Not every pregnancy comes easily. Some couples spend months or even years unsuccessfully trying to conceive. Other couples and single women pursue parenthood through the use of donor eggs or sperm.
Regardless of the scenario, a reproductive endocrinologist can help make the dream of having a child come true.
Albert Hsu, MD, is a reproductive endocrinologist with MU Health Care. In this Q&A, he describes his role and the options available to people who need a little help starting a family.
What is a reproductive endocrinologist?
Reproductive endocrinology is a subspecialty of obstetrics and gynecology. It requires four years of medical school, four years of residency training in obstetrics and gynecology and three years of fellowship in reproductive endocrinology and infertility. A reproductive endocrinologist is trained to evaluate problems that can interfere with conception, and he or she can carry out various treatments to address these problems.
Reproductive endocrinologists are experts in many fields, including polycystic ovarian syndrome (PCOS), endometriosis, infertility, recurrent pregnancy loss, diminished ovarian reserve, hypothalamic pituitary dysfunction, hyperprolactinemia and disorders of the female reproductive tract. They have in-depth knowledge of sperm, eggs, male and female reproductive anatomy, the mechanics of conception and the complex interactions between pituitary and reproductive hormones.
What are the reasons people might consider making an appointment with you?
The most common reason is to address infertility, which is broadly defined as the inability to conceive after one year of frequent unprotected intercourse. For women older than 35 years of age, we encourage evaluation after six months. And for women who are 40 years of age or older, we recommend expediting an infertility evaluation at their earliest convenience.
Another common reason to visit a reproductive endocrinologist is to pursue conception with donor sperm or donor eggs. Intrauterine inseminations with donor sperm are a useful option for same-sex female couples and single women who wish to conceive, and donor eggs can be similarly useful for women with primary ovarian insufficiency or premature ovarian failure.
We also provide something called preimplantation genetic diagnosis (PGD), a procedure that can be used to identify genetic mutations within a patient’s family medical history that can result in disorders that are passed down to future generations. Once these genes are identified, we can use in vitro fertilization and PGD to select and transfer embryos without those genes to achieve pregnancies that do not have such genetic disorders.
Recurrent pregnancy loss is another area where a reproductive endocrinologist can assist patients. If you have experienced more than one miscarriage, we can run tests to help uncover why this is happening and work toward preventing future complications.
Reproductive endocrinologists are also equipped to help patients explore fertility preservation when faced with medical treatments that could cause damage to their oocytes or sperm, such as radiation or chemotherapy for cancer treatments or immunosuppressants for organ transplantation.
Finally, reproductive endocrinologists commonly see patients who have PCOS, hypothalamic amenorrhea, abnormal uterine bleeding and endometriosis.
What can your patients expect during their first visit and what are some of the treatment options you might offer?
A patient should expect for us to conduct an extensive history of both herself and her partner. We will discuss the patient’s personal situation and goals and answer any questions she may have. Then, we will usually order bloodwork, a tubal patency test and a semen analysis if a male partner is involved.
Depending on the results of this fertility workup, we will discuss treatment options such as medications for ovulation induction, intrauterine inseminations and/or in vitro fertilization.
What is your ultimate goal for your patients?
My ultimate goal is to provide effective treatment that helps my patients achieve the families that they seek. I am also passionate about cost-consciousness, as the most expensive treatments are not necessarily the right treatments for every patient.
Patients frequently have questions about cost, insurance coverage and success rates. The answers to those questions are different for every individual, so we encourage you to make an appointment for a consult.
What do you love most about being a reproductive endocrinologist?
I experience many gratifying moments each and every day. I particularly enjoy making sure my patients feel heard by answering concerns that no other provider has previously addressed. But of course, all told, there’s nothing better than seeing a patient who thought she’d never have a baby come into our office and show off her beautiful, healthy child after fertility treatment from our program.
I also greatly enjoy teaching medical students, residents and fellows, and I especially delight in participating in important research studies that seek to answer complex questions within the realm of reproductive endocrinology and infertility.