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Do I need Reproductive Endocrinolgist(REI)


Discussions on "Do I need Reproductive Endocrinolgist(REI)" in "Trying to Conceive" forum.


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    Do I need Reproductive Endocrinolgist(REI)

    A Reproductive Endocrinologist (REI) is a specialist in Reproductive Endocrinology and Infertility, a medical doctor with advanced training in the science of fertility and its evaluation and treatment. An REI focuses on the hormones and mechanics of conception with advanced knowledge of sperm, eggs, male anatomy, female anatomy, and the complex interactions between pituitary and reproductive hormones. An REI will be trained in evaluating the problems that can interfere with conception, and has in depth knowledge of the treatments for fixing these problems.
    An REI starts training after medical school in a 4 or 5 year residency in obstetrics and gynecology. Specialty training in reproduction after residency requires 2-3 years at an advanced educational and research institute. The fellow in REI works side-by-side with experts in the field, developing clinical expertise in evaluation and treatment of fertility, and researching new areas of reproduction. The REI will be trained in laboratory and clinical research techniques, the mechanics and hormones of fertility, and in maintaining a lifelong love of the pursuit of advancing knowledge of fertility.
    After completing the fellowship, an REI is "board eligible". To be “board certified,” an REI must publish a thesis in a peer-reviewed journal. The REI must pass an in-depth written exam and then appear before experts in the field for an oral exam to test their depth of knowledge, defend their thesis, and demonstrate reasoning in solving fertility problems. If they pass the exams, they are then "board certified". This certification is the highest level of achievement in the field of infertility.
    All REIs certified since 1990 are required to maintain their certification every year (a few are grandfathered in). This involves reading and evaluating peer-reviewed journal articles on current advances in the field, and a written exam every year. New standards require demonstration of clinical knowledge and a commitment to advancing standards of clinical care, the Maintenance of Certification (MOC) process.
    While there is no formal requirement, most REIs will maintain membership in national and international fertility societies, such as the Society for Reproductive Endocrinology and Infertility (SREI). The Society for Assisted Reproduction (SART), devoted to in vitro fertilization and its variants, does not require REI certification. The American Society for Reproductive Medicine (ASRM) is the umbrella organization supervising these specialized societies. Most anyone with a professional interest in fertility can join ASRM, but SREI requires board certification.

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    Re: Do I need Reproductive Endocrinolgist(REI)

    When should I see a specialist?
    There are many factors to consider when deciding to see an REI:

    • Age: If you believe that you need help in conceiving, ask for it, regardless of your age. If you are under age 35, seek help after 12 months of trying. If you are over the age of 35, begin fertility testing after trying to conceive for 6 months. If you are over 39, testing should begin within 3 months.
    • Menstrual cycle problems: If menstrual cycles are irregular, seek help. A normal cycle is 27 to 30 days; if cycles are outside this range, there is a problem that should be evaluated. Bleeding between cycles, long or very short flows, or heavy or very light menstrual flows, indicate common problems that can be evaluated and treated. If you have trouble detecting ovulation on the common ovulation prediction kits or temperature charts, seek help. If you sense that things are not quite right – seek help at any time.
    • Tubal disease: If the fallopian tubes are blocked, an REI should be consulted before proceeding with treatment such as surgery. The surgery for damaged tubes is problematic and can increase the chance of tubal pregnancy. IVF is usually a much more successful treatment and surgery is likely not necessary. The common exception to this is a hydrosalpinx, where the fallopian tubes are blocked and filled with fluid. With a hydrosalpinx, surgery is appropriate prior to IVF. Consultation with an REI can determine the appropriate procedure and minimize the need for extra procedures.
    • Very low sperm count: If the sperm count is low or sperm are not present, an REI can help. Inseminations, fertility pills, and surgeries are usually ineffective with this diagnosis. These unnecessary medications and procedures can waste your time and money. Effective and safe treatments to optimize fertility are available.

    Proper identification of the cause of infertility is crucial to the most cost effective, and timely treatment. An infertility specialist can help you avoid unnecessary procedures and tests of limited usefulness.


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    Re: Do I need Reproductive Endocrinolgist(REI)

    Important tests
    What can be done before I see a REI?
    These tests can be done by your primary care physician or gynecologist prior to consulting your REI:

    • Day 3 FSH(follicle stimulating hormone) and Estradiol (Day 2-3 is acceptable)
    • TSH (thyroid stimulating hormone)
    • Prolactin
    • Progesterone: 7 days prior to menses, this test is occasionally helpful
    • Semen analysis

    These tests may be useful based on each patient's particular needs:

    • Hysterosalpingogram (HSG) or documentation of tubal status
    • Hysteroscopy
    • Laparoscopy: The surgeon should be able to treat during this procedure, not just diagnosis.

    The following treatments may be done, if indicated, for a limited number of cycles:

    • IUI (intrauterine insemination)
    • Clomiphene citrate (Clomid, Serophene)

    What tests are best done through my REI?
    These tests are best done through your REI:

    • Strict sperm morphology
      Strict morphology is a very specific method of evaluating the shape of sperm. Most laboratories do not use strict criteria thus potentially missing a sperm problem. Our laboratory is staffed with embryologists trained to analyze sperm with these strict criteria.
    • Evaluation of ovarian reserve
      Evaluation of ovarian reserve includes family history, ultrasound to detect the antral follicle count (AFC), a cycle day 2-3 FSH and estradiol level (both must be done at the same time), Anti-mullerian Hormone AMH, and clinical and family history. An REI can bring all of these assessments together into one consistent picture of a woman’s ovarian reserve.
    • Ultrasound
      A pelvic ultrasound is a very useful test when it is done at the appropriate time in the menstrual cycle. A few days prior to ovulation an ultrasound can evaluate ovulation, follicle growth, endometrial thickness and pattern, polyps, and fibroids. During menses is the best time to evaluate the ovary for cysts and endometriosis.
    • Genetic testing
      Genetic testing is important in women with premature menopause and multiple miscarriages and men with very low sperm counts. Patients with a family history of a genetic disease can use genetic testing to determine if they are carriers of the disease. Universal genetic testing (Counsyl, www.counsyl.com) can be used to assess risk for certain genetic illnesses that run in families. If detected, Preimplantation Genetic Diagnosis (PGD) can help prevent genetic illness in your child.
    • Insulin
      Women who have irregular periods and have been told they have Polycystic Ovary Syndrome (PCOS) should be evaluated by an REI. Testing can lead to more effective treatment.



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    Re: Do I need Reproductive Endocrinolgist(REI)

    Unnecessary tests
    The following tests are rarely needed:

    • Post-coital test
    • Endometrial biopsy
    • Hamster egg penetration (SPA)
    • Serum immune testing
    • Serum antisperm antibodies

    Some of these tests may be appropriate in special situations – talk with your REI.Treatments by a specialist
    The advanced training of a reproductive endocrinologist is helpful to provide the most successful treatments for infertility.
    Some of these treatments include:

    • In vitro fertilization with embryo transfer (IVF, or IVF/ET),
    • Fertility preservation
    • Egg freezing,
    • Intracytoplasmic sperm injection (ICSI),
    • Preimplantation genetic diagnosis (PGD),
    • Ovulation induction,
    • Intrauterine insemination.

    A specialist is able to evaluate simpler treatments and finely tune them to make them more effective. For example, a specialist can monitor ovulation induction with clomiphene (Clomid) with ultrasound and blood tests. The vaginal ultrasound can be used to assess follicle development and endometrial pattern and thickness. Intrauterine inseminations can be done to bypass hostile mucus caused by clomiphene. The specialist can also help decide when to stop a particular treatment and/or proceed with more.
    Alternative medications like letrozole (Femara) are just as effective as clomiphene but have fewer side effects. Since letrozole is not approved by the FDA for marketing for fertility use, its use is generally restricted to specialty clinics, that is, REIs.


    Source: Pacific fertility center



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