Right now, infertility is more common than it's ever been. According to the CDC, one in five heterosexual women aged 15-49 with no prior births will experience infertility. That statistic is staggering, and with it in mind, it’s no surprise that fertility specialists are in high demand.
According to Jacquelyn Shaw, MD, a Reproductive Endocrinologist and Infertility Specialist at NYU Langone Fertility Center, the field of reproductive endocrinology is “booming.” This growth gives providers plenty of options when it comes to job-seeking.
But the road to becoming a fertility expert? It’s a long one. And for patients, the process of choosing the right fertility care provider can be complicated, even when there are so many qualified options.
Here, Dr. Shaw breaks down what it takes to become a fertility expert, what the job involves, and what patients should consider when seeking out a physician to guide them through the infertility journey.
What does it take to become a fertility specialist?
Becoming a fertility specialist doesn’t happen overnight.
“It’s a very long journey,” says Dr. Shaw. “In order to apply to medical school, you need to have had pre-med science requirements. Me, for instance, I did not study medicine or any pre-med as an undergrad, so I had to do an additional year-and-a-half, almost two years, of pre-clinical science classes before I could apply to medical school. Then you do medical school for four years, and that’s where you figure out what area of medicine you want to practice.”
But you don’t become a fertility specialist immediately after medical school ends. “After that, you do a residency program. The length of that really varies based on what your medical specialty is. To pursue reproductive endocrinology, you do a four-year OB/GYN residency [during which] you’re delivering babies, you’re doing all kinds of general obstetric and gynecological women care, [but] you’re not really doing any fertility care,” says Dr. Shaw.
“Every program is obviously a little bit different, but usually you’ll do a rotation (of a couple of weeks at most during residency) at a fertility center if your medical school is affiliated with one. And then you apply for a fellowship, [which] is specifically just reproductive endocrinology and infertility. It’s a three-year fellowship program, and that’s where you’re learning all of the fertility things,” she continues.
The learning doesn’t end once you’re a full-fledged fertility specialist.
In the world of reproductive endocrinology, research and guidelines are ever evolving, with new protocols being put into place as experts in the field learn more. Dr. Shaw admits that keeping up with all this research is hard. Providers have to get creative about how they fit this into their already busy schedules.
“I do think ASRM, our organization [within the field] is really good at providing lots of ways to stay on top of stuff, in terms of podcasts and journal clubs that are very easy to access for providers. I know other providers will listen to podcasts on their way to work to stay up to date on all the new things that are happening,” she says. “But when you have a busy practice, it’s hard.”
What does the day-to-day of a fertility specialist look like?
According to Dr. Shaw, many reproductive endocrinology practices operate under a “doctor of the day” model, which gives providers structure to their schedules. “You have a doctor each day of the week that is doing procedures: That day of the week you are doing monitoring with patients, you’re doing egg retrievals, you’re doing embryo transfers, and you’re coming up with patient plans. That’s usually about one day a week or one day every two weeks, depending on how many physicians are in the group,” she explains.
“The rest of the time typically it’s two or three days of consulting patients in the office — a mix of new patients and patient follow-ups. [Those days may involve] doing procedures like daily sonograms and endometrial biopsies — stuff that’s not in the operating room, but maybe a little bit more procedure-based. The last day, it really depends [on where you work],” she adds.
How does the OB/GYN training come into play?
Reproductive endocrinologists aren’t caring for patients through their pregnancies or delivering babies, but OB/GYN training is still crucial to the job of an RE, according to Dr. Shaw.
Being comfortable with the uterus, understanding the female anatomy, and having some experience performing procedures all come into play for fertility specialists, she says. And having a sense of how pregnancies progress matters as well, even though reproductive endocrinologists are not caring for patients through their pregnancies.
“Understanding the complications that can happen in pregnancy is also really important as you’re counseling patients,” Dr. Shaw explains. “[For example], everybody wants twins. Everybody says ‘put two [embryos] in [during an IVF cycle]’, but when you’ve taken care of twins that deliver really early and have had that experience, it’s a little bit more enriched conversation [based on] your experience. You can discuss why we do or don’t recommend some of those things. [That OB/GYN training] helps you procedurally, it helps your counseling, it helps you see the big picture sometimes.”
What should patients look for in a fertility specialist?
Obviously, someone must complete years and years of necessary training in order to become a reproductive endocrinologist — but that doesn’t mean every fertility specialist is the right one for each patient.
“Typically you’ll become board certified for OB/GYN practice and then board-certified for reproductive endocrinology and infertility. I would say that at a minimum, you should see a doctor who is board certified in both — or at least board eligible, meaning they recently finished their fellowship training and are still in the time period where [they’re working to become board certified],” says Dr. Shaw. “You have to do a lot of work to become board certified: You have to take a written exam for both of the tests, and then you have to do an oral exam where you collect cases after taking care of patients for a year, and then you do an oral exam with usually about three practicing physicians and they ask you questions about your cases [to] really make sure you are a vetted physician and practicing in a good way.”
Looking into a provider and practice’s statistics can help too. “I think one of the most important things is the embryology lab, so making sure that the embryology lab has good outcomes — that data is all available online if you look at the SART website, you can see how a clinic is and what their rates are,” says Dr. Shaw. “You can compare different centers in your area. You want to go to a place that has good outcomes and good results.”
Aside from looking into credentials, you can also rely on patient reviews — but ultimately, you have to feel good about who you see, as the fertility journey can be longer than you might anticipate.
Fertility specialists should individualize care.
When seeking out a fertility specialist, it’s important to feel like you’re working with someone who prioritizes individualization of care, as there are so many factors that go into devising a plan for each fertility patient. During an initial consultation, a fertility specialist should make an effort to get to know each patient and their goals (including the number of children they ultimately want) — and finding someone who makes an effort to understand each individual patient is important.
“We have protocols and we have tools, but it’s an art as much as a science for fertility care that really requires patient individualization,” says Dr. Shaw. “That’s a good thing to look for in a provider — someone that will really look at you, what your goals are, what your medical situation is, and figure out the best way to get you to where those goals are.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, MarieClaire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.
