My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
Elle’s gynecologist smiled sympathetically at her as he said, “From everything I can see you are good to go. The fact that you haven’t gotten pregnant yet leads me to believe you should see a reproductive endocrinologist.”
How can one’s heart sink and rise in hope at the same time? Elle thought. She was disappointed at not having an answer, yet hopeful that there could be someone to help. “Thank you doc, can you send the referral?”
A reproductive endocrinologist (RE), sometimes referred to as an OBGYN endocrinologist or gynecologist endocrinologist, is a doctor that specializes in helping people become, and stay, pregnant. They are the only doctors trained in this area specifically.
The hormones involved in pregnancy are of particular interest and use in the field of fertility medicine. An endocrinologist’s focus is on hormones, for the field of reproductive medicine, and a fertility endocrinologist will aid in the management of pregnancy related hormonal issues.
“Reproduction is a fundamental aspect of life in all species. In a biological sense, it can be argued that reproduction is the essence of life. Passing on one’s genes to the next generation and constantly optimizing the gene pool available for each individual and the species as a whole are vital for continuation and endurance of the species.
“Reproduction and hormones are intimately connected; thus, hormones are a prerequisite for reproduction and govern nearly all aspects of successful creation in both females and males. Therefore, to numerous scientists, reproductive endocrinology is one of the most fascinating disciplines in science…” (Andersen 2017)
When most people think of the medical fields responsible for helping someone with pregnancy, they immediately think of an OBGYN, and their first stop is usually their gynecologist. If someone has never heard of fertility endocrinology, they may not understand the differences between these fields.
To put it simply: All reproductive endocrinologists are also obstetricians and gynecologists. A person can be a gynecologist only, but if one is trained in the field of obstetrics (the surgical side of things), they are also trained in gynecology.
To go into the field of reproductive endocrinology, one must complete the requirements of a gynecologist, an obstetrician, and then complete the training in reproductive endocrinology as well. The credentials require no less than 11 years of schooling. In short, if you are seeing a fertility endocrinologist, you are under the care of a very trained and experienced professional.
Reproductive endocrinology and infertility are closely linked because many people who have struggled with infertility can benefit from the help of a fertility endocrinologist. Contrary to what some may believe, it isn’t just people with uteruses whose infertility is due to hormone issues, males who wish to procreate can be rendered infertile for hormonal reasons as well.
Aside from making people’s dreams of being a parent come true, one of the best things an RE can do is help people find out why they are experiencing infertility. This is great because so much of the heartbreak is not understanding why.
Fertility and endocrinology go hand in hand for many reasons. Knowing the problem, being able to fix it, and providing further treatments resulting in pregnancy are just some of the most common. An RE can help diagnose and find the reasons behind the diagnosis.
Hormonal reasons for infertility often lie with conditions affecting the ovaries. Ovaries are the center for hormone production in the female reproductive organs. Conditions such as:
In miscarriage, one of the most commonly asked questions is, “Why did I miscarry?”. So often an OBGYN has no answers to offer. However, an RE may be able to run tests and find out the specific reason. If that reason has to do with hormones, sometimes a shorter road to pregnancy is as simple as balancing the hormones or replacing them.
Low progesterone levels in pregnancy can result in bleeding and miscarriage. I had low progesterone levels in my pregnancy with my daughter. Taking progesterone stopped my bleeding and saved my baby’s life.
As scientists discover new technologies for helping people with infertility, more men are able to access the medical assistance needed to become parents. Some common reasons for infertility are caused by hormonal issues.
Those wishing to parent, or donate sperm but are having trouble with sperm count or motility may wish to be tested for hormone problems that could be affecting them.
“After the development of the ICSI procedure, endocrinology in males received less attention for some years, but new information on how to improve sperm function and the hormonal regulation of testicular function is now appearing. It appears that some men with poor sperm quality may benefit from exogenous FSH stimulation. The importance of specific FSH isoforms and genetic variants and FSH receptor polymorphisms (i.e., single nucleotide polymorphisms) are being evaluated and a potential sensitizing effect of co-administration of LH-like activity (e.g., hCG) is another option to potentially improve sperm production.” (Andersen, 2017)
Erectile dysfunction (ED) can impede the ability to get pregnant by preventing sexual intercourse and ejaculation. We now know that ED can be caused by hormonal problems.
“The proper function of erection mechanisms depend on correct interrelationship between psychological, vascular, neurological and hormonal factors. Endocrine diseases affect sexual function, and sexual dysfunction may be one of the symptoms of some hormonal anomalies.” (Jabaloyas, 2010)
A simple Google search of “fertility endocrinologist near me”, “gynecological endocrinologist near me”, “best reproductive endocrinologist near me”, or “gynecological endocrinologist near me” could produce some excellent results for those wishing to find fertility care close to where they live. However, finding the best reproductive endocrinologist could require traveling a bit further.
We have learned about the education level these fertility experts have, but that doesn’t always guarantee they will have a great bedside manner, or care about their patients in a way that makes them feel safe. It is important to do research to find the best doctor for you.
Here are some resources that could be of help. Please note I have gathered these from my own research and this article is not an endorsement or recommendation of their services:
There are others that may be of help for someone looking for fertility and endocrine care in the USA:
All of these resources are available to help. Whether you are looking for a doctor near you, looking for support from others, seeking education, or willing to travel to find help for your fertility journey any of these could be of service.
It is important to note that a fertility specialist is not the same as a reproductive endocrinologist. A fertility specialist could just be an OBGYN who chooses to specialize in helping infertile couples succeed in having a baby. An RE is trained and qualified to help on every level of care from prenatal to post.
I hope the information shared here has been helpful to you and that our little journey has enlightened you to the specialized care and RE can provide. If you or someone you know might benefit from reproductive endocrine services, reach out and ask your doctor for some information.
Remember to do your own research as well. Finding the right doctor for you is important, and can make the difference in how you feel and the results to receive. If you are hoping to become a parent, either for the first time or again, I wish you all the best!
References:
Andersen C. Y. (2017). Grand Challenges in Reproductive Endocrinology. Frontiers in Endocrinology, 7, 169. doi.org/10.3389/fendo.2016.00169
Jabaloyas J. M. (2010). Disfunción eréctil de origen hormonal [Hormonal etiology in erectile dysfunction]. Archivos espanoles de urologia, 63(8), 621–627.
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