A Reproductive Endocrinologist's POV: Infertility, IVF Treatments & Surrogacy

The Definition of Infertility

Infertility is more common than many people realize. From a clinical perspective, infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse for women under 35, or after six months for women 35 and older. It’s not just a women’s issue—male infertility contributes to roughly one-third of all cases.

What’s important to understand is that infertility is a medical condition, not a personal failure. And like any other health issue, it requires the right medical attention, care, and compassion. That’s where reproductive endocrinologists come in.

Who Does a Reproductive Endocrinologist Treat?

A reproductive endocrinologist is a specially trained physician who focuses on hormonal and structural reproductive disorders. They treat patients of all genders and a wide range of conditions. Here's a snapshot of who may walk through their doors:

• Heterosexual couples struggling to conceive
• Same-sex couples planning to grow their family
• Single individuals looking to become parents through assisted reproduction
• Women diagnosed with conditions like polycystic ovary syndrome (PCOS), endometriosis, or premature ovarian insufficiency
• Men facing low sperm count or motility issues

Essentially, if you're facing challenges starting or growing a family, this is the expert who builds your roadmap forward.

Causes of Infertility

Female Factors:

1. Ovulation Disorders: Irregular or absent ovulation is a leading cause.
2. Tubal Issues: Blocked or damaged fallopian tubes prevent fertilization.
3. Endometriosis: This condition can distort pelvic anatomy or damage the eggs.
4. Uterine Abnormalities: Polyps, fibroids, or congenital issues can interfere with implantation or cause miscarriage.

Male Factors:

5. Low Sperm Count or Motility: Poor quality sperm can't reach or fertilize the egg.
6. Varicoceles: Enlarged veins in the scrotum that raise testicular temperature and impair sperm production.
7. Hormonal Imbalances: Low testosterone or other endocrine issues.
8. Genetic Disorders: Such as Klinefelter syndrome or Y chromosome microdeletions.

Unexplained Infertility:

Roughly 10–20% of couples receive this diagnosis when no clear cause is found—even after testing. It's frustrating, but not uncommon.

Infertility Treatments

Lifestyle Changes & Monitoring:

Sometimes, adjusting weight, managing stress, or timing intercourse with ovulation prediction tools can make all the difference.

Medications:

Drugs like Clomid or Letrozole help stimulate ovulation. They're often the first line for women with irregular cycles.

Intrauterine Insemination (IUI):

This involves placing sperm directly into the uterus around the time of ovulation—non-invasive and cost-effective.

Surgery:

Used to correct anatomical issues like fibroids, endometriosis lesions, or tubal blockages.

In Vitro Fertilization (IVF):

This is the gold standard for many infertility diagnoses. Let’s dig deeper into what that actually involves.

What Is IVF?

1. Ovarian Stimulation: Daily hormone injections encourage the ovaries to produce multiple eggs.
2. Egg Retrieval: Eggs are collected via a minor surgical procedure.
3. Fertilization: In the lab, eggs are mixed with sperm or injected directly via ICSI (intracytoplasmic sperm injection).
4. Embryo Culture: Embryos are observed and graded over 3–6 days.
5. Embryo Transfer: One or more embryos are placed into the uterus.
6. The Two-Week Wait: Blood tests confirm whether implantation was successful.

Success Rates:

IVF success varies with age, diagnosis, and embryo quality. For women under 35, the success rate per transfer is around 40–50%. Over 40, it drops significantly—this is where donor eggs may be recommended.

You can learn more about IVF standards and outcomes at CDC.gov

What Is Third-Party Reproduction?

Types of Third-Party Reproduction:

• Egg Donation: Used when the intended mother can’t produce viable eggs. Donors are rigorously screened.
• Sperm Donation: Often used by same-sex female couples, single mothers by choice, or when male factor infertility is present.
• Embryo Donation: Embryos from another couple’s IVF journey are gifted to patients who can’t create viable embryos.
• Gestational Surrogacy: A woman (the surrogate) carries a pregnancy for the intended parent(s). The surrogate has no genetic connection to the child.

Gestational surrogacy is the most complex and legally involved path, but for many families, it’s the only way to experience parenthood. In the U.S., surrogacy laws vary by state, so working with experienced legal counsel is essential.

Further guidance on surrogacy legalities is available through NICHD and HHS.gov

Ethical & Emotional Considerations

Assisted reproduction is not just science—it’s deeply emotional. Patients may face grief, uncertainty, and financial pressure. A good reproductive endocrinologist provides not only medical expertise but also referrals for mental health counseling, ethical guidance, and support networks.

For many, especially those pursuing surrogacy, this is not just a medical process—it’s a deeply human journey.

Resources on emotional support and reproductive ethics can be found via NICHD

Conclusion

Infertility affects millions, but it's not the end of the road—far from it. With the guidance of a reproductive endocrinologist, patients can explore a wide array of treatments tailored to their individual needs. IVF has opened doors for countless families, and third-party reproduction, including surrogacy, offers powerful solutions when traditional paths aren’t an option.

The science is real. The hope is real. And with the right care team, the dream of parenthood can become reality.