A Reproductive Endocrinology and Infertility (REI) doctor is a physician who specializes in the diagnosis and treatment of conditions affecting the hormonal function of the reproductive system. These specialists focus on complex reproductive issues, including the medical and surgical management of infertility. Their practice blends advanced hormonal science with sophisticated treatment protocols to help patients build their families.
The Path to Becoming an REI Specialist
The training required to become a board-certified REI specialist spans over a decade of post-secondary education. After four years of medical school, a prospective specialist must complete a four-year residency program in Obstetrics and Gynecology (OB/GYN), which provides a foundation in female reproductive health and gynecologic surgery. Following residency, physicians complete a three-year fellowship dedicated exclusively to Reproductive Endocrinology and Infertility, focusing on advanced training in endocrinology, reproductive biology, and complex surgical techniques. Certification requires passing both written and oral examinations administered by the American Board of Obstetrics and Gynecology (ABOG).
Core Scope of Practice and Conditions Treated
REI specialists manage a wide array of conditions that disrupt normal reproductive processes. They routinely evaluate and treat primary and secondary infertility, which can stem from female factors like ovulation problems (e.g., Polycystic Ovary Syndrome or PCOS) or structural issues (e.g., blocked fallopian tubes). Male factor infertility is also a focus, involving issues such as low sperm count or poor sperm motility.
Beyond infertility, REI doctors treat hormonal dysfunctions, including hypothalamic amenorrhea, which is the absence of menstruation due to hormonal disruptions. They also diagnose conditions like endometriosis and uterine fibroids, which can interfere with implantation or pregnancy maintenance. A significant part of their practice involves evaluating recurrent pregnancy loss, defined as two or more consecutive miscarriages, investigating potential hormonal, genetic, anatomical, or immunological causes.
Common Diagnostic and Therapeutic Procedures
To accurately diagnose reproductive challenges, REI doctors utilize several specialized tests. Hormonal assays measure reproductive hormones like Follicle-Stimulating Hormone (FSH) and Anti-Müllerian Hormone (AMH) to assess ovarian reserve. A hysterosalpingogram (HSG) checks the patency of the fallopian tubes, and semen analysis provides data on sperm quantity and motility.
Therapeutic Procedures
Once a diagnosis is established, a range of therapeutic options are available, starting with less invasive methods.
- Ovulation Induction uses medications to stimulate the ovaries to produce mature eggs, often timed with intercourse or Intrauterine Insemination (IUI).
- IUI is a procedure where prepared sperm are placed directly into the uterus near the time of ovulation.
- In Vitro Fertilization (IVF) involves stimulating the ovaries, retrieving eggs, fertilizing them in a laboratory, and transferring the resulting embryo back into the uterus.
- Advanced genetic techniques, such as preimplantation genetic testing (PGT), are used to screen embryos for chromosomal abnormalities before transfer.
- Reproductive surgery, often performed minimally invasively, may be used to correct anatomical issues like removing fibroids or treating endometriosis.
When a Referral to an REI Doctor is Necessary
Consultation with an REI physician is generally recommended based on age and the duration of time spent trying to conceive without success. For women under 35, the guideline suggests consultation after 12 months of regular, unprotected intercourse. This timeframe is shortened to six months for women aged 35 or older due to the natural decline in ovarian reserve.
Immediate referral is warranted if a patient has a known condition that significantly impacts reproductive function.
- A history of recurrent pregnancy loss (two or more miscarriages).
- Diagnosed conditions like moderate to severe endometriosis or Polycystic Ovary Syndrome (PCOS).
- A known severe male factor infertility diagnosis in the partner.
- Highly irregular or absent menstrual cycles.
- The need to discuss fertility preservation options, such as before starting chemotherapy.