The reproductive endocrinology and infertility subspecialist: definition, training, and scope of practice in the United States

Reproductive endocrinology and infertility (REI) subspecialists are physicians with extensive and specialized training in the diagnosis and treatment of complex reproductive disorders. This unique expertise allows them to provide the highest level of care for patients requiring advanced services for family building, reproductive surgery, and endocrine disorders affecting the female reproductive system. Expertise in reproductive medicine relies on applied physiology and revolves around a fundamental understanding of endocrine physiology and reproductive hormone action at the tissue, cellular, and molecular levels. In addition, an REI’s understanding of the fundamentals of study design and data analysis is essential to understand medical literature, adapt to the rapidly changing medical literature, and promote better individualization of care. Reproductive endocrinology and infertility subspecialists are trained surgeons of the female reproductive tract who particularly specialize in minimally invasive surgical approaches, with an emphasis on minimal tissue trauma. REI physicians are trained in the diagnosis and treatment of endocrine, genetic, anatomical, structural, and molecular causes of reproductive disorders, including infertility and advanced fertility options, such as assisted reproductive technologies. This document discusses the training and role of the reproductive endocrinology infertility subspecialist in the United States. (Fertil Steril ® 2025;124:1201–9. ©2025 by American Society for Reproductive Medicine.)

In the United States, reproductive endocrinology and infertility (REI) subspecialists must complete medical school, an Accreditation Council for Graduate Medical Education (ACGME) accredited 4-year Obstetrics and Gynecology residency, and an ACGME-accredited REI fellowship program (1,2). Reproductive endocrinology and infertility fellowship programs are 3 years in length, during which the fellow receives specialized training in the diagnosis and treatment of reproductive disorders. Fellowship training consists of at least 18 months of clinical rotations, 12 months of research to ormulate and complete an adequate thesis, and 6 months of elective rotations (3). Training includes requirements for performing specialized surgical and procedural cases, including hysteroscopy, laparoscopy, transvaginal ultrasounds, oocyte retrieval, and embryo transfer. As of 2024, there are 52 active REI fellowship programs training, which can graduate 68 REI physicians annually, with programs participating in the Electronic Residency Application Service match (4). All REI fellowship programs in the United States are accredited by the ACGME (5). The board certification process for REI subspecialists is most commonly under the American Board of Obstetrics and Gynecology and less commonly under the American Osteopathic Board of Obstetrics and Gynecology. Board-certified REIs have completed rigorous training in reproductive and gynecologic medicine and surgery and meet the highest certification for treating the depth and breadth of reproductive medicine.

COMPLEX REPRODUCTIVE ENDOCRINOLOGY

Reproductive endocrinology and infertility subspecialists are experts in the physiology, pathology, diagnosis, and treatment of complex endocrine disorders related to the reproductive system. This includes knowledge of hypothalamic, pituitary, adrenal, and gonadal hormone action. Extensive knowledge and clinical skills are needed to treat diseases ranging from primary and secondary amenorrhea to endometriosis and uterine fibroids. Reproductive endocrinology and infertility subspecialists are trained to manage complex diseases that extend beyond treating infertility associated with endocrine disease and include the complex interplay of the reproductive system with bone, cancer, anatomical, and other disease processes. These treatments often include the management of hypoestrogenism and menstrual suppression.

TRANSVAGINAL ULTRASONOGRAPHY

Reproductive endocrinology and infertility subspecialists have extensive training in performing and interpreting transvaginal ultrasounds, typically logging hundreds to thousands of transvaginal ultrasound procedures during fellowship. Reproductive endocrinology and infertility physicians are fully trained in performing, supervising, and interpreting transvaginal ultrasound for gynecology and early obstetrics, and no further certification is required (6).

DIAGNOSTICS AND THERAPEUTICS

Reproductive endocrinology and infertility physicians are experts in the selection and interpretation of diagnostic tests for reproductive disorders, including infertility, endometriosis, and polycystic ovary syndrome (Table 1). The REI subspecialist understands the pathophysiology of reproductive diseases, molecular biology techniques, clinical research methodology, and critical evaluation of literature. Therefore, the REI subspecialist is the most appropriate physician for selecting, interpreting, and managing diagnostics and therapeutics in reproductive endocrinology and infertility. Given their expertise, REI subspecialists are integral to advancing the field of REI through research.

ADVANCED OVULATION INDUCTION AND OVARIAN STIMULATION

Reproductive endocrinology and infertility physicians are experts in the management of all agents utilized to induce ovulation or conduct ovarian stimulation. Adverse outcomes associated with ovarian stimulation include multiple gestation, ovarian hyperstimulation syndrome (OHSS), and other rare but serious complications, such as cyst rupture and ovarian torsion. Reproductive endocrinology and infertility physicians mitigate the risks of adverse events associated with ovulation induction and ovarian stimulation utilizing transvaginal ultrasound, hormone assay assessment, and other information. Reproductive endocrinology and infertility physicians monitor for ovulation timing via transvaginal ultrasound and hormonal assays. Reproductive endocrinology and infertility physicians receive training to safely and effectively manage ovarian stimulation with gonadotropins, which are the most likely medications to cause adverse events related to multiple gestation and OHSS. Although obstetricians and gynecologists and other clinicians may receive some training in performing intrauterine inseminations, REI is the only specialty dedicated to hands-on training in cases of difficult entry into the uterus, such as challenging intrauterine insemination, saline sonogram, and embryo transfer procedures. Reproductive endocrinology and infertility physicians have an overarching understanding of the relevant medical literature, not only the clinical components but also the laboratory components of fertility treatments and their role in developing an appropriate treatment strategy for a particular patient.

ADVANCED REPRODUCTIVE SURGERY

Reproductive endocrinology and infertility physicians are experts in performing advanced reproductive and gynecologic surgery in patients who wish to optimize their fertility. Reproductive endocrinology and infertility physicians are specifically trained to focus on minimizing tissue trauma and enhancing the function of reproductive structures, particularly the endometrium, ovary, fallopian tubes, and uterus. Surgical outcome data consistently demonstrate that surgical volume is key to good surgical outcomes (7). Advanced reproductive surgery, such as for severe endometriosis, complex ovarian cystectomy, reconstructive procedures, tubal surgeries, myomectomy, rare M€ ulleriananomalies, hysteroscopic treatment of uterine synechia, and uterine transplantation, should be managed or comanaged by an REI or, if not available, specialists or subspecialist surgeons who have acquired additional training, experience, and skills to perform such surgeries in a fashion that optimizes reproductive outcomes. Fertility-preserving surgeries, such as ovarian and uterine transposition, ovarian tissue harvest, cryopreservation, and reimplantation, typically involve REI physicians who have the expertise and tools to offer a wide range of fertility preservation options.

Reproductive genetics

Reproductive endocrinology and infertility physicians have extensive training in prepregnancy genetic carrier screening and the use of genetic testing of embryos for aneuploidy, monogenic disease, and translocations. Reproductive endocrinology and infertility physicians must understand the mechanisms, benefits, and limitations of genetic testing platforms, such as next-generation sequencing, polymerase chain reaction, and single-nucleotide polymorphism, and be able to counsel patients on the clinical utility of these tests. Reproductive endocrinology and infertility subspecialists are trained in the diagnosis of female reproductive genetics and disease and their reproductive management. Reproductive endocrinology and infertility subspecialists are trained in the diagnosis and management of genetic diseases that have reproductive phenotypes, such as genetic causes of primary ovarian insufficiency, abnormal puberty, and disorders of sexual development. Management of reproductive genetic pathology often involves a complex team of medical professionals, with the interface of that management being the REI physician.

ASSISTED REPRODUCTIVE TECHNOLOGIES

Assisted reproductive technology (ART) involves various procedures used to help patients achieve pregnancy via the removal of sperm and oocytes from the body to create embryos. Reproductive endocrinology and infertility physicians have a comprehensive understanding of the medical and laboratory components of the ART procedures and extensive experience developing treatment plans to maximize success and mitigate risk in ART. Reproductive endocrinology and infertility subspecialists are the only physicians formally trained to perform oocyte retrievals and embryo transfers. As with all surgeries and procedures, adequate surgeon procedural volume is necessary to optimize patient outcomes. Reproductive endocrinology and infertility fellows receive extensive training in ART procedures to become proficient in their utilization. In addition to the procedures themselves, REI physicians use ovarian stimulation to maximize oocyte yield and minimize OHSS. Reproductive endocrinology and infertility physicians are trained experts in the complexities of third-party reproduction, including oversight over the medical, legal, and social aspects of counseling and developing the best treatment strategy.

The practice of ART is regulated by several governing bodies, including the US Food and Drug Administration, Clinical Laboratory Improvement Amendments, College of American Pathologists, Joint Commission, and Centers for Disease Control & Prevention. Per guidance from the Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine, only an American Board of Obstetrics and Gynecology or American Osteopathic Board of Obstetrics and Gynecology board-certified (or an active candidate for board certification) REI physician can serve as the Medical Director of each ART program. Reproductive endocrinology and infertility physicians with appropriate training and skills can also be certified as High Complexity Laboratory Directors and run the ART laboratory itself. As Medical Director of an ART program, the REI physician leads the multidisciplinary team, including embryologists, nurses, andrologists, urologists, anesthesiologists, geneticists, mental health providers, and others. The REI physician as Medical Director is ultimately responsible for running the ART program and remaining current with updated data entry reporting requirements to report their program’s complete and accurate data to SART and the Centers for Disease Control & Prevention. Reproductive endocrinology and infertility physicians have the training necessary to oversee the multidisciplinary ART program, ranging from third-party reproduction, US Food and Drug Administration requirements, legal issues, and potential risks to offspring, and to maintain a structured program for monitoring quality assurance and improvement. In addition to approving annual program SART data, the SART Medical Director's responsibilities include creating, reviewing, and updating facility policies and procedures, ensuring appropriate modality education and selection for all patients, providing supervision of medical personnel, and ensuring safe and effective patient care. SART Medical Directors must practice ART at the SART member clinic.

Table 1: Summary of the training standards and skillset of REI physicians (derived from published ACGME milestones and ABOG bulletin for subspecialty certification) (2,6).

Topic area	Topic subheadings	Examples (not definitive lists)
Basic science, physiology, and pathophysiology	Hormone structure, mechanisms of action, and signaling pathways Clinical pharmacology Laboratory assays Pathology of normal and abnormal reproductive organs and tissues Immunology of the reproductive endocrine system, implantation biology, and early pregnancy Embryogenesis of the male and female reproductive systems Gamete biology Preimplantation embryo development
Diagnostic techniques and interpretation for the management of reproductive disorders	Molecular biology Imaging Provocative testing Andrology, including methods of evaluating semen quality and fertilizing capabilities	Immunohistochemistry, PCR, endocrine assays, HSG, ultrasound, MRI, and SIS ACTH stimulation, dexamethasone suppression, and clomiphene challenge Semen analysis and DNA fragmentation
Evaluation, diagnosis, and management of reproductive endocrine function and disease	Normal and abnormal puberty Menopause Neuroendocrine disorders Gonad Thyroid disorders Adrenal disorders Metabolic dysfunction Endocrinology of pregnancy Abnormal uterine bleeding Amenorrhea Androgen disorders Gender-affirming hormone therapy	Delayed puberty and precocious puberty Panhypopituitarism, Sheehan Syndrome, Kallmann Syndrome, and congenital adrenal hyperplasia Disorders of sexual development involving ovary, testes, and ovotestes Obesity Polycystic ovary syndrome and idiopathic hirsutism
Female fertility, female infertility, and PCOS	Contraception, preconception counseling, and infertility (develop evidence-based treatment plans, evaluate cost-effectiveness of options, collaborate with other members of the healthcare team) Evaluation, diagnosis, and management of fertility treatment complications, special populations, and early pregnancy loss Specific considerations for polycystic ovarian syndrome (PCOS)	Perform comprehensive medical history and physical examination Provide preconception counseling Obtain and interpret the results of diagnostic testing (e.g., ovarian reserve testing, ovulatory function, hysterosalpingography, pelvic ultrasound, hysterosonography, hysteroscopy, and laparoscopy) Counsel women on fertility treatment options, side effects, and complications (e.g., ovulation induction, ovarian stimulation, intrauterine insemination, and ART) Complications of fertility treatment (e.g., pregnancy of unknown location/ectopic/heterotopic/ovarian stimulation and multifetal gestation) Third-party reproduction LGBTQ family building considerations and care Early pregnancy loss Evaluate, diagnose, manage, and counsel patients regarding health consequences of PCOS (e.g., anovulation and infertility, hirsutism, abnormal uterine bleeding, metabolic disturbances, and endometrial hyperplasia/cancer) Counsel and manage ovulation induction and fertility treatment for PCOS Counsel women on treatment options for hirsutism in PCOS
Male infertility	Evaluation and counseling for male infertility Counseling patients regarding surgical management of male infertility and intracytoplasmic sperm injection (ICSI)	Collaborate with male reproductive urologists in the management of patients with male factor infertility to achieve pregnancy Perform comprehensive medical history (e.g., sexual development history, including testicular descent, chronic disease, surgical history, medication use, infections, exposure to radiation, environmental exposures, family history, steroid use, drug and alcohol use, sexual history, including libido, frequency of intercourse, and prior fertility) Obtain and interpret results of diagnostic testing for male infertility (e.g., semen analysis, post-void semen analysis, hormonal testing, genetic testing, including karyotype, genetic carrier testing, and y-microdeletion testing, and transrectal and scrotal ultrasound), and counsel patients on the results Diagnose and differentiate types of male infertility (e.g., endocrine and systemic disorders, primary testicular defects in spermatogenesis, sperm transport disorders, and idiopathic male infertility) Counsel patients regarding application, efficacy, risks, and benefits of non-surgical treatments for oligospermia (e.g., clomiphene citrate, human chorionic gonadotropin, and letrozole) Counsel patients on the use of donor sperm, including discussion of regulatory issues involving donor sperm Testicular sperm extraction, including microsurgical epididymal sperm aspiration Vasectomy reversal Varicocele repair Intracytoplasmic sperm injection
Recurrent pregnancy loss	Evaluate, diagnose, and manage recurrent pregnancy loss (RPL), including causes of euploid and aneuploid pregnancy loss Counsel patients on advantages and limitations of preimplantation genetic testing for structural rearrangements and aneuploidy for abnormal parental karyotypes and unexplained RPL Counsel patients on the indications for supplements, progesterone, thyroid hormone supplementation, aspirin, heparin, and other available medical therapies Provide and counsel patients (including advantages and limitations) on genetic analysis of aborted fetal tissue	(e.g., contribution of endocrine factors, immunologic factors, anatomic factors, and genetic factors, and relative incidence of each) and counsel patients regarding prognosis and causes of RPL
Fertility preservation	Evaluation, diagnosis, and management of fertility preservation Specific considerations for patients receiving gonadotoxic therapies	Recognize indications and counsel patients for fertility preservation (e.g., elective cryopreservation, gonadotoxic therapies, and genetic conditions) Obtain and interpret results of diagnostic testing (e.g., ultrasound and ovarian reserve markers), and counsel patients regarding fertility preservation Counsel patients on the options and expectations for fertility preservation Perform ART procedures for oocyte and embryo cryopreservation Understand and implement modifications to conventional ART protocols for cancer patients (e.g., use of aromatase inhibitors to suppress estrogen levels and random start protocols to minimize delay) Counsel patients on ovarian transposition if pelvic irradiation is anticipated Counsel patients on fertility-sparing gynecologic surgery Counsel patients on the use of ovarian suppression with GnRH agonists for fertility preservation Counsel patients on experimental options for fertility preservation (e.g., ovarian tissue cryopreservation and transplantation)
Assisted reproductive technology (ART) techniques	Develop and manage appropriate treatment plans, manage complex cycles, and practice evidence-based treatment for patients Transvaginal ultrasound-guided oocyte retrieval Transabdominal ultrasound-guided oocyte retrieval Ultrasound-guided embryo transfer Ultrasound-guided ovarian cyst aspiration Paracentesis/culdocentesis Embryology	Embryo grading systems (e.g., ASRM/SART and Gardner), normal and abnormal embryo development, laboratory conditions (e.g., media, buffers for pH stability and temperature), understanding laboratory key performance indicators (KPIs), and how to troubleshoot laboratory problems
Evaluation, diagnosis, and management of complex reproductive disorders	Pelvic pair (e.g., adhesive disease) Endometriosis Ambiguous genitalia M€ ulleriananomalies Asherman syndrome Leiomyomata
Complex reproductive and surgical procedures	Independently perform basic operative procedures, both invasive and minimally invasive Diagnose and manage intra- and post-operative complications Diagnostic and operative hysteroscopic procedures Diagnostic and operative laparoscopic procedures Tubal surgeries for fertility restoration include tubal reversal and tuboplasty Abdominal myomectomy Laparotomy procedures Surgical management of M€ ulleriananomalies Abdominal salpingo-oophorectomy Abdominal salpingostomy Vaginal septum excision
Genetics	Understanding of genetic testing and screening (patient, partner, and embryo testing) Application of genetic testing and screening to patient care	Basic science of genetics, epigenetics, and genetic testing (e.g., whole exome sequencing, whole genome sequencing, microarray, and karyotype) Inheritance patterns of genetic disorders Preimplantation genetic screening and testing, including benefits and limitations of available platforms (e.g., NGS, PCR, and SNP array) Antenatal genetics testing Obtain and interpret preconception female and male screenings as they relate to female and male infertility diagnosis Obtain and interpret genetic testing because it relates to female and male infertility diagnosis Counsel patients on prognosis and treatment based on genetic testing results
ABOG = American Board of Obstetrics and Gynecology; ACGME = Accreditation Council for Graduate Medical Education; ACTH = adrenocorticotropic hormone; ASRM = American Society for Reproductive Medicine; CAP = College of American Pathologists; CDC = Centers for Disease Control & Prevention; CLIA = Clinical Laboratory Improvement Amendments; FDA = US Food and Drug Administration; GnRH = gonadotropin-releasing hormone; HSG = hysterosalpingography; MRI = magnetic resonance imaging; NGS = next-generation sequencing; PCR = polymerase chain reaction; SART = Society for Assisted Reproductive Technology; SIS = saline infusion sonohysterography; SNP = single-nucleotide polymorphism. Practice Committee of the Society for Reproductive Endocrinology and Infertility and Practice Committee of the American Society for Reproductive Medicine. The reproductive endocrinology and infertility subspecialist. Fertil Steril 2025.

Research and evidence-based medicine

Reproductive endocrinology and infertility physicians complete 12 months of required training in medical research, with an optional 6 additional elective months of research. Reproductive endocrinology and infertility physicians are examined on research methods, including statistical analysis, and are required to submit a research thesis as part of their board certification. Training in and performing research are vital to the continued advancement of the areas of REI medicine, including but not limited to the rapid evolution of the field of ART. The REI’s practice of evidence-based medicine is enhanced by the robust research training received during the fellowship. Even for REI physicians no longer actively involved in research, the extensive research training allows REI physicians to critically appraise the literature on rapidly changing innovation that occurs in reproductive medicine.

Fertility preservation

Reproductive endocrinology and infertility physicians are experts in the complexities of managing fertility preservation for both medical indications and future family planning. Medical indications include gonadotoxic therapies for diseases, such as cancer treatment with chemotherapy, pelvic abdominal radiation, or diseases requiring gonadotoxic treatment. Reproductive endocrinology and infertility physicians are trained to counsel patients with BRCA mutations regarding family planning and genetic testing of embryos. Reproductive endocrinology and infertility physicians provide counseling and treatment for fertility preservation for transgender patients undergoing gonadal suppression or gonadectomy. Some diseases are associated with primary ovarian insufficiency, such as mosaic Turner Syndrome, and require expert counseling and management on the optimal timing, as well as limitations of fertility preservation options in this group. Reproductive endocrinology and infertility physicians are trained in counseling for family planning and fertility preservation for the age-related decline in fertility. Although these are just some examples of fertility preservation counseling and treatment that REIs perform, REIs are trained to provide the complex counseling needed for each unique patient scenario.

CONCLUSION

Reproductive endocrinology and infertility subspecialist physicians are experts on the diagnosis and management of complex reproductive and gynecologic disorders. To assure both continued access to high-quality care for repro-
ductive disorders and advancement in the field, REI fellows should continue to receive extensive training across the breadth and depth of the subspecialty, including reproductive physiology, endocrine disorders, minimally invasive surgery, critical evaluation of the literature to interrogate emerging technologies and therapeutics, and training in the counseling and management of infertile patients, as well as those seeking fertility treatment for other indications. Reproductive care, especially when requiring advanced therapeutics and surgery, complex endocrinology, and reproductive genetics, should require management with or the direct oversight of an REI subspecialist.

Acknowledgments

This report was developed under the direction of the Practice Committees of the American Society for Reproductive Medicine (ASRM) and the Society for Reproductive Endocrinology and Infertility (SREI) as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. The Practice Committee and the Board of Directors of the American Society for Reproductive Medicine have approved this report.

This document was reviewed by ASRM members, and their input was considered in the preparation of the final document. The following members of the ASRM Practice Committee participated in the development of this document: Clarisa Gracia, M.D., M.S.C.E.; Paula Amato, M.D.; Jacob Anderson; Rebecca Flyckt, M.D.; Karl Hansen, M.D., Ph.D.; Micah Hill, D.O.; Tarun Jain, M.D.; Sangita Jindal, Ph.D.; Suleena Kalra, M.D., M.S.C.E.; Bruce Pier, M.D.; Denny Sakkas, Ph.D.; Anne Steiner, M.D., M.P.H.; Cigdem Tanrikut, M.D.; Belinda Yauger, M.D.; Robert Brannigan, M.D.; Elizabeth Ginsburg, M.D.; Jared Robins, M.D.; Chevis N Shannon, Dr.Ph., M.B.A., M.P.H.; and Madeline Brooks, M.B.A., M.P.H. The Practice Committee acknowledges the special contributions of Jennifer Eaton, M.D., Chantel Cross, M.D., and Seif Sadek, M.D., in the preparation of this document. All Committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the Committee who were found to have conflicts of interest on the basis of the relationships disclosed did not participate in the discussion or development of the document.

References

Reproductive endocrinology and infertility qualifying exam. Available at: https://www.abog.org/subspecialty-certification/reproductive-endocrinologyand-infertility/qualifying-exam. Accessed May 5, 2023.
Reproductive endocrinology and infertility certifying exam. Available at: https://www.abog.org/subspecialty-certification/reproductive-endocrinology-and-infertility/certifying-exam. Accessed May 5, 2023.
Subspecialty case list thesis, case list, and abbreviations. Available at: https:// www.abog.org/subspecialty-certification/thesis-guidelines#Content_C011_ Col00. Accessed May 5, 2023.
ERAS 2023 participating specialties & programs. Available at: https://systems. aamc.org/eras/erasstats/par/display.cfm?NAV_ROW=PAR&SPEC_CD=235. Accessed May 5, 2023.
Committee R. Case log Instructions: reproductive endocrinology and infertility. Available at: https://www.acgme.org/globalassets/pfassets/programresources/ rei_case_log_instructions.pdf. Accessed May 5, 2023.
Practice Committee of the American Society for Reproductive Medicine. American Society for Reproductive Medicine position statement on qualifications for providing ultrasound procedures in reproductive medicine. Fertil Steril 2022;118:668–70.
Morche J, Mathes T, Pieper D. Relationship between surgeon volume and outcomes: a systematic review of systematic reviews. Syst Rev 2016;5: 204.

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It is the responsibility of the clinician to assess for erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for infertility. View the Committee Opinion

Journal Club Global - Actualización en la suplementación con progesterona en fase lútea para transferencias de embriones congelados

Efectividad del rescate de progesterona en mujeres que presentan niveles bajos de progesterona circulante alrededor del día de la transferencia de embriones View the Video

Post Vasectomy Infertility

If a husband has had a vasectomy, does the sterilization code apply to the wife's visits? View the Answer

Pregnancy Of Uncertain Viability Ultrasound

My staff is telling me that I am getting reimbursed for the first sonogram and OB visit (using ICD 10 code for pregnancy of uncertain viability – O36.80X0. View the Answer

Pregnancy Ultrasound

Our practice does routine ultrasounds (sac check- 76817) at the end of an IVF cycle and bill with a diagnosis code O09.081, pregnancy resulting from ART. View the Answer

Psychological Evaluation

Many REs require patients (and their spouses/partners) who are considering using donor gametes to see an infertility counselor first. View the Answer

Self-referred New Patient

A patient self-refers to our physician for an initial new patient consultation instead of referred by another physician, how do we code for the consult? View the Answer

Surgery Coding

I took the ASRM coding course, and in that course, coding for bilateral neosalpingostomies was coded using only a dx of N70.11 (hydrosalpinx). View the Answer

Telephone Consult

Does a physician need to speak directly to a patient to code for a telephone consult (99371-99373) or can a staff member relay physician notes to patients? View the Answer

Testing With No History of Infertility

What diagnosis codes should providers submit to insurance carriers while trying to evaluate fertility issues? View the Answer

Infertility Consult

Does ASRM have any examples of evaluation and management documentation for patients being seen for an initial infertility evaluation? View the Answer

Infertility Consult by Nurse

What code is used for a nurse practitioner seeing a fertility patient for the first time? View the Answer

Initial Visit for Infertility With No Mandated Coverage

What code would be appropriate for an initial visit for infertility? View the Answer

IUI or IVF

Should other ovarian dysfunction (diagnosis code E28.8) or unspecified ovarian dysfunction (diagnosis code E28.9) can be used for an IUI or an IVF cycle View the Answer

Monitoring E&M

Our group would like to know if others are billing an evaluation and management code for ultrasound and blood draw visits? View the Answer

New vs Established Patient

How soon can you bill as a new infertility patient? View the Answer

General E&M Consult

Recently we have received a “re-code” on a new patient (we billed a 99203 and the insurance re-coded it to a 99213). View the Answer

Hysteroscopy Recurrent Implantation Failure

What is the appropriate ICD-10 code for recurrent implantation failure? View the Answer

D&C Under Ultrasound Guidance

What are the CPT codes and ICD-10 codes for coding a surgical case for a patient with history of Stage B adenocarcinoma of the cervix ... View the Answer

Diagnostic Testing of an Infertile Couple

The Z31.41 is or is not the correct code to use for diagnostic testing of an infertile couple? And If so can if be used as the primary and only code? View the Answer

Diagnosis of Infertility for IVF Procedure

How important is it to have accurate documentation of the type of infertility diagnosis for IVF procedures? View the Answer

Blood Draws

If a patient comes in only for a blood draw (venipuncture) and is seen only by the lab technician (not an MD, PA, or NP), may we bill for a (minimal) office visit? View the Answer

Blood Tests

Patients are requesting to have lab work drawn from the female patient moved to the males account due to the female fertility coverage being maxed out. View the Answer

Male Infertility

A summary of common codes for Male Infertility compiled by the ASRM Coding Committee. View the Coding Summary

Fertility evaluation of infertile women: a committee opinion (2021)

Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner. View the Committee Opinion

ASRM müllerian anomalies classiﬁcation 2021

The Task Force set goals for a new classification and chose to base it on the iconic AFS classification from 1988 because of its simplicity and recognizability. View the Committee Opinion

Moving innovation to practice: an Ethics Committee opinion (2021)

The introduction of new strategies, tests, and procedures into clinical practice raises challenging ethical issues. View the Committee Opinion

Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion (2020)

Intracytoplasmic sperm injection is frequently used in combination with assisted reproductive technologies. View the Committee Document

Use of exogenous gonadotropins for ovulation induction in anovulatory women: a committee opinion (2020)

Pretreatment evaluation, indications, treatment regimens, and complications of gonadotropin treatment. View the Committee Opinion

Reproductive and hormonal considerations in women at increased risk for hereditary gynecologic cancers: Society of Gynecologic Oncology and American Society for Reproductive Medicine Evidence-Based Review (2019)

Providers who care for women at risk for hereditary gynecologic cancers must consider the impact of these conditions. View the Joint Statement

Guidance for Providers Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure (Updated 2019)

This ASRM guidance specifically addresses Zika virus infection issues and concerns of individuals undergoing assisted reproductive technologies (ART). View the Guideline

Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion (2019)

The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. View the Committee Opinion

American Society for Reproductive Medicine position statement on uterus transplantation: a committee opinion (2018)

Following the birth of the first child from a transplanted uterus in Gothenburg, Sweden, in 2014, other centers worldwide have produced scientific reports. View the Committee Opinion

Child-rearing ability and the provision of fertility services: an Ethics Committee opinion (2017)

Fertility programs may withhold services on the basis that patients will be unable to provide minimally adequate or safe care for offspring. View the Committee Opinion

The International Glossary on Infertility and Fertility Care, 2017†‡§ (2017)

A globally‑consensus glossary of 283 infertility and fertility‑care terms developed in 2017 to harmonize communication across clinicians, researchers & patients. View the Committee Joint Guideline

Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline (2017)

This review evaluates if uterine myomas impact likelihood of pregnancy and pregnancy loss, and if myomectomy influences pregnancy outcomes. View the Guideline

Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement (2014)

Clinical trials testing infertility treatments often do not report on the major outcomes of interest to patients and clinicians and the public. View the Guideline

Endometriosis and infertility: a committee opinion (2012)

Women with endometriosis typically present with pelvic pain, infertility, or an adnexal mass, and may require surgery. View the Committee Opinion