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Most Obstetrician/Gynecologists (Ob/Gyns) complete a residency in this specialty and then go on to practice—delivering babies, seeing patients in their office, performing well-woman exams and performing operations like hysterectomies (removal of the uterus) and removal of ovarian cysts. However, an Ob/Gyn can go on to do more training after their residency in what is called a fellowship so that they sub-specialize. Below are the four sub-specialties of Ob/Gyn.
1. Maternal-Fetal Medicine: These sub-specialists focus on high-risk pregnancies. The pregnancy is complex and high-risk either because of a condition that the mother has or a condition that the fetus or baby has. Some examples of these conditions are (1) difficulties carrying the baby to full gestation, (2) too little fluid in the womb/uterus, (3) severely uncontrolled diabetes in the mother and (4) either over or under active thyroid in the mother. There are many others as well. Typically a pregnant woman starts by seeing a regular Ob/Gyn during the beginning of her pregnancy and is then referred by the Ob/Gyn to a Maternal-Fetal Medicine Sub-Specialist if one of these more complicated situations arises.
2. Reproductive Endocrinology: These sub-specialists are experts in fertility. They assist couples that need assistance conceiving have a baby. Various techniques they use include (1) prescribing medications (in pill and injection form) that cause the woman to produce more eggs, (2) IUI-Intrauterine Insemination and (3) IVF-In Vitro Fertilization. Of note, Reproductive Endocrinology is not a sub-specialty of Endocrinology—it just has a similar sounding name. Endocrinology is a sub-specialty of internal medicine and these doctors treat hormone conditions related to diabetes, the thyroid gland and other glands. Also of note, many times the tests, medications and procedures that Reproductive Endocrinologists order are not covered by insurance. When going to see one of these types of doctors it is important to research how much it may cost out-of-pocket—as it could end up being well over $10,000.
3. Gynecologic Oncology: These sub-specialists are experts in specific cancers that affect women. These cancers include: breast cancer, ovarian cancer, endometrial cancer (sometimes called uterine cancer) and vulvar cancer. These sub-specialists perform surgery to remove the tumor and some even oversee the administration of the chemotherapy as well. Often Gynecologic Oncologists see patients in conjunction with other cancer doctors such as medical oncologists (to oversee the chemotherapy) and radiation oncologists (to administer radiation to treat the cancer). So you could think of a Gynecologic Oncologist as a type of cancer surgeon. There are other types of surgeons that operate of cancers in women as well—namely Surgical Oncologists and General Surgeons—so there are several options for women with their care.
4. Urogynecology: These sub-specialists are experts in urinary problems in women. One of the most common urinary problems that these doctors see women for is what is called—stress urinary incontinence. It is fairly common and involves not being able to control your bladder when you sneeze, cough, laugh or other times you use or ‘stress’ your abdominal muscles. There are various medications and some surgical procedures that Urogynecologists use and perform to treat this condition. Urogynecology is not a sub-specialty of Urology. Urologists often treat women for stress urinary incontinence as well—so it can be confusing who you might want to see for this problem. It largely depends on personal preference or the availability of a Urogynecologist in your area as there are not very many of them.