MCh in Reproductive Medicine and Surgery: Admissions, Medical Colleges, fees, eligibility criteria details

MCh Reproductive Medicine and Surgery or Master of Chirurgiae in Reproductive Medicine and Surgery also known as MCh in Reproductive Medicine and Surgery is a super speciality level course for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of this super speciality course is 3 years, and it deals with the prevention, diagnosis, and management of reproductive problems. It also deals with the issues of sexual education, puberty, fertility control, reproductive system disease (including sexually transmitted diseases), sexual dysfunction, pregnancy and menopause. 

The course is a full-time course pursued at various recognized medical colleges across the country. Some of the top medical colleges offering this course include Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, Kasturba Medical College, Manipal, Karnataka, and National Institute of medical science and research, Jaipur.

Admission to this course is done through the NEET-SS Entrance exam conducted by the National Board of Examinations, followed by counselling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing MCh (Reproductive Medicine and Surgery) varies from college to college and may range from Rs.6,900 to Rs 2,00,000 in government colleges per year and Rs.2,07,000 to Rs.29,00,000 in private colleges.

After completion of their respective course, doctors can either join the job market or can pursue certificate courses and Fellowship programs recognized by NMC and NBE. Candidates can take reputed jobs at positions as Senior residents, Consultants, etc. with an approximate salary range of Rs 15 lakhs to Rs. 30 lakhs per annum.

What is MCh in Reproductive Medicine and Surgery?

Master of Chirurgiae in Reproductive Medicine and Surgery, also known as MCh (Reproductive Medicine and Surgery) or MCh in (Reproductive Medicine and Surgery) is a three-year super speciality program that candidates can pursue after completing a postgraduate degree.

Reproductive Medicine and Surgery is the branch of medical science dealing with the prevention, diagnosis, and management of reproductive problems.

It also deals with the issues of sexual education, puberty, fertility control, reproductive system disease (including sexually transmitted diseases), sexual dysfunction, pregnancy and menopause. 

National Medical Commission (NMC), the apex medical regulator, has released a Guidelines for Competency-Based Postgraduate Training Programme for MCh in Reproductive Medicine and Surgery.

The Competency-Based Postgraduate Training Programme governs the education and training of MCh in Reproductive Medicine and Surgery.

The postgraduate students must gain ample knowledge and experience in the diagnosis, and treatment of patients with acute, serious, and life-threatening medical and surgical diseases.

PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Reproductive Medicine and Surgery would help the specialist to recognize the health needs of the community. The student should be competent to handle medical problems effectively and should be aware of the recent advances in their speciality.

The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of MCh in Reproductive Medicine and Surgery

The eligibility criteria for MCh in Reproductive Medicine and Surgery are defined as the set of rules or minimum prerequisites that aspirants must meet to be eligible for admission, which include:

Note:

• The prior entry qualifications shall be strictly by Post Graduate Medical Education Regulations, 2000, and its amendments notified by the NMC and any clarification issued from NMC in this regard.
• The candidate must have obtained permanent registration with any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off dates for the Postgraduate Degree courses shall be as prescribed by the Medical Council of India (now NMC).

Admission Process

The admission process contains a few steps to be followed in order by the candidates for admission to MCh in Reproductive Medicine and Surgery. Candidates can view the complete admission process for MCh in Reproductive Medicine and Surgery mentioned below:

• The NEET-SS or National Eligibility Entrance Test for Super speciality courses is a national-level master's level examination conducted by the NBE for admission to DM/MCh/DrNB Courses.
• Qualifying Criteria-Candidates placed at the 50th percentile or above shall be declared as qualified in the NEET-SS in their respective speciality.
• The following Medical institutions are not covered under centralized admissions for DM/MCh courses through NEET-SS:

1. AIIMS, New Delhi, and other AIIMS

2. PGIMER, Chandigarh

3. JIPMER, Puducherry

4. NIMHANS, Bengaluru

• Candidates from all eligible feeder speciality subjects shall be required to appear in the question paper of the respective group if they are willing to opt for a super speciality course in any of the super speciality courses covered in that group.
• A candidate can opt for appearing in the question papers of as many groups for which his/her Postgraduate speciality qualification is an eligible feeder qualification.
• By appearing in the question paper of a group and on qualifying for the examination, a candidate shall be eligible to exercise his/her choices in the counselling only for those super speciality subjects covered in the said group for which his/ her broad speciality is an eligible feeder qualification.

Fees Structure

The fee structure for MCh in Reproductive Medicine and Surgery varies from college to college. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for MCh in Reproductive Medicine and Surgery is from Rs.6,900 to Rs 2,00,000 per year in government colleges and Rs.2,07,000 to Rs.29,00,000 per year in private colleges.

Colleges offering MCh in Reproductive Medicine and Surgery.

Various medical colleges across India offer courses for pursuing MCh in (Reproductive Medicine and Surgery).

As per National Medical Commission (NMC) website, the following medical colleges are offering MCh in (Reproductive Medicine and Surgery) courses for the academic year 2022-23.

An MCh in Reproductive Medicine and Surgery is a three years specialization course that provides training in the stream of Reproductive Medicine and Surgery.

The course content for MCh in Reproductive Medicine and Surgery is given in the Competency-Based Postgraduate Training Programme released by National Medical Commission, which can be assessed through the link mentioned below:

The outline of the syllabus is given below:

Competencies to be acquired in the Cognitive domain (knowledge):

1. Basic Sciences Relating to Reproductive Medicine and Surgery

(1) Reproductive tract Anatomy

(2) Reproductive Physiology and Endocrinology

(3) Reproductive Pharmacology

(4) Reproductive Pathology

(5) Pediatric and Adolescent Gynecology

(6) Menopause and Premature Menopause

2. Principles of Reproductive Medicine and Laboratory Techniques

(1) Assisted Reproductive Techniques – Clinical perspective

(2) Imaging Techniques in Infertility

(3) Andrology and Applied urology

(4) Embryology and ART Laboratory

(5) Early Pregnancy Problems

3. Fertility associated Medical and Surgical Diseases, Genetics, Counseling, Ethical and Legal issues related to ART

(1) Fertility-associated Medical and Surgical Diseases

(2) Reproductive Genetics

(3) Ethical and legal issues

(4) Patient Counseling and Management Skills

4. Recent Advances in Reproductive Medicine and Surgery

The outline of the syllabus is given below:

Competencies to be acquired in the Cognitive domain (knowledge):

1. Basic Sciences Relating to Reproductive Medicine and Surgery

(1) Reproductive tract Anatomy

(2) Reproductive Physiology and Endocrinology

(3) Reproductive Pharmacology

(4) Reproductive Pathology

(5) Pediatric and Adolescent Gynecology

(6) Menopause and Premature Menopause

2. Principles of Reproductive Medicine and Laboratory Techniques

(1) Assisted Reproductive Techniques – Clinical perspective

(2) Imaging Techniques in Infertility

(3) Andrology and Applied urology

(4) Embryology and ART Laboratory

(5) Early Pregnancy Problems

3. Fertility associated Medical and Surgical Diseases, Genetics, Counseling, Ethical and Legal issues related to ART

(1) Fertility-associated Medical and Surgical Diseases

(2) Reproductive Genetics

(3) Ethical and legal issues

(4) Patient Counseling and Management Skills

4. Recent Advances in Reproductive Medicine and Surgery

I. Basic Science Relating to Reproductive Medicine and Surgery

1. Reproductive tract anatomy

Objectives: To understand and demonstrate appropriate knowledge, skills, and attitudes about the anatomy of the female and male reproductive tract

Knowledge Criteria

Female:

Uterine anatomy and histology:

• Normal anatomy

• Histology of myometrium

• Different types of congenital abnormalities, their impact on fertility, and their management

Endometrial histology:

• Histological appearance of normal and abnormal endometrium

• Developmental stages of the endometrium (dating)

• Endometrial factors that affect implantation in early pregnancy

Tubal anatomy and histology:

• Normal anatomy

• Different types of congenital abnormalities

Vaginal and cervical anatomy and histology:

• Normal anatomy and histology

• Possible consequences of antenatal hormone exposure

• Effects of various hormones on the vagina and cervix

Ovarian anatomy and histology:

• Different compartments of the Graafian follicle (e.g. granulosa cells, theca, and adjacent stroma) and the primordial, pre-antral, antral and Graafian follicles, including the dynamic changes which occur in the ovary from embryo to menopause.

• Specific staining techniques and cellular ultrastructure as related to function.

• Gross and microscopic findings and the development of gonadal structures.

Pelvic anatomy, blood, nerve, and lymphatic supply Embryology:

• Development of embryo and abnormalities in the development of the genital tract

• Embryology of the urological system

• Embryology of hypothalamic-pituitary and other pertinent endocrine systems

Male:

Male Genital Organs Penis

• Anatomy and histology, blood, nerve, and lymphatic supply

Scrotum

• Anatomy and histology, development, blood, nerve, and lymphatic supply Testes

• Normal anatomy and development of the testis

• Stages of normal spermatogenesis.

Accessory structures

• Normal anatomy and development of epididymis, vas deferens, seminal vesicle and other accessory organs

Clinical Competencies:

• Take history and perform an appropriate physical examination to understand the anatomy

• Interpret ultrasound report of the male and female genital tract

• Discuss the diagnosis of developmental abnormality of the genital tract

• Understand normal ovulation and spermatogenesis

• Understand embryogenesis and implantation

Professional Skills and Attitudes:

• Ability to explain to the patient normal reproductive anatomy

• Knowledge and skills to understand the anatomical abnormality in ultrasound reports and explain the same to the patient

• Ability to explain the normal process of ovulation and spermatogenesis

• Ability to discuss the normal process of fertilization with the patient

• Ability to counsel patients sensitively about anatomical abnormality

• Ability to formulate a management plan related to an anatomical abnormality

• Ability to implement a plan of management and modify the same, if necessary

2. Reproductive Endocrinology

Objectives

To understand and demonstrate appropriate knowledge, skills and attitudes about female and male reproductive endocrinology.

Knowledge Criteria

Female

Neuroendocrine anatomy and physiology

• Neuroendocrine function: central nervous system, hypothalamic-pituitary system in normal and disease states

• Neuroendocrine regulation of the menstrual cycle and ovulation

• Neuroendocrine control of fetus and placenta

• Hypothalamic and pituitary disorders

• Thyroid function and disease states

• Adrenal function and disease states

Disorders of androgen secretion

• Evaluation and management of a hirsute women

• Polycystic ovary syndrome

Male:

• Endocrine profile of male

• Physiology of Spermatogenesis

• Physiology of ejaculation

• Hypothalamic-pituitary-thyroid axis function

Clinical Competencies:

• To take history and perform an appropriate examination.

• To perform and interpret results of endocrinological tests (Hormone evaluation)

• To discuss the causes of anovulation, such as syndromes of inappropriate prolactin secretion, central nervous system-hypothalamic - pituitary and hypothyroidism

• To plan the evaluation of a patient with hyperandrogenism

• To plan the evaluation of a patient with azoospermia and sexual dysfunction

Professional Skills and Attitudes:

• Ability to explain to the patient the normal reproductive hormones and their functions

• Ability to make the patient understand changes in hormones due to disease processes.

• Ability to explain the need for various tests according to the symptoms and signs

• Skill to interpret hormone assay reports and make the patient understand the need for the treatment

• Ability to understand the validity of diagnostic tests, variability and reliability criteria.

3. Reproductive Pharmacology

Objectives

To understand and demonstrate appropriate knowledge, skills and attitudes about drugs used in infertility

Knowledge Criteria

Pharmacokinetics and pharmacodynamics of drugs used in reproductive medicine:

• Drugs used for ovulation induction:

Anti-estrogens Aromatase inhibitors Gonadotrophin therapy

Metformin/insulin sensitizers

• Drugs used for HRT

Oestrogens Progesterone Aspirin

• Drugs used for Hirsuitism
• Drugs used for the treatment of endometriosis
• Oral contraceptive pills
• Antibiotics in ART
• Drugs used in the treatment of precocious puberty
• Drugs used in the treatment of hyperprolactinemia
• GnRH analogues and antagonists
• Steroids and infertility
• Drugs for sexual function

Clinical Competencies:

• To understand the mechanism of action of various drugs used in infertility treatment

• To plan the choice of drugs for various conditions depending on indications and contraindications

• To manage complications of various drugs used in infertility

Professional Skills and Attitudes

• Ability to counsel patients clearly regarding the need for drug administration and its effect on the disease processes.

• Able to explain alternate treatment options, if available

• Able to explain clearly and openly the adverse effects of drug treatment and the need for regular follow-up, when on medication.

• Ability to recognise the adverse effects of the drug and able to manage it

4. Reproductive Pathology

Objectives

To understand and demonstrate appropriate knowledge, skills and attitudes about pathological conditions in the female and male reproductive tract

Knowledge Criteria

Uterine pathology:

• Impact of intrauterine adhesions

Female:

• Impact of fibroids and adenomyosis

• Current data relating estrogens with endometrial hyperplasia and adenocarcinoma

• Acute and chronic endometritis

• Gross and microscopic findings of endometriosis

• Gross and microscopic findings of adenomyosis, leiomyoma and other myometrial lesions related to reproduction

• Relationships of leiomyoma to infertility, including each of the different types (e.g. subserosal, intramural and submucosal)

Tubal pathology:

Gross and microscopic findings of diseases of the oviduct (e.g. acute and chronic salpingitis, granulomatous salpingitis, endometriosis)

Tubal factors of infertility:

• Natural history and clinical course of acute and chronic salpingitis and relate these to subsequent fertility

• Hydrosalpinx – aetiology and management

Ovarian pathology:

• Ovarian cysts and tumours

• Gross and microscopic findings and natural history of ovarian tumours related to reproductive function (e.g. follicular cysts, luteoma, corpus luteum, polycystic ovary Syndrome, endometrioma, granulosa-theca cell tumour, Sertoli-Leydig cell tumour, gynandroblastoma, cystic teratoma, dysgerminoma, gonadoblastoma and mixed germ cell or gonadal tumours)

PELVIC INFLAMMATORY DISEASE (PID)

Pelvic Tuberculosis Para ovarian cyst Endometriosis

• Pathogenesis and aetiology of endometriosis

• Symptoms

• Mechanisms by which minimal and mild endometriosis may impair fertility.

• Investigations: Ultrasound/computed tomography/magnetic resonance imaging.

• Effects on fertility

• Disturbances in the peritoneal fluid environment

• Diagnosis, staging/grading of disease and prognosis

• Place of expectant management, medical and surgical treatment in the management of

• endometriosis

• Role, possible benefits and potential adverse effects of pharmacological agents, e.g. Oral Contraceptives, progestogens, danazol, gestrinone, Gonadotrophin Releasing Hormone (GnRH) analogues, in the management of endometriosis

• Role of assisted reproduction in the management of endometriosis.

• Pain management

Male:

• Gross and microscopic findings in testicular disease (e.g. teratoma, seminoma, Leydig and Sertoli cell tumours)

• Diseases of accessory organs – seminal vesicle and epididymis

• Absence of vas deferens – diagnosis and management

• Testicular biopsy - its interpretation

• Varicocele – Aetiology, diagnosis, symptoms, grading and management.

• Infections of male genital organs

Clinical Competencies:

• To differentiate different types of uterine anomalies, their impact on fertility and management

• To diagnose and plan the management of intra-uterine adhesions

• To know the natural history, pathological changes, and clinical course of acute and chronic Salpingitis and relate these to subsequent fertility

• Vaginal and cervical anatomy and histology: effect of various hormones

• Endometriosis and its effects on fertility

• Aetiology of PID and its effect on fertility

• Diagnostic features of adenomyoma and fibroid uterus

• Diagnosis of different types of ovarian tumours /cysts

• Interpretation of the testicular biopsy report

• Diagnose the absence of vas and formulate a plan of management

• Diagnose and manage male genital organ infections

Professional Skills and Attitudes

• Ability to counsel patients regarding the disease processes and their effect on reproductive health

• Ability to respect patients' confidentiality regarding the disease process

• Ability to formulate and implement a plan of management and discuss it with the patient

• Ability to counsel patients sensitively about the treatment options available for the disease

• Ability to explain clearly and openly about complications of the various treatments that are available for the disease

5. Reproductive Immunology

Objectives

To understand and demonstrate appropriate knowledge, skills and attitudes about immunological aspects and failures of the female and male reproductive system

Knowledge Criteria

Female:

• Immunology of pregnancy

• Allo- and auto- immunological failures

• Repeated pregnancy loss and implantation failure

Male:

• Immunological reproductive failure in men/sperm antibodies.

6. Pediatric and Adolescent Gynaecology

Objectives

To understand and demonstrate appropriate knowledge, skills and attitudes in pediatric and adolescent gynaecological problems

Knowledge Criteria Development of gonads

• Factors controlling the development of the gonadal primordia, internal duct system and external genitalia in male and females, Normal sequence of pubertal changes in the female and male and their chronology

• Hormonal changes and gametogenesis relative to the reproductive cycle: from intrauterine life to the development of normal reproductive cycles (e.g., gonadotrophin secretion in the fetus and the neonate, sensitivity of the feedback system during fetal and neonatal life and childhood; the role of adrenal androgens).

• Delayed puberty including differential diagnosis, evaluation and appropriate therapy

• Developmental abnormalities of the genital tract including ambiguous genitalia, imperforate hymen and vaginal septa

• Uterine anomalies: Müllerian and Wolffian dysgenesis

• Rokitansky syndrome

• Gonadal dysgenesis

• Effects of hormones on bone growth and epiphyseal closure

• Sexual precocity including differential diagnosis, evaluation and appropriate therapy.

• Ambiguous genitalia: Differential diagnosis and its evaluation

• Involvement in the assignment of sex of rearing of infants with ambiguous genitalia,

• Techniques for surgical reconstruction (e.g. vaginoplasty, clitoridectomy and

• clitoral resection)

• Indications and techniques for gonadectomy

• Delayed puberty and primary amenorrhea

• Androgen insensitivity syndrome

• Congenital Adrenal hyperplasia.

Clinical Competencies:

• Take history and perform an appropriate clinical examination.

• Organise appropriate endocrine investigation of disordered ovulation.

• Select and manage appropriate treatment for PCOS.

• Management of hyperandrogenism and ambiguous genitalia

Professional Skills and Attitudes:

• Ability to counsel patients and their parents about changes in reproductive organs during adolescence

• Educate the patient regarding the menstrual cycle, ovulation and its disturbances

• Educate the patient and their parents regarding precocious puberty and the need to treat it

• Ability to understand and advise steps to prevent long-term health consequences in PCOS

• Ability to counsel the patient regarding assigning of sex in cases of ambiguous genitalia

• Ability to educate patients regarding developmental genital tract anomalies and their effects on reproduction

7. Menopause and premature Menopause

Objectives: To understand and demonstrate appropriate knowledge, skills and attitudes in menopause and premenopausal problems

Knowledge Criteria

Predictors of Ovarian reserve

Premature menopause:

• 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 acquired disorders (post-surgery, chemo/radiotherapy)

• Management of the post-menopausal woman

• Interpretation of tests used to evaluate amenorrhoea

• A rational diagnostic and therapeutic approach to patients with amenorrhoea

• Choice of hormone replacement therapy (HRT)

• Advantages and disadvantages, risks and benefits of HRT

• Treatment options for young women with ovarian failure, with particular regard to future fertility

Clinical Competencies:

• A rational diagnostic and therapeutic approach to patients with amenorrhea.

• Liaison with fertility services.

• To plan immunological investigations when required

• Interpretation of dual-energy X-ray absorptiometry bone scans.

• To plan HRT explaining the risks involved and advise appropriate follow up

• Plan for donor oocyte program

Professional Skills and Attitudes

• Ability to counsel patients regarding hormonal changes in menopause and premature menopause

• Ability to analyse and discuss with patients the results of ovarian reserve testing

• To counsel patients with ovarian failure and treatment options available to have a baby

• Ability to counsel patients with ovarian failure regarding the need for HRT.

• Ability to explain clearly and openly the adverse effects of HRT and the need for follow-up when the patient is on HRT.

II. Principles of Reproductive Medicine and Laboratory Techniques

1. Assisted Reproductive Techniques - Clinical perspectives

Objectives

To demonstrate knowledge and competency about patients requiring ovulation induction and assisted conception

Knowledge Criteria

Normal ranges in:

• semen parameters
• endocrine profile: female and male

Ovulation induction

• anti-estrogens and aromatase inhibitors

• gonadotrophins Hyperprolactinemia Stimulation Protocols:

• Long Gonadotrophin-Releasing Hormone (GnRH) protocol

• Short GnRH protocol

• Ultra Short and micro flare protocol

o Stop protocol

o Newer protocols

• GnRH antagonist cycles

• In vitro Fertilisation (IVF).

• Intra cytoplasmic sperm injection (ICSI )

• Frozen embryo replacement:

• Natural cycle

• HRT cycle

• Luteal support

• Donor–recipient cycle

• Donation of Oocyte and Sperm

• Screening of potential egg donors

• Surrogacy

• Egg sharing

• Cryo preservation of gamete, embryo, and tissue.

• In Vitro oocyte maturation

• Management of complications including Ovarian Hyper Stimulation Syndrome.

Clinical Competencies:

• Take the history of infertile couples.

• Examination of the infertile couple:

• Arrange investigations

• Interpret semen analysis

• Interpret endocrine profile: female and male

• Organise and counsel appropriate treatment to an infertile couple

• Ovulation induction: anti-estrogens, gonadotrophins

• Intrauterine insemination

• Plan protocol for patients scheduled for ART

• Plan for Frozen embryo replacement and Donor–recipient cycle

• Ultrasound/Imaging for Follicular, Endometrial development, Uterine abnormalities

• Ovarian pathology

• Oocyte retrieval and Embryo replacement

• Know the different methods of sperm retrieval in patients with azoospermia

• Counsel couples on different aspects of infertility treatment

• Critical awareness of the limitations of investigative procedures

Professional Skills and Attitudes

• Ability to explain clearly the probable cause of infertility and plan treatment for the couple

• Ability to counsel patients regarding the ART procedures available

• To explain in detail the complications of ART

• Ability to understand the limitations of the ART procedures

• To make the patient understand the adverse effects of drugs used for controlled ovarian stimulation

2. Imaging Techniques in Infertility

Objective

To demonstrate the knowledge, skills and attitudes relating to all aspects of imaging techniques in male and female infertility evaluation.

Knowledge Criteria

• Uterine and tubal imaging

• Hysterosalpingography

• Hysterosalpingo-contrast-sonography

• Saline sonosalpingohysterogram

• Computed tomography (CT) / magnetic resonance imaging (MRI

Evaluation of pituitary fossa: X-ray skull, MRI and CT Ultrasound imaging: Abdominal and TVS:

• Follicular tracking: natural/simulated cycles

• Tracking IVF endometrial development

• Uterine abnormalities eg: fibroids, adenomyosis, anomalies

• Endometrial assessment, including normal cyclical changes, changes associated with hormone replacement, hyperplasia and malignancy

• Ovarian pathology

• Early pregnancy assessment

• Oocyte retrieval

Ovarian and uterine Doppler in Infertility Selective Fetal reduction

Clinical Competencies

• Hysterosalpingography

• Contrast sonohysterosalpingogram

• Reading CT/MRI

o Ultra Sonography

o Follicular tracking: natural / stimulated cycles

o Tracking IVF endometrial development

o Uterine abnormalities eg: fibroids, adenomyosis

o Endometrial assessment, including normal cyclical changes, changes associated with hormone replacement, hyperplasia and malignancy

o Ovarian pathology

o Early pregnancy assessment

o Oocyte retrieval

Professional Skills and Attitudes

• Ability to counsel patients about the need for various diagnostic imaging procedures

• Ability to describe the limitations of various diagnostic imaging procedures

• Ability to distinguish the use of different modalities of ultrasonography and Doppler

• Ability to perform abdominal and transvaginal ultrasonography and to interpret findings of ultrasonography and explain it to the patient

• Ability to perform follicular monitoring and identify the signs of ovulation and advice the patient regarding the fertile period

• Ability to perform, interpret and explain to the patient the report of an early pregnancy scan or differential diagnosis of early pregnancy loss / abnormal pregnancy.

3. Andrology and Applied Urology

Objectives

To demonstrate knowledge and competency about men with fertility problems.

Knowledge Criteria

• Appropriate history and investigations

• Assessing sperm function

• Intrauterine insemination

• Investigation of male infertility

• Assessment and management of Erectile dysfunction

• Ejaculatory dysfunction

• Varicocele

• Reconstructive andrology

Methods of sperm retrieval

• Microsurgical epididymal sperm aspiration

• Percutaneous epididymal sperm aspiration

• TESA/TESE

• Open testicular biopsy

Medical treatment of male infertility:

• Antioxidant therapy

• Aromatase therapy

• Anti-estrogens

• Endocrine therapy

• Effect of ageing on sperm function

• Genetic causes for male infertility

Sperm banking:

• Counsel about sperm banking, pre-oncology treatment and before vasectomy - Indian Council of Medical Research (ICMR) – ART GUIDELINES

• HEFA Code of practice

Clinical Competencies:

• Take the appropriate history of a subfertile male:

• Examination of subfertile male

• Arrange investigations

• Interpret semen analysis

• Interpret endocrine profile: male

• Investigation of male infertility

• Form an appropriate management plan.

• Counsel about sperm banking: prior-oncology treatment

• Treatment:

o Endocrine therapy

o Gonadotrophin therapy

o Sexual Dysfunction-Evaluation and management

o Reconstructive Surgery in male reproductive failure

Professional Skills and Attitudes

• Ability to evaluate semen analysis and hormonal assay reports

• Ability to counsel the couple about the disease process/es in the male partner which could be the cause of infertility.

• Ability to formulate a plan of treatment related to pathological findings and discuss it with the couple

• Ability to explain the necessary drug treatment/s and its complication

• Counseling the couple regarding sexual dysfunction and its appropriate management

• Ability to choose between ART vs Surgical management in male factor infertility (varicocelectomy, reconstructive surgery)

4. Embryology and ART laboratory

Objective

To demonstrate the knowledge, skills and attitudes relating to all aspects of Embryology and ART laboratory

Knowledge Criteria Clinical Embryology

• Cell Biology

• History and overview of ART

• Instruments used in IVF

Introduction to embryology

• Fertilization and Embryo development

• Control of early follicular development

• Control of terminal follicular development

• Oocyte maturation – In vivo

• IVM

• Gamete transport

• Implantation

• Endocrinology of implantation

• Molecular basis of fertilization

• Gene expression in early embryos

• Epigenetic events in early embryos

ART laboratory

• Maintenance of ART lab

• Media for ART procedures

• Semen preparation techniques

• Collection and culture of oocytes and embryos

• Grading of oocytes and embryos

• IVF and ICSI, TESE

• IVM

• Embryo transfer techniques

• Cryopreservation of embryo, gametes, tissue

• Assisted hatching

Regulation and Ethics in Embryology

• ART and law

• Semen banks and donor sperms

• Ethics – case studies

• Counseling

Clinical Competencies:

• Embryology lab setup and maintenance of equipment

• Culture media selection

• Semen preparation methods

• Methods of fertilization

• Culture methods

• Grading of the oocyte and embryo

• Cryopreservation techniques

• Embryo transfer

• Semen bank

• Ethics in embryology

Professional Skills and Attitude:

• Ability to respect patient's confidentiality regarding the chosen ART procedure

• Ability to explain clearly and openly different techniques of fertilization in ART

• Ability to formulate a line of treatment and choose the method appropriate for the couple

• Ability to liaise effectively with colleagues in other disciplines, clinical and non-clinical (e.g. andrologists, endocrinologists, IVF centre team and urologists).

• Ability to describe limitations of the ART procedures.

• Ability to understand the oocyte and embryo morphology

• Ability to set up, maintain and supervise the Lab

• Troubleshooting in the Lab

• Quality control of the Lab

5. Early Pregnancy Problems

Objective: To demonstrate the knowledge skills and attitudes related to early pregnancy and its complications

Knowledge Criteria Ectopic pregnancy:

• Causes

• Investigations

• Medical management

• Surgical management

Miscarriage:

• Causes

• Investigations

• Medical management

• Surgical management

Molar pregnancy Multiple pregnancies

Clinical Competencies:

Recurrent miscarriage:

• Take history:

Pregnancy history Medical history

• Organise appropriate investigations

• Interpret endocrine assessment

• Interpret immunological assessment

• Formulate a management plan

• Liaise with colleagues in other disciplines.

Molar pregnancy

Counsel about:

• Causes of miscarriage

• Treatment options

• Implications following molar pregnancy.

Manage clinical conditions:

• Antiphospholipid syndrome

• Uterine abnormalities.

Emergency gynaecology:

• History and examination

• Organise appropriate investigations

• Interpret endocrine assessment

• Formulate a management plan

Clinical Competencies:

• USG confirmation of intrauterine gestational sac with the embryo, yolk sac, cardiac pulsation and assessment of gestational age.

• Diagnose ectopic pregnancy and heterotropic pregnancy

• Surgical and medical management of ectopic pregnancy

• Medical and surgical management of miscarriage

• Plan the management of multiple pregnancies

Professional Skills and Attitudes:

• Ability to explain the problems of early pregnancy and to emphasise the need for early pregnancy scans.

• Ability to discuss the management options and the risk of complications associated with higher-order multiple pregnancies, with the patient.

• Ability to discuss causes of miscarriage and therapeutic options

III. Fertility associated Medical and Surgical Diseases, Genetics, Counseling, Legal and Ethical issues related to ART

1. Fertility-associated Medical and Surgical Diseases

Objectives

To achieve skills appropriate for a subspecialist in managing Medical and Surgical diseases related to Infertility.

Knowledge Criteria

• Anatomical systems about human reproduction.

• Medical diseases associated with fertility.

• Basics of surgery (laparotomy)

• Basics of laparoscopy

• Basics of hysteroscopy

• Role of endoscopic and open surgery in the treatment of fertility-related conditions

• Indications for diagnostic and operative laparoscopy

• Indications for diagnostic and operative hysteroscopy

• Complications of endoscopy & open surgery

• Tubal Recanalization – laparoscopic and open surgery method

• Principles of microsurgery

• Post-operative adhesion preventive measures

• Role of fertility-enhancing surgery in men

• Role of reconstructive microsurgery surgery for male infertility

• Varicocelectomy– diagnosis, indications and complications

• Methods of surgical sperm retrieval

• Surgical management of ectopic pregnancy

Clinical Competency Laparoscopic surgery:

• Diagnostic laparoscopy

• Treatment of minimal/mild endometriosis

• Treatment of ovarian endometrioma

• Treatment of ovarian dermoid

• Division of adhesions

• Salpingectomy for hydrosalpinx

• Salpingostomy for hydyoslapinx

• Salpingectomy for ectopic pregnancy

• Salpingostomy for ectopic pregnancy

• Laparoscopic myomectomy

• Ovarian diathermy.

Hysteroscopic surgery:

• Diagnostic hysteroscopy

• Outpatient hysteroscopy

• Resection of fibroid

• Resection of polyp

• Division of septum

• Division of adhesions

• Proximal tubal cannulation

Open fertility surgery:

• Reversal of sterilisation

• Myomectomy

• Excision of vaginal septum

• Imperforate hymen

• Excision of the rudimentary horn of the uterus

• Hysterectomy for severe endometriosis.

• Reversal of vasectomy

• Vasectomy

• Ligation of varicocele

• Percutaneous epididymal sperm aspiration

• Open testicular biopsy

• Testicular Sperm Aspiration

Surgery in Males:

• Ligation of varicocele

• Sperm retrieval techniques: PESA, MESA, FNAC of the testis (TESA) and Open Testicular biopsy (TESE)

Professional Skills and Attitudes

Ability to diagnose the medical disease associated with infertility and plan appropriate treatment.

Ability to choose the correct surgical procedure for the disease process and explain it in detail to the patient

Ability to explain clearly and openly the complications of the surgery. To counsel the patient about the reproductive performance after the surgery Ability to plan the correct method of surgical sperm retrieval

Able to choose between reversal of sterilization and ART procedures for patients and counsel them appropriately

2. Reproductive Genetics:

Objective: To demonstrate the knowledge, skills and attitudes relating to Reproductive Genetics

Knowledge Criteria

• Genetic history and counselling

• Cell cycle and biology

• Approach to chromosome analysis

• International System for Human Cytogenetic Nomenclature

Normal variation:

• Banding techniques

• Prenatal diagnosis

• Cell culture and processing

• Preimplantation genetic diagnosis

• Preimplantation genetic screening

Basis of genetic inheritance and transmission of genetic disease:

• Single gene disorders: recessive and dominant

• Sex-linked disorders

• Late-onset disorders and disease susceptibilities

• Chromosome rearrangements: Robertsonian reciprocal translocations and their consequences

• Aneuploidy, sporadic aneuploidy and important aneuploidy syndromes (e.g. Edwards, Turner, Patau).

Tools for genetic diagnosis

• Cytogenetics

• Molecular cytogenetics: Principles and application

Clinical Competencies:

• Genetic history and counselling

• Cell cycle and biology

• Approach to chromosome analysis

• International System for Human Cytogenetic Nomenclature

• Normal variation

• Banding techniques

• Prenatal diagnosis

• Cell culture and processing

• Preimplantation genetic diagnosis and screening

Professional Skills and Attitudes

• Ability to counsel patients regarding genetic causes of infertility

• Ability to plan chromosomal and genetic studies in an infertile couple when indicated and explain it to the couple

• To interpret the results and counsel the patient about the consequences of the abnormal report

• Clinical awareness of the limitations of chromosomal and genetic studies in the evaluation of infertility

• Use of Preimplantation Genetic Screening (PGS) and preimplantation genetic diagnosis (PGD) procedure in patients undergoing ART

3. Ethical and legal issues

Objectives

To demonstrate knowledge of various Guidelines in ART

Knowledge

Regulations of Assisted Reproductive Technology

ICMR guidelines in ART

1. Staff

2. Facilities

3. Assessing Clients, Donors and the Welfare of the Child

• Confidentiality

• Assessment of potential gamete donors

4. Information

5. Consent

6. Use of gametes and embryos

7. Storage and handling of gametes and embryos

8. Third-party reproduction: rules & guidelines

9. Cross-border reproduction: problems and guidelines

10. Adoption Guidelines

Clinical Competencies:

• Guidelines in ART – ICMR, ASRM, ESHRE and guidelines of other fertility societies

• Consent taking and the importance of documentation

• Adoption procedure

• Third-party reproduction- ethical and legal issues

• Guidelines on the number of embryos to be transferred

• Posthumous reproduction - ethics and legal issues

• Storage and use of frozen gametes and embryos

Professional Skills and Attitudes:

• Ability to counsel and take consent for ART procedure as per the guidelines

• Ability to explain the ethical and legal issues in third-party reproduction

• Ability to discuss the success rate and the cost involved in ART and to document it

• To discuss the complications of ART and to document it in the case sheet

• Maintenance of the IVF unit record as per guidelines

• Ability to discuss the adoption guidelines and guide them to appropriate centres

4. Patient Counseling and Management Skills

Skills -- the trainee would be expected to acquire skills in the following domains:

A) ACADEMIC SKILLS:

i. Teaching

• Formal training in teaching methodologies.

• Experience in undergraduate and postgraduate teaching, including working in different teaching media (lecture, seminar, interactive tutorial).

• Experience and willingness to undertake undergraduate and postgraduate medical teaching and nurse education.

• Development of teaching materials and organization of teaching courses.

• Involvement in the audit processes.

ii. Continued personal development:

• Computer literacy and familiarity with commonly used systems.

• Critical approach to information gained from literature review and audit.

• Preparation of manuscripts and teaching materials.

• Oral presentation skills.

• Time management skills.

• "Reflective practice" skills – learning and creating knowledge by personal reflection.

iii. Research

• Innovative approach to clinical problems.

• Willingness to assess evidence on which to base practice.

• Understanding of research methodology, including the randomized controlled trial.

• Attendance research-orientated national meetings.

• To have undertaken a defined piece of academic research, which has led to publication in a peer-reviewed journal.

B) MANAGEMENT SKILLS

The trainee would be expected to have received training or experience in the following areas and to have been involved as a participant in the management Unit

i. Personnel:

• Training in personnel management.

• Organizational skills, duty rosters etc.

• Awareness of current medical manpower regulations and nurse staffing issues.

• Understanding of the role of counsellors and art nurses.

ii. Audit:

• Data capture and collation, including national and local statistics and preparation of annual reports.

• Assessment of performance; benchmarking.

• Risk management and clinical governance.

• Assessment of equipment and resource.

iii. Financial – training in:

• Budgetary management.

• Setting of contracts.

• Assessment of performance.

iv. Wider strategic issues - awareness of:

• Provider and purchaser communication.

• Service development strategy.

• National representation and professional development.

After completing an MCh in Reproductive Medicine and Surgery, candidates will get employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from which include Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector, the options include Resident Doctor, Consultant (Reproductive Medicine and Surgery), Visiting Consultant (Reproductive Medicine and Surgery), Junior Consultant (Reproductive Medicine and Surgery), Senior Consultant (Reproductive Medicine and Surgery), Assistant Professor (Reproductive Medicine and Surgery), Associate Professor (Reproductive Medicine and Surgery).

Courses After MCh in Reproductive Medicine and Surgery

MCh in Reproductive Medicine and Surgery is a specialization course that can be pursued after finishing a Postgraduate medical course. After pursuing a specialization in MCh in Reproductive Medicine and Surgery, a candidate could also pursue certificate courses and Fellowship programs recognized by NMC and NBE, where MCh in Reproductive Medicine and Surgery is a feeder qualification.

These include fellowships in:

· Reproductive physiology, endocrinology, and genetics.

· Medical and surgical treatment of infertility.

· Assisted Reproductive Technologies in Infertility.

Frequently Asked Questions (FAQs) –MCh in Reproductive Medicine and Surgery

· Question: What is the full form of an MCh?

Answer: The full form of an MCh is Master of Chirurgiae.

· Question: What is an MCh in Reproductive Medicine and Surgery?

Answer: MCh Reproductive Medicine and Surgery or Master of Chirurgiae in Reproductive Medicine and Surgery also known as MCh in Reproductive Medicine and Surgery is a super speciality level course for doctors in India that is done by them after completion of their postgraduate medical degree course.

· Question: What is the duration of an MCh in Reproductive Medicine and Surgery?

Answer: MCh in Reproductive Medicine and Surgery is a super speciality program of three years.

· Question: What is the eligibility of an MCh in Reproductive Medicine and Surgery?

Answer: The candidate must have a postgraduate medical Degree in MS/DNB (Obst. & Gynae) obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE, this feeder qualification mentioned here as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the scope of an MCh in Reproductive Medicine and Surgery?

Answer: MCh in Reproductive Medicine and Surgery. offers candidates various employment opportunities and career prospects.

• Question: What are the average salary for an MCh in Reproductive Medicine and Surgery candidate?

Answer: The MCh in Reproductive Medicine and Surgery candidate's average salary is between Rs. 15 lakhs to Rs. 30 lakh per annum depending on the experience.

Question: Can you teach after completing an MCh Course?

Answer: Yes, the candidate can teach in a medical college/hospital after completing an MCh course.