Every living creature, from the largest whale to the smallest micro-organism, is designed to reproduce itself. In humans, that biological programming is often reinforced by social and emotional factors. This combination of genetic and psychological urgency makes infertility one of the most emotionally wrenching medical conditions for patients. Reproductive endocrinologists are the primary specialists in fertility, though urologists and other physicians also treat infertile patients.
Basic Medical Education
The first eight years of any doctor's training are very similar. They begin with a four-year bachelor's degree in any major, with coursework that meets the prerequisites for admission to medical school. This typically includes math and humanities courses, as well as a range of foundational sciences. Students also take the Medical College Admissions Test, or MCAT, before their senior year. Those whose MCAT score and grade point average are high enough are accepted into medical school and will spend four more years learning the science and practice of medicine in classrooms and in supervised clinical rotations.
Aspiring fertility specialists spend their first year after graduation in a general internship, then focus on obstetrics and gynecology for three more years in a residency program. After taking and passing examinations from the American Board of Obstetrics and Gynecology, the doctor becomes a board-certified obstetrician/gynecologist. However, human reproduction is a complex field requiring further in-depth training. Physicians who want to specialize in the field must complete another three years in a specialized fellowship, treating infertile patients under the supervision of experienced practitioners. At the end of three years, each fellow must take and pass a second set of board exams to become certified as a reproductive endocrinologist.
Reproductive endocrinologists treat both men and women for conditions contributing to infertility, but their background is in women's health. Since male factors contribute to approximately 40 percent of infertile couples, urologists also play a role as fertility specialists. Urologists are specialists in the urinary tract and male reproductive organs, and often focus their practice on male infertility. Urologists complete the same eight years of education as reproductive endocrinologists, then spend five years in residency. The first year is a general surgical internship, while the following four years provide experience in the surgical and non-surgical treatment of fertility, erectile dysfunction and urinary problems. Urologists must also pass a set of board exams administered by the American Board of Urology.
Conditions and Treatments
Several factors can contribute to infertility. Healthy couples sometimes only need coaching about lifestyle factors and times of maximum fertility, which can be gotten from a family doctor or gynecologist. Gynecologists can also prescribe drugs to make ovulation more regular, or perform intrauterine insemination procedures. In more complex cases, reproductive endocrinologists are needed to perform in-vitro fertilization or administer fertility drugs. They can also diagnose other problems of the reproductive organs and either treat them medically, or arrange for surgical correction. Urologists do the same for men, when physical or medical causes reduce their fertility or sexual function.