Couples experiencing infertility issues often see a variety of medical specialists to help them achieve pregnancy. Urologists and reproductive endocrinologists both work with infertile couples. Some of the care they provide overlaps, particularly in the area of male infertility. While urologists and reproductive endocrinologists often work together and provide complementary care, the two specialties can also differ in their approach to male infertility.
Urologists treat specific male infertility issues related to problems within the genito-urinary tract. Like other medical doctors, urologists first attend four years of medical school, then complete a residency of an additional five years in urology. Urologists work mainly with male infertility patients. A urologist might surgically remove varicoceles, dilated blood vessels in the testicles that may damage sperm. Other common urology procedures include vasectomy reversal and hormonal treatments to increase sperm counts. If blockages in the genito-urinary tract prevent sperm from entering the ejaculate, urologists can remove sperm directly from the testes and use the sperm for advanced reproductive procedures such as in vitro fertilization (IVF).
Reproductive endocrinologists -- often called REs -- undergo three years of additional training after completing their four-year medical residency in obstetrics and gynecology. While obstetricians treat pregnant women, REs specialize in getting women to that point. To achieve this goal, REs conduct a battery of tests, including semen analysis for male fertility issues. An RE also looks for underlying female fertility issues such as hormone imbalances, blockages in the fallopian tubes or problems preventing an embryo from implanting in the uterus.
Urologists and REs sometimes have different approaches to male infertility. A urologist might suggest correcting a male issue such as a previous vasectomy with surgical reversal. The RE might suggest skipping the surgery and having the urologist do a sperm aspiration, removing sperm directly from the testes with a fine needle. The urologist might argue that vasectomy reversal -- if successful -- provides permanent results, so that a couple can avoid expensive procedures such as IVF and intracycloplasmic sperm injection, better known as ICSI -- the injection of one sperm into one egg.
With between 10 percent to 15 percent of couples experiencing problems conceiving or carrying a child, according to the American Urological Association, the demand for specialists to treat infertility issues will remain high. Both urology and reproductive endocrinology are high-paying specialties. Urology salaries range from $331,192 to $443,518, the Association of American Medical Colleges reports. Reproductive endocrinologists make between $269,000 to $366,000 annually, with a median income of $326,000, according to the National Human Genome research Institute.
- American Urological Association: Male Infertility
- The New York Times: Are Men Overlooked at Fertility Centers?
- NIH Clinical Center: Combined NICHD/Federal Fellowship in Reproductive Endocrinology
- National Human Genome Research Institute: Reproductive Endocrinologist
- Association of American Medical Colleges: Urology
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