Nicolo DeFazio

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So you want to be a reproductive endocrinologist. You love babies and want to help make your patients’ dreams of parenthood come true. Let’s debunk the public perception myths of what it means to be a reproductive endocrinologist and give it to you straight. This is the reality of reproductive endocrinology.

Reproductive endocrinology and infertility, or REI for short, is the field of medicine concerned with helping people get pregnant who are unable to do so on their own. REI physicians are experts in all things related to conception and reproduction and are adept at managing any issues that may be preventing patients from becoming pregnant.

REI doctors are often best known for fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF); however, their actual scope is much broader. REI physicians handle the full spectrum of issues that cause infertility from hormone imbalances to polycystic ovarian syndrome (PCOS) to even some forms of cancer. In addition, REI physicians also help patients preserve their ability to have children in the future through procedures such as egg and sperm cryopreservation.

There are a few ways to categorize reproductive endocrinology.

Let’s start with infertility versus reproductive endocrinology.

In general, infertility comprises the bulk of what an REI physician does day-to-day. It encompasses all of the evaluations and treatments for patients who want to become pregnant but have difficulty doing so on their own.

The bread and butter of infertility is focused on the evaluation of the uterus, fallopian tubes, ovaries, and sperm, as well as the patient’s general health and genetics, to determine why the patient or couple is having difficulty conceiving.

The infertility aspect of REI also includes various procedures to help patients become pregnant, most notable of which are ovulation induction and intrauterine insemination, sometimes called artificial insemination, and in vitro fertilization.

With ovulation induction and IUI, patients are given a series of medications followed by a trigger shot to help their bodies release an egg. Once the egg has been released, sperm is introduced into the uterus in an attempt to fertilize the egg.

In contrast, in vitro fertilization requires the extraction of eggs from the patient after which they are combined with sperm in a laboratory. The embryo will then be allowed to grow within the lab for a few weeks after which it will be transferred into the uterus to, hopefully, result in pregnancy.

In contrast, the reproductive endocrinology aspect of REI is similar to medical endocrinology; however, it focuses solely on the hormones related to reproduction – namely estrogen, progesterone, and testosterone. The bread and butter of reproductive endocrinology involves working with conditions such as menopause, premature ovarian insufficiency, and PCOS.

Another method of differentiating an REI practice is academic vs private.

REI physicians working in the academic setting will split their time between clinic, teaching, and research. Depending on the arrangement, academic REI doctors may spend as much as 80% of their time teaching and researching and as little as 20% of their time in the clinic seeing patients. It should be noted, however, that this varies significantly depending on the specific arrangement.

The majority of REIs work in private practice. This means that they are either running their own clinic or working for a private group. In private practice, the focus tends to be on clinical medicine and less on research or teaching as evaluating and treating patients is often what drives revenue. That being said, hybrid practices splitting one’s time between clinic, research, and teaching do exist.

In terms of compensation, physicians working for private practices will generally make more than their colleagues in academia. That being said, there is a great deal of variation in terms of compensation within private practice.

Let’s clear up some of the misconceptions about REI.

To start, many people believe that fertility treatment is only available for male and female couples. This is not true. There are many single women, LGBTQ+ couples, and even the occasional single male who seek fertility treatment. REI physicians see the full spectrum of patients with regard to race, sexual orientation, and socioeconomic status.

Another misconception is that REI physicians can help you get pregnant regardless of the situation. People see celebrities in their 50s getting pregnant and believe that it’s possible for everyone. The reality is that REI doctors can help enhance your ability to get pregnant, but only if it’s possible in the first place.

Female patients who have children later in life generally either froze their eggs when they were younger or used an egg donor. If there are no eggs left in the ovaries or no sperm being created in the testicles, REI doctors can’t change that. They can, however, provide a donor.

Lastly, many people incorrectly believe that it is an easy specialty. REIs have to be incredibly detail-oriented as seemingly small mistakes can be the difference between your patient becoming pregnant or not.

In addition, miscarriages, ectopic pregnancies, and negative pregnancy tests are common occurrences and those conversations are never easy – even for the most seasoned physicians.

To become an REI physician, you must first complete four years of OB/GYN residency followed by 3 years of REI fellowship. Occasionally there are urology residents who will cross over to REI; however, the vast majority are OB/GYN trained.

This makes sense as REI physicians still use many of their OB/GYN skills in their daily practice. For instance, when patients become pregnant, the reproductive endocrinologist will typically follow the patient through the first trimester of pregnancy. Additionally, REIs still have to deal with the many complications that can occur during pregnancy such as miscarriages and ectopic pregnancies.

REI fellowship is generally divided evenly between research and clinical work. Due to the heavy emphasis on research, REI fellows are required to present a thesis, or original piece of research, as a part of their fellowship curriculum and as part of their oral board exams.

The majority of time during the second half of fellowship will be spent in the REI clinic; however, they are also required to complete rotations in medical endocrinology, pediatric endocrinology, urology, and genetics.

In terms of competitiveness, OB/GYN is considered tier 4 or “less competitive.” The average match rate is 89%, average Step 1 is 229, Step 2CK is 245, and the average number of publications hovers around four and a half.

That being said, REI is known for being one of the most competitive OBGYN subspecialties. In 2021, there were 70 applicants that applied out of which 49 were offered positions. That’s a match rate of 70%.

Medical students best suited for reproductive endocrinology and infertility tend to be detail-oriented, patient, and adept at working in a slower-paced yet still high-stress environment.

There’s a lot to love about REI.

To start, being an REI doctor is immensely gratifying. The feeling of satisfaction you get when you see a baby’s first heartbeat on an ultrasound after you’ve spent months, or even years, helping a patient conceive is difficult to put into words.

As an REI physician, you also get to spend a lot of time with your patients. This allows you to build very close relationships that you don’t necessarily get in many other specialties.

REI physicians also tend to have higher compensation. According to the 2020 MGMA Physician Compensation Report, the median salary is $457,000 with a mean compensation of $461,000.

It should be noted that compensation can vary significantly, with some making $250,000 at the low end and others making more than $500,000 at the high end. That being said, those at the higher end of the salary range will generally own their own practice, which comes with all of the additional work that goes into owning a business.

REI also offers flexibility within the specialty. If you want to focus on procedures, you can do that. Or if you’re more interested in the medical aspects of REI, that’s fine too. And if you’re interested in teaching, the heavy emphasis on the basic sciences during your training also opens up many opportunities to teach.

Lastly, the lifestyle of an REI physician is generally pretty good. The hours spent in the clinic are fairly predictable and night-call or night emergencies are very rare. That being said, due to the time-sensitive nature of fertility treatments, you do have to remain fairly accessible to your patients.

While reproductive endocrinology and infertility is an awesome specialty, it’s not for everyone.

To start, the training is longer than most specialties as you must complete 4 years of OB/GYN residency followed by 3 years of REI fellowship.

In addition, if you’re interested in opening your own practice, there is a great deal of overhead that you don’t necessarily have with other specialties. Even if you’re opening a small practice with only one physician, operating an REI practice requires a large team.

You’ll often need at least a lab, a surgery center, an office, and the associated staff. This includes front staff, medical assistants, an embryologist, an anesthesiologist, and other staff to help coordinate the care. As such, it can often be incredibly difficult to start your own REI practice.

Fertility treatments also don’t work 100% percent of the time and it can be incredibly frustrating for both the patient and physician when things don’t go as expected. In some instances, patients burn out, become angry, or don’t have the financial resources to continue pursuing fertility treatment and, as an REI physician, you’re often the one that has to bear the brunt of those frustrations.

As such, REI can be stressful. You have to be confident in yourself and your abilities and be able to acknowledge that if someone doesn’t get pregnant, it isn’t necessarily your fault. No treatment is 100% effective.

That being said, it can often be difficult not to internalize these feelings as there are very clear lines regarding whether the treatment was successful. Either the pregnancy test was positive and the baby was born, or it wasn’t – and that’s a heavy burden to bear, both for the patient and the physician.

How can you decide if REI is right for you?

You should enjoy both the procedural and non-procedural aspects of medicine and be willing to dedicate extra years in training for the satisfaction of knowing you’re helping bring new life into the world.

You should also be patient and persistent – willing to endure the rollercoaster of emotions that comes with unsuccessful pregnancies if it means ultimately getting your patient to that one successful pregnancy.

Lastly, you should enjoy research and basic sciences, at least to some degree, as they are a major component of the training to become an REI physician.

Are you hoping to become a reproductive endocrinologist? To get into medical school and match into a top OB/GYN residency, you’ll need to score well on your exams and have a killer application. As you look for experts to work with, seek out those who are actual MD physicians who crushed their MCAT and USMLE, gained multiple top medical school acceptances, matched into competitive residencies, and even had medical schools fighting over them by throwing merit-based scholarships to sway their decision. Only the top performers can best show you how to most effectively improve your own performance.

At Med School Insiders, we’ve been empowering a generation of happier, healthier, and more effective future doctors since 2016. By recruiting the top talent and pioneering a systems-focused approach to our services, we’ve become the fastest growing company in the space with industry-leading customer satisfaction. If you decide on Med School Insiders, we’d love to be a part of your journey to becoming a future physician.

If you enjoyed this article, be sure to check out So You Want to Be an OB/GYN or another specialty in our So You Want to Be series.

Had the same question! Thanks for asking, I feel less alone now haha Upvote 2 Downvote Reply u/Witty_Snow9455 avatar

This feature is very useful when two issues have some type of a dependency on each other as if they are duplicates or relate to each other, upstream downstream dependency or blocking issues.

For creating a link to another issue, the user has to navigate to the issue and click on the View Issue Page. After that, click More → Link to display link dialogue page.

The following screenshot shows how to access Link feature −

Select JIRA Issue item in the left side of the dialogue and select “This issue” field from the dropdown list. The following screenshot shows how to link an issue by providing the details.

The next step is to select/search issue. The following screenshot shows how to add an issue as a link in another issue.

Add the comment; it is optional and then Click on Link. The View Issue page shows up and the user can go down and verify whether the linked issue is displayed or not under the Section Issue links.

The following screenshot shows how to view linked issue in parent issue −

To delete a link, a user should go to the View Issue page and to that issue which contains the links. Scroll down and go to Issue Links section. Hover the mouse over the link that should be deleted and then click on the Delete icon.

The following screenshot shows how to delete a link −

A confirmation pop-up will display; click on the Delete button. The following screenshot shows the confirmation pop-up for deletion.

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If you lose cross-premises VPN connection on one or more site-to-site tunnels, setting an azure gateway connection is helpful. In this situation, your on-premises VPN devices are all working, but aren't able to establish tunnels with the Azure gateways. The article helps reset a gateway connection.

A gateway is composed of two instances that are running in active-standby configuration. When you reset the gateway, it restarts and then reapplies the cross-premises configurations to it. The gateway has an existing public address. You won't need to change the configuration of the VPN Router with a new public address.

When you issue the command to reset the gateway, the current active instance of the gateway is immediately shut down. There will be a brief gap between the active instance being rebooted and the standby instance. It should be less than a minute.

If the connection isn't restored after the first restart, you have to restart the second instance. There will be a slightly longer period where both instances are being rebooted if the two reboots are requested back to back. It will cause a longer gap on the VPN connection, up to 45 minutes for the VMs to complete the reboots.

If you are still having issues with cross-premises connections after two restarts, please open a support request from the portal.

The gateway does not restart when you reset it.

Only the selected connection is restored.

You can reset a connection using the portal.

Before you reset your gateway, make sure to check the key items listed below.

The S2S tunnel will be disconnected if there is a mismatch in the items. If you verify and correct the configurations for your on-premises and azure gateways, you will not have to deal with any disruptions for the other connections.

Before you reset your gateway, make sure the following items are checked.

You can use the portal of the Microsoft company to reset the Resource Manager gateway.

If you want to reset a classic gateway, you can see the steps in the PowerShell.

The Reset-AzVirtualNetworkGateway is a tool for resetting gateways. Before you perform a reset, make sure you have the latest version of the Az commands. The TestRG1 resource group contains a virtual network gateway called VNet1GW.

The result was.

You can assume the gateway reset was successful when you receive a return result. There is no indication in the return result that the reset was successful. You can see the history of the gateway reset in the portal if you want to look closely. You can navigate to 'Gateway Name' in the portal.