Elevating REIs and Expanding Access Through Innovative Training and Leadership – an Interview with Dr. Paul Magarelli

About the expert

Paul Magarelli, MD, Ph.D, MS

Obstetrics and Gynecology Reproductive Endocrinology and Infertility

Dr. Paul Magarelli is a highly experienced, double board-certified Reproductive Endocrinology & Infertility Specialist (REI). He has been in private practice building families through Assisted Reproductive Technology (ART) for more than 25 years. Dr. Magarelli completed his REI fellowship at the University of California, Los Angeles/ Cedars-Sinai, his OB/GYN residency at Duke University Medical Center, and his MD at the University of Arizona.

Silvia

Can you introduce yourself in three sentences for those who may not already know you?

Paul

Paul Magarelli, MD, PhD, MS: Thank you for asking. I am a board-certified reproductive endocrinologist and fertility specialist. Before becoming a physician, I trained as a marine biologist, focusing on marine animal reproduction. This scientific foundation has deeply informed my approach to reproductive medicine. I’ve also opened five IVF centers in the U.S., led an international Chinese-American IVF center, served as Chief Research Scientist for a large fertility company, and was Special Projects Director for Kindbody. I love research, have been president of the Pacific Coast Reproductive Society, and now focus on training the next generation of doctors.

Silvia

Let’s talk about the talents and interests necessary for those pursuing a career in fertility care. Where should fellowship programs place more emphasis, in your opinion?

Paul

First and foremost, a strong foundation in science is essential for anyone pursuing a career in reproductive medicine. This field is one of the most intricate and dynamic areas of medicine. Intellectual curiosity is vital—there’s so much we still don’t know, and things are constantly evolving. Of course, compassion is a given for any physician, but in reproductive medicine, you must be driven by a passion for discovery and a commitment to solving complex problems.
As for fellowship training, it’s historically been heavily focused on research—up to 18 months out of a three-year program in the U.S. This was critical when the field was still developing, but now, many day-to-day tasks in fertility care—like educating patients, documenting cases, and performing repetitive procedures—don’t necessarily require the involvement of a fully trained reproductive endocrinologist. These tasks could be delegated to other well-trained healthcare providers.
That’s where I see room for growth. We need to reimagine the role of the REI to focus on what they’re uniquely qualified to do: managing complex cases, advancing research, and leading care teams. Fellowship programs could better prepare trainees for this elevated role by incorporating more hands-on procedural skills and leadership training, while leveraging innovative technologies like simulators to enhance practical learning. In my opinion, the entire field must adapt to train more clinicians while maintaining rigorous standards.

Silvia

Speaking of adapting, what are your thoughts on how the role of REIs should evolve given the growing demand for fertility services?

Paul

The role of REIs must shift toward leadership. REIs should function as the "brain" of the system, guiding strategy and ensuring high standards across teams. They should lead and oversee the work of gynecologists, nurse practitioners, and other skilled providers who handle the majority of routine procedures. This allows REIs to focus on the most complex cases, research, and innovations.

Fertility care involves many repetitive, manual tasks that highly trained REIs don’t necessarily need to perform. By delegating these tasks to well-trained clinicians and advanced practice providers (APPs), REIs can focus on solving complex cases, advancing the science, and contributing to leadership at the institutional or organizational level. This approach not only improves access to care but also elevates the entire field.

Silvia

How would you address the concerns of REIs who may feel threatened by this shift in responsibilities?

Paul

Fear of change often stems from a concern about financial security or a loss of professional identity. My argument is that this model elevates the role of REIs, making them more valuable as leaders while potentially increasing their income through new models of care. For example, an REI supervising multiple satellite clinics staffed by gynecologists and APPs could oversee significantly more cycles and earn a percentage of each—essentially achieving more impact with less hands-on work.
We must frame this shift as an opportunity for REIs to use their expertise in more meaningful ways, focusing on leadership, strategy, and solving the most challenging cases. This approach is about progress, not replacement, and requires REIs to embrace a higher level of responsibility.

Silvia

Let’s dive into your IVF Academy. Who is it designed for, and how do you envision it contributing to this new model of care?

Paul

The IVF Academy is designed to train the next generation of fertility care providers, including gynecologists, APPs, and others, in both clinical and procedural skills. The program combines rigorous didactic education—about 60 hours of live instruction and 120 hours of homework—with hands-on procedural training using advanced simulators. These simulators allow participants to practice skills like egg retrievals, embryo transfers, and hysteroscopies in a controlled, measurable environment.
The curriculum is based on global best practices, ensuring that participants graduate with knowledge and skills that meet or exceed the standards of current fellowship programs. By training what I call Clinical Fertility Gynecologists or CFGs, we can expand access to care without compromising quality. I foresee that these professionals will handle the majority of routine cases, freeing REIs to focus on leadership and complex cases.

Silvia

How do you ensure that the people trained through the IVF Academy meet the highest standards of care?

Paul

The IVF Academy is built on a foundation of rigorous education and validation. Trainees go through a structured curriculum that covers the didactics of reproductive medicine in depth. We use Speroff's 9th Edition textbook, the “bible” of training in this field, along with guidelines from the American Society for Reproductive Medicine and other recognized resources. This ensures that everyone who completes the program has a deep understanding of the science behind the procedures.
For hands-on training, we use the best virtual simulators available, which provide quantifiable feedback on skills like egg retrievals, embryo transfers, and IUIs. These tools are so advanced that even experienced REIs have found them valuable for improving their technique. Trainees must complete progressively challenging modules and demonstrate proficiency at each level. By the time they finish, they’re not just competent—they’re highly skilled.
We’ve also validated this approach through research. Clinical Fertility Gynecologists trained through this program have outcomes that are equal to or better than those of experienced REIs in terms of key metrics like the number of eggs retrieved and embryos transferred that result in live births. This gives us confidence that our graduates are fully prepared to deliver high-quality care.

Silvia

What role do you see for technology in transforming fertility care, and how does it complement the training provided by the IVF Academy?

Paul

Technology is a game-changer in fertility care. Tools like decision support systems, data analytics, and virtual simulators can enhance every aspect of the patient journey, from diagnosis to treatment planning. For example, clinical decision support software can help pre-select candidates for specific treatments, allowing care teams to focus their time and expertise where it’s most needed. Virtual education tools can empower patients to make informed decisions without relying on one-on-one consultations for every question.
The IVF Academy integrates these technologies into its training. Trainees learn how to use data-driven tools to improve decision-making and streamline workflows. This not only enhances their skills but also prepares them to work in a modern, tech-enabled healthcare environment. Ultimately, technology allows us to provide better care to more people while reducing costs and improving efficiency.

Silvia

Thank you for sharing your vision. This has been incredibly insightful.

Paul

Thank you! It’s been a pleasure to discuss these ideas. I’m passionate about the future of fertility care, and I believe we have an exciting opportunity to make meaningful changes.