A fertility doctor, formally known as a Reproductive Endocrinologist and Infertility specialist (REI), is a physician with advanced training in hormonal function related to reproduction. Specialists complete a four-year residency in Obstetrics and Gynecology followed by a three-year subspecialty fellowship focused on diagnosing and treating reproductive disorders in both men and women. The primary objective of an REI is to help individuals and couples identify the underlying causes of their reproductive challenges and implement medical or surgical strategies to achieve a successful pregnancy.
Conditions Treated and Patient Population
The most common reason for seeking a fertility specialist is infertility, defined as the inability to achieve pregnancy after one year of regular, unprotected intercourse if the female partner is under 35. For women 35 and older, evaluation begins sooner, after six months of trying, due to the age-related decline in egg quality. The patient population also includes individuals requiring medical intervention, such as donor gametes, to conceive.
Fertility doctors manage specific medical conditions that interfere with reproductive function. These include Polycystic Ovary Syndrome (PCOS), which causes irregular ovulation, and endometriosis, where uterine-like tissue grows outside the uterus. Male factor infertility, encompassing low sperm count or poor motility, is another frequent cause of consultation. Specialists also treat recurrent pregnancy loss, defined as two or more failed pregnancies, investigating causes like uterine anomalies or genetic factors.
The patient population also includes those with unexplained infertility, where evaluation reveals no identifiable cause. Expertise is also sought by individuals facing a known risk of future infertility, such as those undergoing chemotherapy or radiation treatment.
Initial Diagnostic Testing and Evaluation
The comprehensive evaluation begins with diagnostic testing to pinpoint the source of reproductive difficulty. A fundamental step involves assessing ovarian reserve, the quantity of eggs remaining in the ovaries, typically through hormonal blood tests. Anti-Müllerian Hormone (AMH) levels estimate the remaining egg supply, as AMH is produced by small follicles and remains stable throughout the menstrual cycle.
Follicle-Stimulating Hormone (FSH) and Estradiol levels are also measured early in the menstrual cycle to evaluate communication between the brain and the ovaries. Concurrently, a transvaginal ultrasound counts the Antral Follicles (AFC), which are small, resting follicles visible in the ovaries, providing a physical count that correlates with the AMH blood test.
For structural assessment, a Hysterosalpingogram (HSG) is performed. This X-ray procedure uses a contrast dye injected through the cervix to visualize the uterine cavity and confirm the openness of the fallopian tubes. For partners providing sperm, a Semen Analysis (SA) evaluates concentration, motility, and morphology, which is essential for diagnosing male factor infertility.
Core Assisted Reproductive Technologies
Fertility doctors employ a tiered approach, often beginning with less invasive methods. Ovulation induction is a first-line therapy for patients with ovulatory dysfunction, such as PCOS, using oral medications like Clomiphene Citrate (Clomid) or Letrozole. Clomiphene works by stimulating the brain to produce more Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH), promoting egg development and release. Letrozole also stimulates FSH release but avoids potential negative effects on the uterine lining.
These medications are often paired with timed intercourse or Intrauterine Insemination (IUI). IUI involves collecting a sperm sample, concentrating the highest-quality sperm through washing, and then placing this prepared sample directly into the uterus using a thin catheter around the time of ovulation.
The most advanced treatment is In Vitro Fertilization (IVF), a multi-step process beginning with Ovarian Stimulation. The patient takes injectable hormones for 8 to 12 days to mature multiple eggs simultaneously, monitored closely with daily ultrasounds and bloodwork. A “trigger” injection is administered once follicles reach optimal size to initiate final egg maturation.
Egg Retrieval is a minor surgical procedure under light sedation. The doctor uses ultrasound to guide a needle into the ovaries, aspirating the fluid containing the eggs from each follicle. Retrieved eggs are fertilized in the laboratory, either conventionally or via Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected directly into the egg. Embryos are cultured, often to the blastocyst stage, before Embryo Transfer into the uterus.
Specialized Surgical and Preservation Services
Fertility doctors perform specialized, minimally invasive surgical procedures to correct anatomical issues. Hysteroscopy involves inserting a scope through the cervix into the uterus to visualize and remove abnormalities inside the uterine cavity. These include endometrial polyps, fibroids, or scar tissue that can interfere with implantation or cause recurrent pregnancy loss.
Laparoscopy is another common technique, using a scope inserted through small abdominal incisions. This allows the specialist to diagnose and treat conditions outside the uterus, such as endometriosis, ovarian cysts, or pelvic scar tissue blocking the fallopian tubes. These procedures improve the environment for conception and typically result in faster recovery.
Fertility preservation is an essential service for individuals facing medical treatments or those who wish to delay childbearing. For patients undergoing cancer therapy, cryopreservation is performed prior to treatment. This involves Egg Freezing, Embryo Freezing, or Sperm Freezing.
Elective fertility preservation is also common, allowing individuals to freeze gametes to mitigate age-related fertility decline. The doctor manages the entire process, including ovarian stimulation and ensuring the long-term storage of the frozen reproductive material.