Responding to Change in Reproductive Endocrinology Fellowships

Thirty years ago, in the days when I was a reproductive endocrinology fellow, the field looked far different than it does today. Reproductive endocrinologists at that time were most assuredly the experts in diagnosing and treating infertility, but were often, if not usually the go-to doctors for patients with congenital uterovaginal anomalies, endometriosis, and those in need of complicated endoscopic procedures. The REI was not only the authority on polycystic ovary syndrome and other hormonal problems, but often the leader in addressing clinical issues in contraception, abnormal uterine bleeding, and menopause. In the early to mid-1980’s infertility treatment, such as it was, was largely a surgical specialty. Many reproductive endocrinologists performed hundreds of operations per year, albeit with only modest success rates. There were less than 10 IVF programs in the country when I began my fellowship, and IUI was a new and novel treatment. The educational priorities of REI fellows reflected the practice at the time. We were trained primarily in reproductive surgery, medical and pediatric endocrinology, and to a lesser extent in the emerging field of ART