Departments

Our Reproductive Endocrinology & Infertility Division specializes in aiding patients facing challenges with their reproductive abilities . We are committed to diagnosing conditions and guiding each patient through the available treatment options to help them realize their dreams of starting or expanding their family. We focus on diagnosing and managing endocrine disorders and other chronic conditions that hinder conception or the maintenance of pregnancy. Additionally, we assist patients in preserving their fertility before undergoing cancer treatments. Our expertise extends to supporting individuals without partners, same-sex couples, and transgender individuals in overcoming barriers to parenthood. With its globally recognized reputation, our academic health center is known for cutting-edge therapies and exceptional success rates. Our state-of-the-art facility is staffed by approachable clinicians, many of whom are esteemed experts in fertility treatment. Our clinicians deliver compassionate and personalized care tailored to our patients’ individual needs throughout their journey. Several of our clinicians have held or currently hold leadership positions in prestigious professional organizations, such as the American Society for Reproductive Medicine (ASRM) and the Society for Reproductive Investigation (SRI), underscoring our commitment to excellence in the field of reproductive medicine. Our clinicians have contributed to over 1,000 scientific publications, significantly advancing the field. They have also authored the seminal reference book Speroff's Clinical Gynecologic Endocrinology and Infertility , which guides clinicians in providing comprehensive care to patients with infertility and reproductive disorders. With decades of experience treating patients and helping them achieve pregnancy, our clinicians are also dedicated to advancing research in their specialized areas. Their findings have led to the development of new diagnostic tests, surgical procedures, and innovative technologies, shaping and advancing the field of assisted reproductive technology. As research is integral to our practice, patients can access clinical trials conducted at our facility. Recognizing the emotional complexities associated with infertility, our clinicians offer empathy, support, and a celebration of successes, guiding patients through their challenges. Financial coordinators are available to clarify health insurance eligibility and costs, ensuring transparency and minimizing unexpected fees. The Yale Medicine Reproductive Endocrinology & Infertility Division offers specialized programs including: Endometriosis Program: We diagnose and treat endometriosis , addressing pelvic pain and infertility to improve pregnancy outcomes. Fertility Center: We offer an array of individualized treatment options for both women and men looking to start a family. Our physicians, staff, and scientists share our patients’

Urologic diseases affect more than 20 million men, women, and children in the United States. Yale Medicine Urology, named one of the nation’s best urology programs by U.S. News & World Report, cares for adults and children with conditions that affect the bladder, kidneys, pelvic floor, penis, testicles, and urinary tract. Some urologic conditions are present at birth, and others develop over time. Whether for a routine checkup or highly specialized care, our urologists and caregivers provide the most advanced treatment, grounded in research. Our urologists are leaders in the fields of female pelvic medicine and reconstructive surgery, as well as men’s health. Our oncology team has made key research breakthroughs in the treatment of metastatic bladder cancer and kidney cancer. In addition, we offer specialized care for kidney disease, incontinence, stone disease, sexual medicine, neurogenic bladder, transgender care, and reconstructive surgery after trauma. We use the most advanced technology and procedures to give our patients the best care available. Our urologists offer Artemis MRI-ultrasound fusion for prostate biopsy, advanced imaging, laparoscopic and daVinci Si robotic surgery, Holmium Laser Enucleation of the Prostate (HoLEP), as well as UroLift and GreenLight laser procedures. Our doctors and the hospitals where we provide care rank among the best in the country. In addition to providing treatment at Yale New Haven Hospital, Smilow Cancer Hospital, Yale New Haven Children’s Hospital, Greenwich Hospital, and Lawrence + Memorial Hospital, we also have offices located in communities across Connecticut. Above all, at Yale Medicine Urology, we believe in the importance of the patient-doctor relationship. It is the cornerstone of what we do—provide compassionate, quality urologic care to every patient, every day. A multidisciplinary team of urologists, specialty-trained nurses, caregivers, and support staff will take care of patients and their families. The urologist leads the care team, providing a diagnosis and treatment recommendations, as well as performing surgery, if needed, and overseeing the patient’s recovery and postsurgical care. The nurse coordinator is the patient’s advocate and care manager throughout care. Studies show that using nurse coordinators can reduce the length of hospital stays and enhance patient outcomes. Practice nurses provide the day-to-day care during clinical appointments or hospital stays. They administer medications, track vital signs, review general test results, respond to patients’ specific needs, and report to other members of the team. They are available around the clock to answer questions and to help patients through their care. The intake specialist helps to ensure patients are ready in advance of their appointment and have all forms and records completed and sent in advance. Intake specialists are experts at understanding the patient appointment and transfer process. If faced with a diagnosis o

Many urologic problems can affect sexual and/or reproductive health. Urologic conditions may be common, but they should not negatively impact patients’ quality of life, confidence, or relationships. Our urologists are here to discuss patients’ concerns, find solutions that work with their lifestyle, and meet their current and future goals.

Couples experiencing difficulty achieving pregnancy, despite trying for six months to a year (depending on their ages), should seek guidance from a fertility specialist. Male infertility contributes to about half of these cases. Still, numerous treatments are available that may enable men to become parents, even if they have been diagnosed with conditions such as a low sperm count. When a couple consults with a Reproductive Endocrinology & Infertility (REI) specialist, the clinician assesses the health of both partners. A comprehensive health history is obtained, and a semen sample is analyzed. Our Fertility Center employs computer-assisted semen analysis, one of the most advanced methods for evaluating semen quality. This analysis assesses sperm count, morphology (shape and structure), and sperm motility—crucial factors in fertilization. If abnormalities are detected, patients may be referred to a reproductive urologist for further evaluation and treatment. Our Fertility Center is among the few in the country to offer on-site consultations with a reproductive urologist. Poor semen quality is often the primary factor contributing to male infertility. Some patients may have insufficient sperm production or a complete absence of sperm. Others may produce enough sperm, but with abnormalities in morphology or motility. Anatomical abnormalities may also obstruct sperm passage or semen ejaculation. Following a diagnosis, our reproductive specialists collaborate with patients to enhance their chances of achieving parenthood. In cases with a reduced but sufficient number of motile sperm, intrauterine insemination (IUI) may be recommended. Here, ejaculated sperm is washed and directly injected into the uterus by a clinician. IUI is often combined with ovarian stimulation medications to increase the chance of achieving a pregnancy. If sperm quantity is insufficient for an IUI procedure, or if IUI proves unsuccessful, in vitro fertilization (IVF) may be employed to improve pregnancy success rates. A patient’s sperm is combined with their partner's egg in the IVF laboratory. Intracytoplasmic sperm injection (ICSI) is often utilized, in which a single sperm is injected directly into the egg to facilitate fertilization. Subsequently, one of the resulting embryos is transferred into the partner's uterus. For patients with complex male fertility issues, medications may be prescribed to enhance sperm production, or procedures may be performed to address physical barriers hindering sperm release. This may include repairing varicoceles , which are dilated blood vessels in the scrotum that impact sperm production. In cases of severely diminished or absent sperm, advanced sperm retrieval techniques may be necessary. Our reproductive urologists perform microsurgical procedures to locate and extract sperm from the testes, a procedure available at only select fertility centers. Extracted sperm is then used in conjunction with IVF, ensuri

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

Polycystic ovary syndrome (PCOS) is one of the most commonly misdiagnosed conditions associated with female infertility . It is a prevalent yet intricate endocrine disorder marked by an imbalance of female reproductive hormones. Common symptoms include irregular menstrual periods, acne , and excessive facial or body hair growth. PCOS is often linked with obesity. In addition to fertility issues, women with PCOS face an increased lifetime risk of conditions such as diabetes , uterine lining pre-cancer, cholesterol abnormalities, high blood pressure , sleep apnea , and depression . Effective PCOS management typically requires a multidisciplinary approach involving primary care physicians (for general health, weight loss, diabetes risk, high blood pressure, and depression), gynecologists (for gynecological health and uterine lining protection), endocrinologists (for hormonal issues, including hair excess and acne, obesity, diabetes, and elevated cholesterol ), and reproductive endocrinology and infertility specialists (for pregnancy goals). Maternal-fetal medicine specialists may also be involved for fertility-seeking women at risk of gestational diabetes or pregnancy-related blood pressure problems. Mental health providers and nutritionists can also provide valuable support for improving overall well-being. Our aim is to optimize the family-building goals of women with PCOS while prioritizing the overall well-being of both mothers and babies. For overweight or obese women with PCOS, lifestyle modifications focusing on diet and exercise can lead to significant improvements in menstrual cycles, acne, and mood. Metformin, commonly prescribed for diabetes, may also benefit overweight or obese women with PCOS, as well as some undergoing fertility treatment. Treatment options for PCOS should be tailored to reduce symptoms (such as abnormal menstruation, acne, and excessive hair growth), address individual goals (such as fertility), and mitigate lifetime risks (such as diabetes, depression, heart disease, and uterine cancer ). Treatment may include birth control pills with or without anti-androgens for acne and hair growth, as well as medications like metformin. Our team is dedicated to helping patients with PCOS achieve their fertility goals through personalized treatment plans. Our approach begins with a comprehensive evaluation, including hormonal and metabolic profiling and an assessment of uterine and fallopian tube health. For couples in heterosexual relationships, semen analysis is a critical step. Endometrial biopsy may be recommended for women with irregular menstruation. Preconception consultations with high-risk obstetricians may also be advisable for those at higher risk of pregnancy complications. For women with PCOS-related infertility, various treatment options are available, such as ovulation induction with medications like letrozole. Metformin may be added if the ovaries are unresponsive to these medications. Injectable hormo

Our specialists treat a diverse range of benign (non-cancerous) urinary tract conditions, including male urinary issues (enlarged prostate, difficulty urinating, overactive bladder, urinary incontinence), female pelvic floor disorders (urinary incontinence, overactive bladder, pelvic organ prolapse), urinary tract reconstruction, and penile and scrotal reconstruction. Genitourinary tract reconstruction Our fellowship-trained specialists offer a wide range of options to address congenital or acquired issues of the urinary tract and male genital tract. We partner with patients to achieve their goals, restore urinary and sexual function, and improve quality of life. Benign prostatic hyperplasia Benign prostatic hyperplasia (BPH) is one of the most common reasons patients have bothersome voiding symptoms or difficulty with urinating. Our specialists can help get to the root cause and offer several treatments, including minimally invasive surgeries such as Urolift. We were also the first in Connecticut to offer Holmium Laser Enucleation of the Prostate (HoLEP). Neurogenic bladder We expertly treat those experiencing loss of bladder control after an injury to the nervous system. Our specialists serving those with neurogenic bladder help deliver treatments that can restore independence and make symptoms more manageable. Urogynecology / Female Pelvic Medicine and Reconstructive Surgery [FPMRS] More than 50% of women report bladder issues, such as urine leakage or overactive bladder (urinary urgency or frequent urination). Another common issue is pelvic organ prolapse, a condition in which the uterus and vagina can drop, causing a feeling of a vaginal bulge. There are nonsurgical treatments, such as pelvic floor physical therapy, as well as effective office procedures and minimally invasive surgeries that can treat many of these symptoms. Our specialists will work with our patients to develop an individualized treatment plan and get them back to their active lifestyle, restoring their quality of life.

Endometriosis, a common gynecological disease, affects one in 10 women in the U.S., and is diagnosed in up to half of women who experience infertility . Due to its nonspecific symptoms, endometriosis often goes undetected for years. Many individuals attribute their chronic pelvic pain to menstrual cramps rather than recognizing it as a symptom of endometriosis. Additionally, some may remain unaware of their condition due to silent symptoms. It can take up to a decade for some patients to receive a proper diagnosis. Normally, the uterine lining (endometrium) grows along the interior walls of the uterus, providing a cushioned and receptive environment for embryo implantation during pregnancy. However, in endometriosis, the endometrium grows outside the uterus, commonly on the exterior of the uterus, ovaries, fallopian tubes, bladder, intestines, or other pelvic structures. This displacement frequently leads to chronic pelvic pain and may cause secondary symptoms, such as irritability, difficulty sleeping , anxiety , depression , or low self-esteem. Over time, endometriosis induces inflammation, bleeding, and scar tissue formation within the pelvic cavity, regardless of whether the patient experiences pelvic pain. The presence of scar tissue can hinder fertility. Early diagnosis of endometriosis, before the formation of scar tissue, can help preserve fertility. A delayed diagnosis may pose challenges for conception, even with assisted reproductive procedures like in vitro fertilization (IVF) . To confirm endometriosis, clinicians biopsy a small sample of uterine tissue and examine it under a microscope for signs of the condition. For patients diagnosed with endometriosis, the news may bring emotional relief after years of pelvic pain without a clear cause. Our providers offer treatments to alleviate chronic pain and related physical and emotional symptoms, and assess whether endometriosis has contributed to infertility. Treatment options for endometriosis include medications and/or surgical procedures, such as excision surgery, to relieve pain, remove scar tissue, and improve organ function. These treatments may also prevent a recurrence. In cases of endometriosis-related infertility, clinicians may recommend IVF or other assisted reproductive therapies to enhance pregnancy chances. Many patients with endometriosis benefit from therapy alongside medical treatments. Additionally, we conduct various research projects, offering patients access to medication and testing at no cost. Throughout the infertility journey, our counselors support patients with endometriosis, explaining different assisted reproductive technologies and helping patients understand their options fully.

Although perimenopause and menopause represent natural stages in a woman’s life, some women may find the common symptoms of this stage burdensome to the point of affecting their quality of life. On average, women experience menopause at age 51. Approximately 1% of women experience “premature” menopause, which occurs before age 40. (Menopause is considered “early”—but not premature—when it happens after age 40 but before 45.) Some medical conditions, such as autoimmune disorders, and some treatments, such as chemotherapy, radiation therapy, and ovarian surgeries, may increase the risk of early or premature menopause. Both premature and early menopause can be particularly burdensome—not only are the physical symptoms (hot flashes, night sweats, and vaginal dryness) more severe, but the psychological distress that accompanies an early onset of menopause can be particularly stressful, especially for women who may not have met their fertility goals. Our team of clinicians is equipped to help optimize the quality of life and health of the reproductively aging population of women by addressing their symptom burden, as well as identifying and minimizing their long-term health risks (such as osteoporosis or fractures). Our team is equally responsive to the reproductive needs and goals of our patients. Our Fertility Preservation Program addresses the needs of those who require treatments that may result in ovarian compromise or early ovarian failure. Our Third-Party Reproduction Program is committed to helping women with premature and early menopause meet their fertility goals through the use of donor eggs or gestational surrogacy . Our clinicians strive to serve our perimenopausal and menopausal patients’ immediate medical needs while also anticipating and reducing the risk of health problems that may arise in the future.