The subspecialty of reproductive endocrinology and infertility (REI) is fascinating and challenging. It includes both male and female reproductive disorders associated with the relevant endocrine systems and the hormones they produce. It covers conditions such as polycystic ovarian syndrome, hyperprolactinemia, thyroid conditions, hyperandrogenism, and many more (eg. See PCOS).

Polycystic Ovarian Syndrome (PCOS):

This condition produces irregular cycles in females, signs of over production of androgens, weight gain, acne, increase hair growth and is often accompanied by infertility. It sometimes is part of a greater picture, which is called Metabolic Syndrome, which includes hypertension. There is often a link to diabetes, with a family history of such. An ultrasound of the ovaries displays multiple small cysts in the ovaries, which are follicles, which have not fully ovulated. The ovary is enlarged and dense. A blood test reveals a number of changes of the major female hormone, FSH (follicle stimulating hormone), and LH (luteinizing hormone). When this condition is diagnosed there are many areas requiring attention and treatment. For example, I have two excellent dieticians that I refer to for many of these patients.

Infertility:

The second part of the subspecialty is that of infertility. Often reproductive endocrine problems lead to this. Infertility is now being broken down into many areas. Male factor, female factor and sometimes unexplained.

Female infertility may include problems with ovulation (eg.PCOS), with excessive exercise, with the fallopian tubes, with the uterus or even as a result of other illnesses.

Male factor infertility is a multiple and varied field. Causes may range from low sperm counts through to blocked vas, systemic illness or anatomical problems. Medications can affect male fertility, as can illnesses and many other possibilities.

I often apply a simple list to questions on infertility which I call the. This simple mnemonic which I call the South CCOOAASSTT principle, gets me through many of the causes of infertility, but of course it could be used anywhere.

C		Cervical - Previous surgery and congenital problems with
C		Coital (sex) - Not enough and problems with
O		Ovulation - Not enough or never
O		Other - Covers many other areas such as lifestyle, illnesses and family history.
A		Anatomy - Both male and female
A		Age - Female age is a significant factor. Male, not so much.
S		Sperm - A semen analysis answers most male factor questions
S		Sex (Coitus)
T		Tubes - Where egg and sperm have to meet to fertilize
T		Timing - When coitus takes place is vital

Once I have taken a thorough history from my patients (that means the couple) and I have examined them both, I know in what direction to take the next step. Sometimes that is straightforward, i.e. previous vasectomy; sometimes it is not so obvious.

Treatments:

Treatments can be extremely varied. Once I have a diagnosis then I can look at the treatment/s required. Often reassurance is all that is required for a couple. Sometimes IVF is the treatment that is required. Between reassurance and IVF are many options from surgery to tubes, ovulation treatments, lifestyle changes, intrauterine insemination, excision of endometriosis and so forth.

Microsurgery such as tubal re-anastomosis or vasectomy reversal is also one area of my subspecialty. This is far less common now than previously with the success of IVF, but still has a place.

IVF:

Sydney IVF Illawarra is just one of the many Sydney IVF locations. It offers many different services ranging from assessments of semen, to Ovulation induction, IVF and now includes IVF with PGD (pre-implantation genetic diagnosis). That is cutting edge technology to identify very serious genetic conditions in embryos. Previously this meant travelling to Sydney but now can be done here in the Illawarra with Sydney IVF technologies.



Sydney IVF Illawarra has two very experienced nurses who have both been in the practice over ten years and are to be found in rooms at 3 Urunga Street, Wollongong situated around the corner from the Wollongong Day Surgery.

IVF has recently come under the Medicare Safety Net making it a lot less expensive than previously. Where embryos have been frozen for future use, the costs of using these embryos is considerably less. Sydney IVF has a strong association with the public IVF unit at Royal Prince Alfred (RPA) and many times I refer on to RPA depending on the circumstances. Public IVF is not free but has a smaller gap for patients.

Sydney IVF Illawarra is a small unit of Sydney IVF but with all the backing of this world-renowned company. Success rates reflect this.

Miscarriage Investigations Program (MIP):

In 2002 along with Professor Robert Jansen, I put together a comprehensive program dedicated to miscarriage. This is a difficult area of reproductive disorders. Investigations, treatment and then careful management of the ongoing pregnancy are all part of this program.