

By: Robin H. Fogle, MD, ACRM

Reproductive endocrinology and fertility specialists (REIs) are subspecialists in the general specialty of obstetrics and gynecology (Ob/Gyn). In addition to undergoing the 4 year Ob/Gyn residency training, they complete three years of fellowship training focusing just on REI issues. Such issues can be divided into two general categories, just as the name implies: reproductive endocrinology issues, and fertility issues. There is, of course, a significant bit of overlap between these two areas, such that reproductive endocrinology problems can result in subfertility. But they also see many patients who are not attempting pregnancy.

Reproductive Endocrinologists | What They Do

Reproductive endocrinology problems include things like, but are not limited to, menstrual cycle irregularity or heavy menstrual bleeding, problems with thyroid or prolactin hormone levels, and menopausal symptoms. Some specific examples of reproductive endocrine problems include:

Hypothalamic amenorrhea – The absence of menstrual cycles due to inadequate signaling from the brain to the ovaries.

Polycystic ovary syndrome – A syndrome in which menstrual cycles are irregular due to an excess production of male hormones by the ovaries.

Hyperprolactinemia – A condition where prolactin levels are elevated and can therefore result in symptoms of absent or irregular menstrual cycles, galactorrhea (breast milk production in the absence of a recent pregnancy), and headaches.

Menopausal hormone replacement – The individualized hormone regimen used in peri- and postmenopausal women to alleviate the side effects of menopause.

Male hypogonadism – A condition where a man has low testosterone (and possibly low sperm counts) due to problems of the testicles or of the signalling between the brain and testicles.

Mullerian anomalies – A congenital defect involving the uterus and vagina which tends to require either physical therapy or surgery.

Turner's Syndrome – A chromosomal abnormality in females that results in premature menopause.

Premature ovarian insufficiency – A condition whereby a woman has prematurely run out of eggs and therefore experiences menopausal symptoms at a very early stage in her life.

Infertility Treatment

The other general area of expertise for an REI is infertility of all causes. The initial fertility evaluation of a patient or couple includes tests specifically designed to evaluate the various components required to achieve pregnancy: normal egg reserve, a normally shaped uterus, patent fallopian tubes, and normal sperm counts. Once the cause of infertility is determined, or a diagnosis of unexplained infertility is made, then treatment is offered. Treatment ranges from menstrual cycle monitoring and ovulation prediction, to the addition of fertility drugs to induce multiple eggs to ovulate at a time, or to in vitro fertilization (IVF) where an egg and sperm are combined in a laboratory. Treatment may also include the use of donor eggs or donor sperm. This is especially true when caring for single female patients, lesbian couples, or gay male couples.

Reproductive endocrinology and infertility specialists take care of a variety of types of patients, ranging from adolescents to menopausal women. We also care for males with reproductive hormone problems and members of the LGBT community needing assistance with starting a family. Each patient presents a unique problem than an REI is trained to evaluate and care for.

Trying to conceive? Schedule an appointment to meet with one of our fertility specialists today!