First Steps into Gynaecological Endocrinology and Reproductive Medicine in Resource-poor Countries: An Eritrean Experience

Background: Gynecological endocrinology and reproductive medicine within the reproductive health systems of developing countries is underappreciated and methods to incorporate basic infertility workup and treatment needs to be addressed. However, most recommendations of how to proceed in particular, though, are very general. We exemplarily report our approach in Eritrea. Methods: Two one-week intensive training courses on gynecological endocrinology and reproductive medicine (lectures and hands on training) were given 2011 and 2012 at the Orotta National Referral Maternity Hospital in Asmara, Eritrea. Important subjects included: education and training in contraception fertility awareness, methods to optimize fertility potential, utilization of vaginal ultrasound for cycle monitoring, performance of hysterocontrastsonograhy, and one-step semen preparation for intrauterine inseminations. Results: After two intensive courses a basic infertility work up is possible with pelvic ultrasound assessment and contrastsonography for tubal patency. Simplified intrauterine inseminations after mild ovarian stimulation are possible as well and represent the first step into assisted reproduction. All procedures are feasible and performed independently by the trainees. Conclusions: Basic gynecological endocrinology and infertility care in resource-poor countries is possible. The Eritrean example of intensive courses with training in hysterocontrastsonography and one step intrauterine inseminations may encourage others to follow and introduce basic infertility care into other resource-poor countries.