Starting an Infertility Practice: Skills Every Gynaecologist Needs

Many gynaecologists see couples struggling to conceive every week. Adding structured fertility services to a practice can help those couples sooner - but it needs a specific set of skills beyond general gynaecology. Here are the competencies that matter most.

1. A systematic infertility work-up

Good fertility care starts with evaluating both partners promptly. Couples are usually evaluated after 12 months of trying, or after 6 months if the woman is 35 or older - and sooner when there is an obvious cause such as irregular cycles or known tubal disease.

A complete work-up covers:

• Ovulation - cycle history and, where needed, hormonal assessment
• Ovarian reserve - AMH and antral follicle count, interpreted with age
• Tubal patency - HSG or sono-salpingography
• Uterine cavity - ultrasound, with hysteroscopy when indicated
• Male partner - semen analysis by WHO 6th edition methods, never skipped or delayed

2. Confident transvaginal ultrasound

Ultrasound is used at nearly every step: baseline scans, follicle tracking, endometrial assessment, oocyte pick-up guidance and embryo transfer. Investing in ultrasound skills pays off across the whole practice.

3. Ovulation induction and IUI

These are the foundation of a first-line fertility service:

• Choosing between letrozole, clomiphene and gonadotropins
• Monitoring to achieve one or two mature follicles
• Cancelling or converting over-responding cycles to prevent multiple pregnancy and OHSS
• Performing IUI with good sperm preparation and gentle technique

Read our step-by-step IUI guide and our comparison of ovulation induction protocols.

4. Knowing when to refer for IVF

Good fertility practice means not delaying effective treatment. Clear criteria help: female age, duration of infertility, tubal disease, severe male factor, diminished ovarian reserve, and the number of unsuccessful IUI cycles.

5. IVF clinical skills

For gynaecologists who want to offer IVF, additional competencies include:

• Controlled ovarian stimulation protocols and trigger strategies
• Oocyte pick-up under ultrasound guidance
• Embryo transfer technique
• Luteal phase support and early pregnancy follow-up
• Prevention and management of OHSS

These procedures need supervised, hands-on training - see our article on the Fellowship in Reproductive Medicine.

6. Counselling and communication

Infertility is emotionally demanding. Couples need clear explanations, realistic expectations, cost transparency and empathy. Good counselling improves adherence and trust.

7. Regulation and documentation

In India, ART services must comply with the Assisted Reproductive Technology (Regulation) Act, 2021 and its rules - including registration, consent, record keeping and reporting. Building compliant documentation from the start avoids problems later.

8. Working with a team

Successful fertility care depends on teamwork between clinicians, embryologists, andrology staff, nurses and counsellors. Understanding what happens in the laboratory makes you a better clinician.

Build these skills with ReproNest

ReproNest's Fellowship in Reproductive Medicine & Infertility Management in Delhi NCR covers infertility work-up, ultrasound, stimulation, IUI, OPU and embryo transfer through supervised clinical training. Explore our courses, or contact us.