Meeting the demand for fertility services: the present and future of reproductive endocrinology and infertility in the United States.

The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. This document's focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, offer approaches to rectify the developing physician shortage problem, and suggest a framework for the discussion on how to meet that increase in demand. The Society of REI recommend the following: 1. Our field should aggressively explore and implement courses of action to increase the number of qualified, highly trained REI physicians trained annually. We recommend efforts to increase the number of REI fellowships and the size complement of existing fellowships be prioritized where possible. These courses of action include: a. Increase the number of REI fellowship training programs. b. Increase the number of fellows trained at current REI fellowship programs. c. The pros and cons of a 2-year focused clinical fellowship track for fellows interested primarily in ART practice were extensively explored. We do not recommend shortening the REI fellowship to 2 years at this time, because efforts should be focused on increasing the number of fellowship training slots (1a and b). 2. It is recommended that the field aggressively implements courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision. 3. Automating processes through technologic improvements can free providers at all levels to practice at the top of their license.

The modern role of reproductive surgery.

The modern role of reproductive surgery has changed because of improved capabilities of endoscopic surgery resulting from innovation, instrumentation and experience, the development and increasing applicability of assisted reproductive technologies, and improved knowledge of the optimal application of these and other technologies. Rather than these technologies being competitive, the challenge for the reproductive specialist is to know and utilize reproductive surgery appropriately and effectively in the management of unexplained infertility, endometriosis, myomas, hydrosalpinges, proximal tubal occlusion, adhesions, ectopic pregnancy, tubal reversal, laparoscopic ovarian drilling for polycystic ovarian disease, as an adjunct to assisted reproductive technologies and in other clinical reproductive conditions.

Genetic evaluation of oocyte donors: recipient couple preferences and outcome of testing.

OBJECTIVE: To report preferences of recipient couples for genetic testing of their oocyte donors. DESIGN: Observational report of results from a genetic testing-options form implemented as part of routine care. SETTING: Private practice. PATIENT(S): Recipients and oocyte donors. INTERVENTION(S): Recipient couples completed a form before screening of their oocyte donor that outlined required screening and recommended tests that the couple could accept or decline. Couples were given information about carrier frequency, risk to their child if results were abnormal, and cost. MAIN OUTCOME MEASURE(S): Percentage of couples accepting optional testing. RESULT(S): Of the 63 couples with data available from their first testing-options form, 42 (67%) accepted and 21 (33%) declined fragile X testing, whereas 34 (54%) accepted and 29 (46%) declined karyotyping. When asked whether they would accept additional testing of their donor if it was recommended by a genetic counselor, 15 (24%) said that they would accept additional testing regardless of cost, 35 (56%) declined, and 13 (20%) indicated that their decision would depend on the cost. In many cases, history was elicited by the genetic counselor or test results were obtained that influenced further testing, decisions to proceed, or provided information important for the child. CONCLUSION(S): Recipient couples sometimes chose to decline tests that we recommended but did not require, despite the relatively low cost of this testing compared with the total cost of the oocyte donation cycle.