Infertility is the inability to conceive after trying for one year, or six months if the woman is older than 35. There are many causes of infertility: ovulatory abnormalities, anatomical blockages or defects, endometriosis, decreased ovarian reserve, genetic problems, or abnormal sperm. Approximately 90% of couples who undergo an evaluation will have a cause discovered. One third of the time it is a male (sperm) factor and two thirds of the time it is a female issue. Most couples have only one problem. Fertility treatments are highly individualized and may include surgery, ovulation-boosting medication, insemination, or in vitro fertilization. Sometimes correction of a medical problem like insulin resistance will result in pregnancy.
Reproductive endocrinology and infertility (REI) is a subspecialty of obstetrics and gynecology. REI doctors complete a fellowship, usually lasting two years, after the four year residency in ob-gyn. Special training in the endocrinology (hormones) of reproduction allows REI doctors to diagnose and treat hormone issues in women and men. Correcting hormone issues can help a couple get pregnant, or a menopausal woman get relief from hot flashes, or figure out why an older teen has not started her period yet. As hormone specialists some REI doctors prescribe hormones for transgender persons. REI doctors usually learn advanced surgical techniques for rare gynecologic problems, and for correction of ovary and uterus abnormalities in women who still want to have children. REI doctors help women and men with cancer preserve options for having children after their cancer is treated, a process referred to as fertility preservation, or oncofertility.