Reproductive Endocrinology

Reproductive Endocrinology:

Comprehensive Overview:

Reproductive Endocrinology is a vital subspecialty of obstetrics and gynaecology dedicated to understanding and managing disorders related to reproductive hormones and infertility. It explores the intricate interactions between the endocrine system and reproductive organs in both women and men, with a core focus on diagnosing and treating conditions that impair hormonal function, fertility, and reproductive health.

This field delves into the physiological regulation of reproduction by hormones such as oestrogen, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), testosterone, prolactin, and thyroid hormones. Disruptions in these pathways can lead to a wide range of clinical issues, including polycystic ovary syndrome (PCOS), anovulation, amenorrhea, premature ovarian insufficiency (POI), endometriosis, and male factor infertility. Reproductive endocrinologists are skilled in identifying these disorders through detailed clinical evaluation, hormonal assays, imaging (such as ultrasound), and genetic testing when indicated.

A major aspect of reproductive endocrinology is the evaluation and treatment of infertility, defined as the inability to conceive after one year of regular, unprotected intercourse. Reproductive endocrinologists investigate the underlying causes and create tailored treatment plans. These may involve ovulation induction, intrauterine insemination (IUI), or advanced assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). The choice of treatment depends on the patient’s age, ovarian reserve, uterine and tubal health, sperm quality, and reproductive goals.

In addition to treating infertility, reproductive endocrinologists manage fertility preservation, particularly for individuals undergoing chemotherapy, radiotherapy, or elective fertility delay. Techniques such as egg freezing, embryo cryopreservation, and sperm banking offer future reproductive options and have become increasingly accessible.

Reproductive endocrinology also addresses broader hormonal conditions across all stages of life. Adolescents with delayed or early puberty, women with menstrual irregularities, and menopausal women experiencing hormonal symptoms are often referred for specialist care. Disorders such as hyperprolactinaemia, thyroid dysfunction, adrenal abnormalities, and congenital reproductive anomalies fall within the scope of this specialty.

Conditions Treated:

Reproductive endocrinologists treat a wide range of conditions, including:

• Polycystic Ovary Syndrome (PCOS)
• Anovulation and Ovulatory Dysfunction
• Amenorrhoea (absence of menstruation)
• Infertility (female and male)
• Endometriosis
• Premature Ovarian Insufficiency (POI)
• Hyperprolactinaemia
• Hypogonadism
• Congenital reproductive anomalies
• Menstrual disorders
• Thyroid-related reproductive dysfunction
• Male factor infertility (e.g., poor sperm count, motility, morphology)

Prevention and Screening:

Although some reproductive conditions are genetic or congenital, many can be identified early and managed with timely interventions:

• Lifestyle Modification: A healthy diet, regular exercise, weight control, smoking cessation, and stress reduction can all improve reproductive function.
• Early Evaluation: Timely investigation of menstrual disorders, delayed puberty, or signs of subfertility can prevent long-term complications.
• Fertility Preservation: Recommended for cancer patients or those postponing parenthood.
• Vaccination: The HPV vaccine reduces the risk of cervical abnormalities and associated reproductive health issues.

Screening Tools:

• Hormonal assays (FSH, LH, oestradiol, progesterone, prolactin, TSH, testosterone)
• Ovarian reserve testing (AMH, antral follicle count)
• Semen analysis
• Transvaginal and pelvic ultrasound
• Hysterosalpingography (HSG)
• Genetic testing for chromosomal abnormalities or inherited conditions

Treatments and Procedures:

Reproductive endocrinologists offer a full range of medical, surgical, and advanced reproductive technologies:

• Ovulation Induction – using clomiphene citrate, letrozole, or injectable gonadotropins
• Hormonal Therapies – to regulate cycles, correct imbalances, or support ovulation
• Assisted Reproductive Technologies (ART) – including IVF, ICSI, IUI, donor sperm or egg programmes
• Fertility Preservation – egg, embryo, and sperm freezing
• Minimally Invasive Surgery – laparoscopy or hysteroscopy for treating fibroids, endometriosis, adhesions, and congenital anomalies
• Male Infertility Management – hormonal treatment, surgical sperm retrieval (TESE, PESA), collaboration with andrologists
• Hormone Replacement Therapy (HRT) – for POI and menopause management

Reproductive endocrinology bridges the disciplines of endocrinology, reproductive medicine, and gynaecology, offering hope and scientifically grounded solutions to individuals and couples navigating hormonal and fertility challenges. With advancements in diagnostics and reproductive technologies, it plays a pivotal role in modern reproductive healthcare, improving not only fertility outcomes but also the broader hormonal health of patients across their reproductive lifespan.