What is Infertility, and How Can a Reproductive Endocrinologist Help?

Dr. Christine Skiadas is a board-certified obstetrician and gynecologist and a subspecialist in reproductive endocrinology and infertility, or a reproductive endocrinologist. In her practice at Atrius Health in the Boston area, she works with a broad population of patients, many of whom are trying to get pregnant.

Pamela DeGregorio, a Women’s Health Writer at Ovia Health, spoke with Dr. Skiadas about her work, just what it means to be infertile, and the future of the field of reproductive endocrinology. Answers have been lightly edited for length and clarity.

There are a lot of myths about infertility. What exactly does a medical diagnosis of infertility mean?

Infertility is a disease that is defined by the American Society of Reproductive Medicine as “the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination.” Essentially, this means trying to get pregnant on your own for a year or more without success. However, most physicians recommend proceeding with an earlier evaluation — after 6 months of attempted pregnancy — for women over 35 or couples with other risk factors. Once you have a medical diagnosis of infertility, this may open up additional diagnostic testing and treatment options.

You’re an OB/GYN with a subspecialty in reproductive endocrinology and infertility, or a reproductive endocrinologist. What does that mean from a patient’s perspective?

I work with a broad population of patients — from teenagers who are not getting regular periods to women who are facing premature menopause. However, the vast majority of my patients are couples trying to get pregnant.

I see a wide range of patients with difficulty getting pregnant or who have had recurrent miscarriages, as well as those with irregular menstrual cycles and other reproductive health problems that may put their fertility at risk or call for surgical treatment. I also help women who want to preserve their fertility by freezing eggs, single women considering parenting on their own, and same-sex couples who want to build families.

The majority of patients I see have been attempting pregnancy for about a year before they seek consultation. However, if the female partner is over 35, it’s reasonable to plan a consultation after 6 months. Usually an initial consultation would include a thorough review of past medical history, with attention to risk factors that could harm fertility, and then we would determine a diagnostic testing plan and course of action.

Treatment is highly individualized, both in terms of what is medically appropriate for a couple, as well as paying careful attention to their own values and reproductive goals. Treatments could range from medications to help with ovulation all the way to robotic assisted reproductive surgery to correct factors negatively impacting chances of pregnancy.

What are some recent developments in the field of reproductive endocrinology that you find particularly promising?

Within the past five years, the technology involved in freezing eggs has revolutionized this procedure and has made it possible for women to preserve eggs for the future. This has also vastly changed the field of egg donation (the process of getting pregnant using an egg donated by another woman) and has made it more analogous to that used for sperm donation (where either egg or sperm is frozen in advance). This holds the promise of potentially being able to somewhat circumvent Mother Nature, but this technology is still a recent development and only became widespread (and effective) in the past five years or so. If you’re reading this and regretting you didn’t freeze your eggs 5-10 years ago, don’t regret it — this is a newly developing area.

The field of genetics also continues to change rapidly, which has allowed for much greater testing of genetic disorders in embryos. Increasingly, we are offering more genetic screening to couples — even prior to getting pregnant — to try to identify genetic traits within a family that could cause birth defects or longer term impacts on a healthy life. If we identify something within the parents, we now have the capability to use genetic testing to identify embryos that carry certain genetic diseases, predispositions to cancer, or chromosomal problems that would result in miscarriage.

I anticipate that these two advances will continue to evolve the way in which we practice reproductive medicine in the future.

What would you most like people who are trying to conceive to know about infertility and the field of reproductive endocrinology?

First is acknowledging that infertility is a disease and not a personal failing. Second is that there are a wide range of treatment options available, many of which are highly successful. Third, we are much better at controlling the risk of a multiple pregnancy now than previously, so there are a lot of ways to optimize the chances of having a single pregnancy.

Finally, there are lots of ways in which we can individualize treatment plans to increase the comfort of the couple undergoing treatment — from limiting the number of embryos created, to genetic testing, to including alternative therapies such as acupuncture in a treatment plan.

The field of reproductive endocrinology is fascinating and continues to evolve quickly. Treatments that were done routinely five years ago have now been completely replaced. It makes sense to discuss your fertility with a specialist if things are not happening naturally. Board-certified reproductive endocrinologists have done advanced training in reproductive endocrinology following an OB/GYN residency. Like any subspecialty, the training is much different than other physicians whom patients may have discussed their fertility concerns with.

The guidance and care a reproductive endocrinologist can provide is also much different than the advice that many people get from their families — that they just need to relax and it will happen. The one thing that we haven’t (yet) been able to completely overcome is Mother Nature and the impact of advanced maternal age. Success rates are highly linked with age, and it makes me sad when I see patients who have been trying to conceive for many years who had not previously seen a physician and may not have realized what an impact age can have.

If pregnancy is not happening and you’re concerned, speak with a specialist. There are so many things that can be overcome with treatment — I am truly amazed every day with what our field can do.    

You can find Dr. Christine Skiadas at Atrius Health’s locations in Boston (Kenmore Square), Burlington, or Quincy and read part two of her interview here. For more articles like this, download Ovia Fertility from the App Store or Google Play!