Reproductive Endocrinology

Reproductive endocrinology is a subspecialty of obstetrics and gynecology (OB/GYN) that focuses on the evaluation and treatment of hormonal disorders, anatomical disorders, and other conditions that can affect fertility (the ability to become pregnant) or the ability to carry a pregnancy to term. Doctors who practice in this field of OB/GYN are called reproductive endocrinologists. Reproductive endocrinologists first complete training in obstetrics and gynecology before completing advanced training in reproductive endocrinology.

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Reproductive endocrinologists treat many problems involving the reproductive organs or affecting pregnancy and childbearing, including:

Infertility in women and men
recurrent pregnancy loss
Menstrual disorders
uterine fibroids
Endometrial
Polycystic ovary syndrome
early menopause
Early or late puberty
Congenital defects of the genitals
Hormonal disorders that affect reproduction

Most reproductive endocrinologists focus their practice on fertility issues. As such, their goal is to improve and maintain fertility potential (in both men and women) and to identify and treat the causes of infertility.

An obstetrician-gynecologist or primary care physician may refer a woman or couples to a reproductive endocrinologist after failed attempts to conceive. In general, further evaluation by a reproductive endocrinologist is warranted if a couple has not succeeded in conceiving after 12 months of unprotected intercourse if the woman is younger than 35, or after 6 months of unprotected intercourse if the woman is older than 35 years old.

An infertility assessment begins with a thorough physical examination and a detailed personal and family medical history for each partner. This is followed by a careful review of the results of blood tests, semen analysis, and imaging tests to look for an anatomic cause of infertility (eg, a problem with the uterus, ovaries, or fallopian tubes).

Once the diagnosis is established, an individualized treatment plan is provided, with the ultimate goal of a successful pregnancy. Treatments may include monitoring hormone levels, giving medications to stimulate ovulation or regulating hormones, or surgically correcting a problem that interferes with conception (for example, a blocked fallopian tube).

If pregnancy cannot be achieved with these measures, reproductive endocrinologists are skilled in assisted reproductive techniques, such as:

Intrauterine insemination – the introduction of sperm directly into the uterus to facilitate fertilization
In vitro fertilization (IVF) – the fusion of an egg with semen outside the body in a laboratory for fertilization, then transfer of the fertilized egg (embryo) to the uterus
Intracytoplasmic sperm injection (ICSI) – similar to ICSI, except that a single sperm is injected directly into an egg in a lab, then the embryo is transferred to the uterus
Egg or Embryo Cryopreservation – Freezing of an Egg or Embryo for Future Pregnancy Attempts
Sperm Freezing – Freezing sperm cells to preserve them for future pregnancy attempts
Ovarian tissue cryopreservation – a procedure to preserve a portion of the ovary for future pregnancy attempts (usually for women whose fertility is threatened by cancer)
Once a woman becomes pregnant, medical care is often transferred to the obstetrician-gynecologist, who will continue to monitor the pregnancy until the baby is born.

Reproductive endocrinologists are trained in minimally invasive and open surgical techniques to help treat a range of reproductive organ abnormalities. For example, they can perform surgery to remove uterine fibroids, uterine polyps, ovarian cysts, or scar tissue, treat endometriosis, correct congenital abnormalities, open blocked fallopian tubes, and tie off varicose veins in the testicles.