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ART Training Alumni 2004 - 2015 Hands on Training in Assisted Reproductive Technology

Abu Dhabi

Korea

Austria

Kosovo

Bahrain

Kuwait

Brazil

Lebanon

Canada

Malaysia

Chile

Mexico

China

Nigeria

Colombia Croatia Czech Republic Egypt

Pakistan Peru Philippines Romania

Greece

Saudi Arabia

Guyana

Serbia

Hong Kong

Slovak Republic

India Iraq Israel Italy Jamaica

South Africa Spain Syria Turkey

Japan

UAE

Jordan

USA

Kazakhstan

Venezuela

Learn from the Leaders The American Center for Reproductive Medicine Cleveland Clinic’s American Center for Reproductive Medicine was established 23 years ago in 1993 with a three-fold mission to: conduct cutting-edge research into the causes of human reproductive pathologies, develop new fertility biomarkers and treatment modalities, and train physicians and scientists with a commitment to advancing the understanding of human reproduction, infertility and fertility preservation.

About Cleveland Clinic Cleveland Clinic is ranked as one of America’s Top 5 Hospitals by U.S.News & World Report. Located in Cleveland, Ohio, Cleveland Clinic is a nonprofit, multispecialty academic medical center that integrates clinical and hospital care with research and education. Founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation, it is the second largest group practice in the world with 3,262 physicians and scientists practicing and researching in more than 130 medical specialities and more than 1,400 beds. In addition to the main hospital located near Cleveland’s historic University Circle, the Cleveland Clinic operates nine regional hospitals, a children’s hospital, and 18 fullservice family health centers in Ohio, as well as hospitals in Florida, Las Vegas, Canada, and Abu Dhabi, employing more than 43,000 individuals and providing global world class medical care. Last year alone, 5.9 million patients from 147 countries and all 50 states received their care at the Cleveland Clinic.

Training program in Assisted Reproductive Technology (ART)

The main hospital campus, located near downtown Cleveland, occupies 167 acres and 44 buildings. It includes a hospital, an outpatient clinic, a children’s hospital, cancer institute, eye institute, research institute, a medical school and supporting labs and facilities. To learn more, visit www.clevelandclinic.org.

We offer a unique opportunity to learn the latest techniques in this rapidly changing subspecialty at one of the world’s premier ART centers:

Course Content

• • • • • • •

World-class faculty State-of-the-art training facilities Personalized hands-on training Multiple comprehensive training modules Tremendous satisfaction rates Trained over 160 alumni from 43 countries since 2003 Certificate of Training awarded at the end of training

This intensive, 320-hour course is available exclusively to scientists and physicians with specific interest in gynecology, andrology or embryology as well as other health professionals such as embryologists, reproductive biologists and technologists. • In vitro fertilization (IVF) • Intracytoplasmic sperm injection (ICSI) • Gamete cryopreservation • Routine and advanced tests in andrology

Hands on Assisted Reproduction (IVF/ICSI) Module 5A - 5C (160 hours) Learn basic and advanced techniques in: IVF Techniques • Module 5A • ICSI: Intracytoplasmic sperm injection • Classical IVF • Oocyte handling and scoring • Embryo handling and scoring • Catheter loading for embryo transfer • Module 5B • Preparation of ICSI dishes • ICSI: injection of the spermatozoon into the oocyte • Oocyte handling (using fresh mouse oocytes)

inee 5 Tra e ART Modul a g e n i v i k ta l rece of l y i p w E co k FRE RT Boo . A an more.. and

MODULE 5 Module 5A: IVF/ICSI/Micromanipulation (80 hours) Module 5B: ICSI/Micromanipulation (40 hours) Module 5C: Advanced ART Techniques (40 hours) Module 5D*: Customizable ART Training (40 - 320 hours)

*How Module 5D Works: 1) Candidates select a) the techniques Laboratory Training they wish to learn (Modules 1-8); and b) the duration of their training • Equipments • Micromanipulators: components and mechanics (1- 8 weeks). • Installing and aligning the ICSI instruments 2) Candidates consult with the Course Director regarding their training • Supplies & Culture Medium needs and choices, and • Preparation of culture medium and dishes together, they will decide on the for IVF/ IVF-ICSI cases appropriate modules and duration • Embryo culture required by the candidate • Extended embryo culture 3) A personalized training schedule is Advanced ART Techniques created specifically for the candidate • Assisted hatching (laser and chemical [acidified Tyrode’s] method) 4) Training is provided at a pace • Embryo biopsy (laser and chemical methods) established by the candidate and Pre-Implantation Genetic Diagnosis is geared towards fulfilling the • Blastomere biopsy: candidates personal needs. • Learn the setting up of the micromanipulator • Biopsy of mouse/hamster 8-cell stage embryos • Use of laser and acid Tyrode’s solution for zona drilling • Blastomere and polar body aspiration and Referral to a Human IVF Clinic may be available to fixation techniques select candidates looking for clinical observation. • Cell spreading • Logistics of running an IVF Lab • Fixation techniques • Observe IVF/ICSI procedures Cryopreservation • Embryo cryopreservation (mouse embryos) • Vitrification Andrology • Sperm preparation for IVF/ICSI

• Oocyte retrieval • Oocyte assessment • Fertilization check • Embryo assessment • Intrauterine insemination

Virtual Tour of Facilities 2 | Cleveland Clinic American Center for Reproductive Medicine

Learn more about our ART Training Program

Semenology - Modules 1A (8 hours) and 1B (16 hours)

Cryopreservation - Module 4 (8 hours)

Gain proficiency in:

Learn the proper procedures for freezing human spermatozoa: • Procedure for freezing of ejaculated human spermatozoa • Cryopreservation of epididymal and vas deferens aspirates* • Isolation and cryopreservation of sperm from testicular biopsy specimens* • Protocol for cryopreservation of ovarian tissue from cancer patients* *demonstration only

Module 1A: • Collection and delivery of semen sample • Routine semen analysis • Computer assisted semen analysis (CASA) • Review quality control method for semen analysis • Proficiency survey for semen analysis Module 1B: • Name and perform sperm morphology assessments by WHO and Kruger’s strict criteria (WHO 4th and 5th Ed.) • Distinguish the differences between the two morphology classification systems • Observe semen smear preparation and practice staining techniques • Review quality control measures

Advanced Andrology Techniques - Module 2A (40 hours) and 2B (80 Hours) Gain proficiency in these advanced techniques: Module 2A (40 hours) • Measurement of sperm DNA fragmentation by TUNEL assay using FACS* Flow Cytometry • Measurement of Oxidation Reduction Potential (ORP) in semen samples • Measurement of Reactive Oxygen Species (ROS) levels in semen samples • Measurement of lipid peroxidation in semen samples • Measurement of Total Antioxidant Capacity (TAC) in seminal plasma • Selection of non-apoptotic spermatozoa using MACS** technique

Module 2B (80 hours) • Measurement of sperm DNA fragmentation by TUNEL assay using FACS* BD Accuri C6 Benchtop Flow Cytometer • Measurement of Oxidation Reduction Potential (ORP) in semen samples • Measurement of Reactive Oxygen Species (ROS) levels in semen samples • Measurement of lipid peroxidation in semen samples • Measurement of Total Antioxidant Capacity (TAC) in seminal plasma • Selection of non-apoptotic spermatozoa using MACS** technique

*Fluorescence-activated cell sorting **Magnetic-activated cell sorting

ART Sperm Preparation - Module 3 (16 hours) Develop skills in sperm preparation for ART: • Preparation of ejaculated sperm for ART: Sperm wash Double density gradient technique Swim-up protocol • Method of retrieval of sperm from retrograde ejaculate (demonstration only) • Sperm retrieval and preparation of testicular biopsy specimens (using rat or mouse specimens)

Vitrification - Module 6 (8 hours) Acquire competency and knowledge of vitrification: • The fundamentals of vitrification • Setting up vitrification for routine use in an embryology laboratory • Hands on training in vitrification of oocytes and embryos using techniques such as: open and closed vitrification system, warming of cryopreserved oocytes and embryos, oocyte and blastocyst vitrification, cleavage stage embryo vitrification

Management of IVF and Andrology Laboratories - Module 7 (16 hours) Gain proficiency in: • Implementing a Total Quality Management Program • Regulation, licensing and accreditation • Quality Control and Quality Assurance • Proficiency Testing • Quality management tools • Troubleshooting

Preparing for CAP Accreditation and FDA Inspection - Module 8 (16 hours) Learn how to prepare your laboratory or tissue bank for accreditation by the College of American Pathologists (CAP) Reproductive Laboratory Inspection Program • How to prepare for your laboratory accreditation by the College of American Pathologists (CAP) Reproductive Laboratory Inspection Program or your tissue banks by the United States Food and Drug Administration (FDA) inspection (Client Depositor only). • What to do: Pre-inspection, during inspection and post inspection • Inspection Techniques • Quality Management (pre-analytic, analytic and post-analytic processes) • Critical indicators for all three processes • Laboratory General Checklist • Reproductive Laboratory Checklist (Embryology and Andrology) • Team Leader assessment • FDA Compliance

Training Faculty Ashok Agarwal, PhD, HCLD Director, Andrology Center Director, American Center for Reproductive Medicine Professor, Lerner College of Medicine

Edmund Sabanegh, MD Chairman, Department of Urology Head, Section of Male Infertility Professor, Lerner College of Medicine

Christina Anagnostopoulou, MS Clinical Embryologist IVF Clinic “Embryo ART” Athens, Greece

Rakesh Sharma, PhD Research Coordinator, American Center for Reproductive Medicine Associate Professor, Lerner College of Medicine

Israel Maldonado Rosas, MSc IVF Lab Director Mexican Institute for Advanced Reproductive Technology (Inmater) Mexico City, Mexico

Sajal Gupta, MS, MD, TS (ABB)

Testimonial

Testimonial

(MS in Clinical Embryology, Jones Institute)

Reproductive Specialist Supervisor, Andrology Center Assistant Professor, Lerner College of Medicine

Learn more about our ART Training Program

Cleveland Clinic American Center for Reproductive Medicine | 3

Training Methodology:

Scholarship in Teaching Award

Training Program in Advanced Reproductive Techniques

1. Training provided by 2 certified, practicing Clinical Embryologists 2. Trainers include Andrologists, Reproductive Endocrinologists and other experts in ART 3. Fully hands-on, one-on-one laboratory training sessions under the direct guidance of Clinical Embryologists • Training is done using animal models (frozen hamster oocyte and mouse embryos) (Module 5) 4. Each training session is customized to the trainee’s • Professional background • Level of skill and competence • Specific training needs • Desired outcomes from attending the ART training course 5. Interactive discussion and teaching sessions 6. Live lectures and multimedia presentations in small group sessions 7. Four state-of-the-art micromanipulators dedicated solely for training purposes (IVF/ICSI) Note: • Training is offered in a dedicated ART training suite inside a non-clinical research laboratory • There is no patient contact

The Case Western Reserve School of Medicine Scholarship in Teaching Awards is an annual program designed to recognize faculty contribution to education from the preceding year and promote undergraduate, graduate, and continuing medical education teaching as a scholarly activity.

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American Center for Reproductive Medicine

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Center for Reproductive Medicine ART Training

Let it be known that

This document reflects the performance of the candidate during the 2015 ART Training Session: Module 5A (IVF/ICSI/Micromanipulation)

Shazia Magray, M.D, MRCOG

This is to attest that the trainee,

Dubai, UAE has received

“Bindu Garg”

Hands on Training in Human Assisted Reproduction Module 3: Sperm Prepration, Module 4: Cryopreservation, Module 6: Vitrification and Module 5A: IVF/ICSI, Micromanipulation, for 160 hrs offered by the American Center for Reproductive Medicine, Cleveland Clinic

has successfully completed the course work prescribed by the Cleveland Clinic’s Center for Reproductive Medicine and is therefore recommended for the award of the ART Training Certificate

October 5, 2015 - October 30, 2015 ASHOK AGARWAL, Ph.D. Professor, Department of Urology Director, American Center for Reproductive Medicine Director, Andrology Center

Registered Trainees Will Receive…

RAKESH SHARMA, Ph.D. Associate Professor, Department of Urology Coordinator of Research, American Center for Reproductive Medicine

SAJAL GUPTA, M.D. Assistant Professor, Department of Urology Assistant Research Coordinator American Center for Reproductive Medicine

Grading Report Theoretical Component (30%)

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American Center for Reproductive Medicine

30

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Marks Obtained

Contribution (30%)

24 (80%)

24

Practical component (50%)

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Total Marks

1. Course Syllabus with Reading Material and Lab Protocols 2. Free Access to the Cleveland Clinic Alumni Library 3. Free Text Book on “Practical Manual of In Vitro Fertilization: Advanced Methods and Novel Devices” edited by Dr. Peter Nagy et al, Springer (only for Modules 5A-5D) 4. WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. Fifth Edition (CD) 5. Certificate of Training (issued upon successful assessment by the instructor) 6. Daily Meal Tickets

Learn More

This award was given out at the Case Medical School Education Retreat on March 12, 2015. ACRM’s hands-on ART training program has previously been twice-recognized with this prestigious Scholarship in Teaching Award, in 2013 and again in 2014. Besides the ART Training Program, ACRM’s Summer Internship program has also been thrice-recognized with this prestigious Scholarship in Teaching Award, in 2011, 2013 and 2014 respectively. dicine Me

Each Trainee is tested at the end of their training for: 1. Knowledge/Theoretical Component (30%): Multiple choice questions on lab techniques linked to each course module 2. Practical Skills (50%): Tested on specific lab techniques taught during the training 3. Verbal Communication & Comprehension Skills/Integrative Component (20%): • The performance of the candidate throughout the course will be reflected in a Grading Report. • Candidates who meet the training requirements and successfully complete the course work will be awarded a Training Certificate

Teaching approaches considered scholarly are characterized by 1) purposeful planning 2) systematic implementation and 3) reflection and assessment for improvement. The result should be an academic product that is actively shared and that will support the development of a community of teaching scholars.

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Trainee Evaluations:

Cl ic eve land Clin

40

Let it be known that

100

Abdullah Ahmed Al Najmi, M.D.

29 (76%)

38

Integrative Component (20%) Presentation and viva voce

FINAL GRADE

100 (20%)

20

82%

Grading Scale: A+ (>96%), A (91-95%), A- (86-90%), B+ (81-85%), B (76-80%), B- (71-75%), C (