In the early 1970s, the specialty of obstetrics and gynecology began the process of sub-specializing into three areas: perinatology, gynecologic oncology, and reproductive endocrinology. The early programs in reproductive endocrinology focused extensively on surgical treatments for women experiencing infertility or other reproductive abnormalities. However, in 1978, after the first in vitro fertilization (IVF) was performed, these fellowship training programs changed dramatically in their scope. They began focusing almost completely on advanced training in IVF and the other artificial reproductive technologies with a decreased emphasis on restorative surgical techniques.
In the late 1980s, Dr. Veasy Buttram, a well-known reconstructive pelvic surgeon initiated a one-year fellowship program in reproductive surgery. The program was developed because he recognized that most graduating residents in obstetrics and gynecology were not fully trained in modern reproductive (infertility) surgery. This was the first of a group of ad hoc fellowship programs which were developed mostly in non-university hospitals by private physicians. This has now evolved into an advanced endoscopy fellowship training program sponsored by the Society of Reproductive Surgeons and the American Association of Gynecologic Laparoscopists.
In the meantime, a good deal of progress has been made over the last 15 to 20 years in one of the problematic areas of reconstructive pelvic surgery: the potential for adhesion formation associated with these procedures. Adhesion-prevention techniques have been outlined and their success documented in the new medical textbook, The Medical and Surgical Practice of NaProTECHNOLOGY.
The reproductive endocrinology programs do not represent universal ethical principles which are applicable to all patients. The embryo-destructive nature of IVF procedures excludes a large population of patients from being assisted by these approaches. Furthermore, the artificial reproductive technologies are oriented towards “skipping over” the underlying disease process and attempting to treat the reproductive abnormality by replacing it with an artificial approach. All in all, the overall success rates with such approaches have remained relatively stagnant over the last 25 years.
In a research program which began in 1976 at St. Louis University School of Medicine and continued at Creighton University School of Medicine in the Department of Obstetrics and Gynecology from 1977 to 1985, Thomas Hilgers, MD, Clinical Professor, Department of Obstetrics and Gynecology, developed a natural means of regulating fertility called the Creighton Model FertilityCare System. Since 1978, Dr. Hilgers has been training allied health professionals called FertilityCare Practitioners (FCP) to teach this system (over 1,000 FCPs have gone through this 13-month program). These programs have been affiliated formally with Creighton University on a continuous basis since their origin in 1978. Since 1981, these programs have also trained physicians in the basic principles of the medical applications of natural fertility regulation. The students, upon satisfactory completion of the course material, receive a certificate signed, not only by Dr. Hilgers, but also the President of the University and the Vice President for Health Sciences.
In 1991, in a book entitled The Medical Applications Of Natural Family Planning (Saint Paul VI Institute Press, Omaha, NE, 1991) and subtitled “A Physician’s Guide to NaProTECHNOLOGY,” Dr. Hilgers first described the new women’s health science of NaProTECHNOLOGY (Natural Procreative Technology). This new approach to women’s health care had a universal moral and ethical application, while at the same time, an acute focus on making a diagnosis of the underlying cause of the reproductive abnormality.
In 2004, the first definitive textbook on NaProTECHNOLOGY was published (Hilgers TW: The Medical and Surgical Practice of NaProTECHNOLOGY, Saint Paul VI Institute Press, Omaha, NE 2004). In this textbook, the Creighton Model FertilityCare System, which is the foundational family planning system to NaProTECHNOLOGY, along with its laboratory support systems, its applications in a medical setting, its applications in infertility and obstetrics and its surgical applications were all, for the first time, definitively described. This textbook, and the work of NaProTECHNOLOGY over the last 14 years, has generated a considerable amount of interest among physicians and there is a growing number of young obstetrician-gynecologists who are requesting advanced training in this approach.
The Saint Paul VI Institute for the Study of Human Reproduction under the direction of Thomas W. Hilgers, MD, has established a one-year fellowship training program in Medical and Surgical NaProTECHNOLOGY. It has been named after Pope Saint John Paul II who was very supportive of the education and research efforts at the Saint Paul VI Institute. On February 17, 2004, the textbook on NaProTECHNOLOGY was officially presented to him.
The purposes of this fellowship are the following:
- To provide an opportunity for obstetrician-gynecologists who have completed their residency to acquire additional skills in approaches to the treatment of women’s health problem which are designed to cooperate with the menstrual and fertility cycle.
- This would include advanced study in reproductive endocrinology and its application to such conditions as infertility, repetitive miscarriage, premenstrual syndrome, postpartum depression, recurrent ovarian cysts, etc.
- This fellowship would also expose the individual to the surgical procedures and specialized techniques which are specifically designed both endoscopically and via open laparotomy approaches to be “near adhesion free” procedures.
- The individual physician would have the potential to become eligible for certification through the American Academy of Fertility Care Professionals as a FertilityCare Medical Consultant.
- The program would be conducted entirely within the scope of Catholic reproductive and sexual ethics consistent with the founding principles of the Saint Paul VI Institute for the Study of Human Reproduction.
The Saint Paul VI Institute for the Study of Human Reproduction was incorporated under the laws of the State of Nebraska in 1985 as a non-profit organization committed to education and research in human reproduction in such a way as to be completely consistent with the teachings of the Catholic Church. The Institute occupies approximately 20,000 square feet of space at 6901 Mercy Road, Omaha, NE. It houses a state-of-the-art reproductive ultrasound center (which is nationally accredited by the American Institute for Ultrasound in Medicine), a National Reproductive Hormone Laboratory (which is also nationally certified), a patient services division (The National Center for Women’s Health), the FertilityCare Center of Omaha, (the service delivery program for the Creighton Model FertilityCare™ System in the Omaha metropolitan area), the Creighton Model FertilityCare Allied Health Education Program, Administrative Offices, Library and Chapel.
Patients who are served by the Saint Paul VI Institute come from the Omaha metropolitan area, as well as, nearly every state in the United States. This is in part due to a national network of 175 FertilityCare™ Centers which are formally affiliated with FertilityCare™ Centers of America (FCCA), a national organization designed to promote and unite the Creighton Model FertilityCare programs throughout the United States. The national offices of the FCCA are also housed at the Saint Paul VI Institute.
People who seek services at the Institute are those who have reproductive abnormalities, including infertility, repetitive miscarriage, previous stillbirth, a history of prematurity and other reproductive disorders. It also serves patients who have premenstrual syndrome, premenstrual Dysphoric Disorder, postpartum depression, recurrent ovarian cysts, chronic pelvic pain and dysmenorrhea, endometriosis, polycystic ovarian disease, extensive pelvic adhesive disease, and other patients in the general field of obstetrics and gynecology.
The Institute also has ongoing research activities in the field of reproductive endocrinology, ultrasound, reconstructive pelvic surgery, laser surgery, microsurgery, adhesion prevention techniques, the statistical evaluation of the menstrual cycle, etc.
The director of this fellowship program is Thomas W. Hilgers, MD, Dip. ABOG, ABLS, SRS. Dr. Hilgers is a board-certified obstetrician-gynecologist who trained at the Mayo Graduate School of Medicine and the Medical College of Ohio at Toledo. He has published extensively in the fields related to human reproduction, reproductive endocrinology, and the various aspects of the menstrual cycle that are important in the natural regulation of human fertility. He is currently a Senior Medical Consultant in Obstetrics, Gynecology, Reproductive Medicine and Surgery at the Saint Paul VI Institute and serves as its Director. He is a clinical professor in the Department of Obstetrics and Gynecology at Creighton University. In 1995, he received a lifetime appointment to the Pontifical Academy for Life, given by Pope Saint John Paul II.
The Medical and Surgical NaProTECHNOLOGY
fellowship of the Saint Paul VI Institute is planned to be a one-year,
full-time, salaried position. The course is designed to train the
interested postgraduate obstetrician-gynecologist in areas related to
natural fertility regulation, reproductive endocrinology and surgery,
and its many applications that are described in the medical textbook, The Medical and Surgical Practice of NaProTECHNOLOGY. A research project will be mandatory for the completion of this fellowship program.
The fellow will participate in regular, didactic conferences ranging from issues related to reproductive medicine, the use of ultrasound in reproductive medicine, the regular participation in case management discussions and discussions regarding bioethical issues and the Theology of the Body (supervised by Sr. Renée Mirkes, OSF, PhD, an ethicist who directs the Center for NaProETHICS at the Saint Paul VI Institute).
In the clinical training of the fellow, emphasis will be placed on the individual’s training in reconstructive pelvic surgery, the use of lasers in both open, as well as, endoscopic procedures and in microsurgical techniques with special emphasis on adhesion prevention techniques. This training will be done through a directly supervised surgical experience with exposure to those patients coming to the Saint Paul VI Institute.
The fellow will also see outpatients at the Saint Paul VI Institute where all of the didactic training and education will take place. In-hospital experiences will be obtained at Creighton University Medical Center and Bergan Mercy Medical Center.Back to Top
The FertilityCare™ Medical Consultant portion of this program is formally affiliated with Creighton University. This program is accredited by the American Academy of Fertility Care Professionals and places the fellow into the position of becoming certified as a FertilityCare™ Medical Consultant by that same academy. This program is approved for over 120 cognates of continuing education credit on a yearly basis by the American College of Obstetricians and Gynecologists.Back to Top
TEXTBOOKS USED FOR THE PROGRAM
The following textbooks will be used during the course of this fellowship training program:
- Hilgers TW: The Medical and Surgical Practice of NaProTECHNOLOGY, Saint Paul VI Institute Press, Omaha, NE, 2004.
- Hilgers TW, Daly KD, Hilgers SK, Prebil AM: The Creighton Model FertilityCare™System: A Standardized Case Management Approach to Teaching. Book I – Basic Teaching Skills, 2nd Edition, Saint Paul VI Institute Press, Omaha, NE, 2002.
- Hilgers TW, Hilgers SK, Prebil AM, Daly KD: The Creighton Model FertilityCare™System: A Standardized Case Management Approach to Teaching. Book II – Advanced Teaching Skills. Saint Paul VI Institute Press, Omaha, NE, 2003.
- Hilgers TW: Reproductive Anatomy and Physiology: A Primer for FertilityCare Professionals. Saint Paul VI Institute Press, Omaha, NE, 2002.
A research project will be mandated during the course of this one-year program. The research will be in the area of the medical and surgical aspects of NaProTECHNOLOGY and may involve either existing data analysis at the Saint Paul VI Institute or new projects to be worked out directly between the fellow and the Director of the Institute.Back to Top
SATISFACTORY COMPLETION OF THE FELLOWSHIP
A criterion-referenced final examination will be given to the fellow at the conclusion of the fellowship program. A score of 75.0% or greater will be necessary for the completion of that examination. In order to satisfactorily complete the fellowship program, the fellow must progress satisfactorily during the course of the year, complete the FertilityCare™ Medical Consultant course assignments and content, complete one research project and satisfactorily complete the criterion-reference examination.Back to Top
In order for the applicant to become eligible for participation in this fellowship program, the fellow must indicate a sincere interest in the course description and exhibit a sufficient amount of commitment to the satisfactory completion of the course material. In addition, the applicant must be either board certified or in the active candidate status (formerly referred to as board eligible) by the American Board of Obstetrics and Gynecology (or its equivalent). In addition, the physician must be of good moral and ethical character, fill out an appropriate application form and be personally interviewed by the Director of the Institute prior to acceptance into the program.
Finally, to participate in the program, the individual must be licensed in the State of Nebraska to practice medicine and surgery and a member of the staff in Obstetrics and Gynecology at Creighton University Medical Center and Bergan Mercy Medical Center.
Applications can be obtained by writing:
Thomas W. Hilgers, MD
Saint Paul VI Institute
6901 Mercy Road
Omaha, NE 68106
Telephone (402) 390-9167
Fax (402) 390-9851