* What is a reproductive endocrinology and infertility (REI) specialist?
Reproductive endocrinology and infertility (REI) is a subspecialty of obstetrics and gynecology (OB/GYN). The REI specialist is trained in both general obstetrics and gynecology and in diagnosing and treating specific problems such as infertility, recurrent miscarriages, endometriosis, pelvic pain, irregular menstrual periods, fibroids, polycystic ovarian syndrome, menopause, and puberty issues. most REI specialists do not deliver babies and refer pregnant women to general OB/GYNs. To become an REI specialist, one must complete 4 years of medical school, 4 years of OB/GYN residency, and 3 years of fellowship (subspecialty) training in REI.
* What is infertility?
Infertility is defined as one year or more of inability to conceive in a woman is under age 35, or 6 months or more of inability to conceive if over age 35.
* What are the causes of infertility?
Approximately 30-40% of infertility is due to male factors; 50% percent is due to female factors; and 10-20% is due to either combined male and female factors or unexplained infertility. In the female, the combination of endometriosis, tubal disease, or adhesions (scarring), collectively known as the “peritoneal factor”, is the most common cause. Problems with ovulation is the second most common cause. Cervical mucus abnormality is the third most common cause.
* Is infertility becoming more common?
Not necessarily. There has not been a significant rise in the rate of infertility in the United States, though the increasing awareness of treatment options and the increasing success of modern treatment such as in vitro fertilization (IVF) have resulted in an increase in utilization of infertility services.
* When should I see a reproductive endocrinology and infertiliy (REI) specialist?
The basic infertility evaluation consists of a semen analysis, test for the fallopian tubes (hysterosalpingogram, HSG), and tests for ovulation (basal body temperature chart, ovulation predictor test, blood level of progesterone). This evaluation can be performed by a general OB/GYN who is adequately trained to evaluate infertility. Short-term treatment with fertility pills (oral ovulation induction) can also be offered by a general OB/GYN. Generally, infertile female patients over age 35 or patients who have not conceived after at most 6 months of simple therapy should be referred to an REI specialist. If a patient has a complex reproductive issue such as absence of sperm or severe edometriosis or long-term infertility (over 3 years), she should be referred to an REI specialist without delay.
* How should I choose an infertility clinic?
The most important questions a couple should ask before selecting a clinic for evaluation and treatment are as follows:
– Does the clinic provide a wide range of state-of-the-art infertility treatments (e.g. IVF, inseminations)?
– Is the clinic certified by the appropriate national institutions?
– Is the clinic managed by qualified and experienced physicians, including REI specialists?
– Is the clinic staff friendly, well-informed, accessible, and flexible?
– Is the clinic open at convenient and flexible hours?
– Does the clinic observe strict ethical and moral standards?
– What is the clinic’s success rates in assisted reproductive technology compared to national standards? Are these success rates readily available?