Meeting the demand for fertility services: the present and future of reproductive endocrinology and infertility in the United States

Abstract

The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. This document’s focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, offer approaches to rectify the developing physician shortage problem, and suggest a framework for the discussion on how to meet that increase in demand. The Society of REI recommend the following:1. Our field should aggressively explore and implement courses of action to increase the number of qualified, highly trained REI physicians trained annually. We recommend efforts to increase the number of REI fellowships and the size complement of existing fellowships be prioritized where possible. These courses of action include:a. Increase the number of REI fellowship training programs.b. Increase the number of fellows trained at current REI fellowship programs.c. The pros and cons of a 2-year focused clinical fellowship track for fellows interested primarily in ART practice were extensively explored. We do not recommend shortening the REI fellowship to 2 years at this time, because efforts should be focused on increasing the number of fellowship training slots (1a and b).2. It is recommended that the field aggressively implements courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision.3. Automating processes through technologic improvements can free providers at all levels to practice at the top of their license. The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. This document’s focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, offer approaches to rectify the developing physician shortage problem, and suggest a framework for the discussion on how to meet that increase in demand. The Society of REI recommend the following: 1. Our field should aggressively explore and implement courses of action to increase the number of qualified, highly trained REI physicians trained annually. We recommend efforts to increase the number of REI fellowships and the size complement of existing fellowships be prioritized where possible. These courses of action include: a. Increase the number of REI fellowship training programs. b. Increase the number of fellows trained at current REI fellowship programs. c. The pros and cons of a 2-year focused clinical fellowship track for fellows interested primarily in ART practice were extensively explored. We do not recommend shortening the REI fellowship to 2 years at this time, because efforts should be focused on increasing the number of fellowship training slots (1a and b). 2. It is recommended that the field aggressively implements courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision. 3. Automating processes through technologic improvements can free providers at all levels to practice at the top of their license. Satisfacer la demanda estadounidense de servicios de fertilidad: el presente y el futuro de endocrinología reproductiva e infertilidad en los Estados UnidosEl campo de la endocrinología reproductiva y la infertilidad (ERI) se encuentra en una encrucijada; existe un desajuste entre la demanda de servicios reproductivos de endocrinología, infertilidad y tecnologías de reproducción asistida (ART), y disponibilidad de atención. El objetivo de este documento es proporcionar datos que justifiquen la necesidad crítica de una mayor prestación de servicios de fertilidad en los Estados Unidos ahora y en el futuro, enfoques que rectifiquen el creciente problema de escasez de médicos y sugerir un marco para el debate sobre cómo hacer frente a ese incremento en la demanda. La Sociedad de REI recomienda lo siguiente:1. Nuestro campo debe explorar e implementar agresivamente cursos de acción para aumentar el número de médicos REI calificados y altamente capacitados anualmente. Recomendamos esfuerzos para aumentar el número de becas REI y el tamaño de las becas existentes, priorizándose donde sea posible. Estos cursos de acción incluyen:A. Incrementar el número de programas de formación de becas REI.B. Incrementar el número de becarios capacitados en los programas de becas REI actuales.C. Se exploraron ampliamente los pros y los contras de una beca clínica de dos años para becarios interesados principalmente en la práctica de ART. No recomendamos acortar la beca REI a 2 años en este momento, porque los esfuerzos deben centrarse en aumentar el número de plazas de becas de formación (1a y b).2. Se recomienda que el campo implemente agresivamente cursos de acción para aumentar el número y el uso apropiado de proveedores que no pertenecen a REI para aumentar la eficiencia clínica bajo la supervisión adecuada de un médico de REI certificado por la junta.3. La automatización de procesos a través de mejoras tecnológicas puede liberar a los proveedores de todos los niveles para ejercer al máximo su licencia. Satisfacer la demanda estadounidense de servicios de fertilidad: el presente y el futuro de endocrinología reproductiva e infertilidad en los Estados Unidos El campo de la endocrinología reproductiva y la infertilidad (ERI) se encuentra en una encrucijada; existe un desajuste entre la demanda de servicios reproductivos de endocrinología, infertilidad y tecnologías de reproducción asistida (ART), y disponibilidad de atención. El objetivo de este documento es proporcionar datos que justifiquen la necesidad crítica de una mayor prestación de servicios de fertilidad en los Estados Unidos ahora y en el futuro, enfoques que rectifiquen el creciente problema de escasez de médicos y sugerir un marco para el debate sobre cómo hacer frente a ese incremento en la demanda. La Sociedad de REI recomienda lo siguiente: 1. Nuestro campo debe explorar e implementar agresivamente cursos de acción para aumentar el número de médicos REI calificados y altamente capacitados anualmente. Recomendamos esfuerzos para aumentar el número de becas REI y el tamaño de las becas existentes, priorizándose donde sea posible. Estos cursos de acción incluyen: A. Incrementar el número de programas de formación de becas REI. B. Incrementar el número de becarios capacitados en los programas de becas REI actuales. C. Se exploraron ampliamente los pros y los contras de una beca clínica de dos años para becarios interesados principalmente en la práctica de ART. No recomendamos acortar la beca REI a 2 años en este momento, porque los esfuerzos deben centrarse en aumentar el número de plazas de becas de formación (1a y b). 2. Se recomienda que el campo implemente agresivamente cursos de acción para aumentar el número y el uso apropiado de proveedores que no pertenecen a REI para aumentar la eficiencia clínica bajo la supervisión adecuada de un médico de REI certificado por la junta. 3. La automatización de procesos a través de mejoras tecnológicas puede liberar a los proveedores de todos los niveles para ejercer al máximo su licencia. The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services and availability of care. Specifically, this mismatch involves suboptimal numbers of properly trained physicians in the subspecialty of REI at the present time and in the foreseeable future; inadequate numbers of trained embryologists and other reproductive laboratory scientists; and geographic misdistribution and poor financial coverage of fertility services leading to major challenges involving access and equity. The goal of this document is not to provide analysis and solutions to all these fundamental problems, many of which are being concurrently addressed by other constituencies of the American Society for Reproductive Medicine (ASRM). This document’s focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, suggest approaches to rectify the developing physician shortage problem, and initiate a discussion on how to meet that increase in demand. With the total number of children born using in vitro fertilization (IVF) approaching 10 million worldwide and 100,000 infants annually in the United States (1Centers for Disease Control and Prevention2018 assisted reproductive technology national summary report. US Department of Health and Human Services, USA2021Google Scholar), reproductive endocrinologists should take pride in the important contributions that they have made to family building worldwide, in partnership with colleagues in embryology, nursing, mental health, healthcare administration, allied health fields, and genetic counseling. The growth of ART is largely attributable to improvements in the effectiveness and safety of IVF, along with the expansion of indications for its use. However, the field of REI is, in a sense, victim of its own success and now needs to address how it can provide access to treatment for any individuals or family that need it. This includes overcoming financial and geographic barriers to care, expanding access to genetic carrier screening and IVF for genetic disease prevention, defining and making available options for the LGBTQ+ community, and offering proactive solutions for fertility preservation. In addition, it is a real possibility that the application of gene editing technologies to the germ-line treatment of devastating genetic diseases will be a reality in coming years. It needs to be recognized that only through adequate numbers of rigorously trained reproductive endocrinologists and a robust ART infrastructure could such technologies be safely and ethically applied. the of assisted the REI needs to IVF that 10 million children to that the to family building on the of that to The United million children were born worldwide in of infertility of infertility and need and demand for infertility that million have children treatment were available to a of and Scholar), a of genetic and and Scholar), and a that for of the to in Scholar), the number of is to be to the number of worldwide IVF This not fertility or genetic indications for ART. 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