Are reproductive endocrinologists still gynecologists?

Then it’s time for the mendacity and entropy to stop, and some radical changes should be made in the training of the fellows and the practice of reproductive endocrinology and infertility. Let’s face it, we have moved from having an academic bent to a cooperate one. Training should be expanded so that fellows become facile in running the embryology laboratory associated with their ART program. The American Board of Bioanalysis has a program that provides certifications for Embryology Laboratory Directors (ELD). This should be an elective—not mandatory—part of the fellowship. In an editorial one year ago, Schlaff suggested that REI’s should also be responsible for managing male infertility ( 1 ). Should this include the surgical aspects? The rapid expansion and the scientific advances in pre-implantation genetic diagnosis mean that genetics should be a more integral part of the program and reproductive endocrinologist could also—if they elect to do so—become boarded in clinical genetics. Even though there is considerable overlap among the 25 areas that reproductive endocrinologists are responsible for (e.g., contraception, menopause, dysfunctional uterine bleeding, and gynecology) it’s time to move ahead. Even PCOS is moving out of our realm. The leader of this change has to be the American Board of Obstetrics and Gynecology. Although this might take a long time to change, one would predict that in the future people finishing their residency will be board certified in obstetrics and gynecology, but after that their maintenance of certification will only be in reproductive endocrinology and infertility (if that is their field of subspecialization). Today ABOG states that less than ten percent of an REI fellow’s time can be spent on gynecology. In conclusion, reproductive endocrinologists are not gynecologists in 21st century America. Their areas of responsibility should be expanded and the body of knowledge should be more and more about less and less. “I am not lost for I know where I am. But however, where I am may be lost.”- A.A Milne, Winnie-the-Pooh