400 procedures/year).
- Access to a diverse array of consultative services within the Department and the Yale-New Haven hospital system that allows us the ability to provide care to patients with complex medial and surgical problems. Our trainees thus gain experience in management of clinical challenges of high complexity.
- Through a combination of structured series of didactics, departmental and on campus seminars, attendance at national meetings, and through opportunities for trainees to interact with authorities within the field (visiting faculty/lecturers and during national meetings), our program ensures that the educational mission of our fellowship is met for each trainee. Didactic sessions provided by over 20 faculty (divisional and institutional) ensure that the subspecialty curriculum for REI as specified by ABOG is covered twice over the course of 3 years of fellowship.
- During the three years of training, our fellows work closely with the Yale Ob/Gyn residents and acquire the requisite skills to become effective educators and peer mentors.
- Yale REI fellowship is committed to fostering excellence in research and takes pride in contributing to the leaders of tomorrow. Fellows have the opportunity of involvement in a wide array of research across the spectrum of the discipline including research relevant to oocyte biology, andrology, reproductive immunology, endometrial biology, endometriosis, steroid biochemistry and PCOS. Approximately 20,000 sq.ft laboratory space is available to 14 independent primary investigators who are directly associated with the division of REI and who welcome the involvement of REI fellows for the pursuit of thesis-related research. Those with an interest in clinical research have the opportunity of engaging in patient driven research and may pursue epidemiological data based analyses. Our fellows also have an opportunity of working with eminent scientists within the Yale University (including Joan Steitz, PhD, Haifan Lin, PhD, Tamas Horvath, PhD, DVM) who are or have previously mentored our fellows. Our commitment to fellows’ research is reflected by the publication records of our current and past fellows (Mol Cell, Endocrinology, Mol Syst Biol, PNAS).
- Our goal is to ensure our fellows’ ongoing success beyond completion of their training. Our program prioritizes that those committed to academia have access to the resources and mentorship that will ensure a successful transition to independence (within the past 10 years, 4 of our fellows have received K level training grants (for physician scientists) and 2 have already been awarded R01 funding from the NIH).