When to See a Fertility Specialist
When to see a fertility specialist at a glance
- Fertility specialists are OB/GYNs who have undergone additional training in order to treat complex causes of infertility.
- Women should see a fertility specialist if they have not been able to conceive after a year, sooner if they are over 35.
- Women may also benefit from seeing a fertility specialist if they’ve had multiple miscarriages or have a history of fertility-related diagnoses or injuries.
- Men should see a fertility specialist if they or their doctor suspect male infertility may be an issue in their partner’s inability to conceive.
Who should see a fertility specialist
Fertility specialists, also called infertility specialists, are typically OB/GYNs who underwent additional training to treat advanced cases of infertility. In most cases, fertility specialists undergo three additional years of rigorous fellowship training in reproductive endocrinology or reproductive endocrinology and infertility (REI) after earning their medical degree.
Women younger than 35 are usually advised to try to get pregnant naturally for 12 months before consulting a fertility specialist. Those with prior knowledge of conditions, such as irregular menstrual cycles or a history of tubal infections or miscarriage, should consider getting an examination sooner.
Women older than 35 should request an initial examination after only six months of trying to get pregnant. Women older than 40 may begin fertility tests immediately.
Men should consult a specialist if they have a had a medical condition or injury that could affect their testicles or other reproductive organs and glands. They should also seek evaluation if they have erectile dysfunction or problems releasing semen during climax.
Most gynecologists have enough training to handle the basic infertility workup for women, although some refer patients to a specialist immediately. Some OB/GYNs begin the testing process and appropriate treatments, then refer the couple to a fertility specialist if simple treatments are not successful.
In the following video, Dr. Louis Weckstein from the Reproductive Science Center of the Bay Area discusses more situations when it’s appropriate, and often encouraged, to see an infertility specialist.
You might think that financial reasons are a big obstacle for patients not getting pregnant. Certainly that’s true, but we know from studies that the number one reason that patients stop fertility treatment before achieving their dream of a pregnancy is frustration.
So if you’ve been with a general OB/GYN and had treatment and diagnostic testing for some time and you feel your frustration level rising, it’s time to see a fertility specialist.
Advanced maternal age
In general, female age greatly influences egg quantity and quality. We feel that in women under 35, a year or more of trying to get pregnant is a reasonable amount of time before seeking fertility care, and if you’re over 35, six months is a time to seek fertility care. So particularly as women get older it’s important to accelerate the speed at which they seek care with a fertility specialist rather than a general OB/GYN.
Many women these days certainly feel their biological clock ticking when it comes to starting a family. But this is an area that we continue to feel we need to get information out to the public and educate them on.
As women get older they have fewer eggs left and the quality of those eggs – and what we mean by quality is genetic normality – goes down. So a higher and higher percentage of eggs that a woman has left as she gets older are genetically abnormal.
And when those eggs ovulate in a given cycle they either don’t fertilize or if they fertilize, they’re often lost very early, miscarried very early or don’t implant, and that accounts for generally lower fertility as women get older. Because of this, because the number of good eggs is low as women get older, it’s important as women get older to have prompt evaluation and treatment of their infertility.
Failed Clomid treatments
Clomid is an oral fertility medication that definitely has a role in fertility treatment in specific situations. Its role is in women who don’t ovulate regularly on their own and in situations of unexplained infertility when it’s combined with intrauterine insemination (IUI).
But many studies have shown that after three or four treatment cycles of Clomid and intrauterine insemination, if a woman is not pregnant, the likelihood of Clomid working is low in the future. So after three or four cycles that’s also a time to consider seeing a fertility specialist.
Severe male factor infertility
Many studies have shown that with male factor infertility lower level fertility treatment is not very effective. So if the sperm count in general is less than 20 million per milliliter or the motility is lower than 40-50 percent, most low-level fertility treatments don’t work very well. It’s important in situations like that to promptly seek care with a fertility specialist because most often in vitro fertilization (IVF) with ICSI is the most effective treatment with a significant sperm factor.
ICSI stands for intracytoplasmic sperm injection, and when the sperm count is very low or the sperm motility is very low, the sperm may not be able to fertilize an egg even when placed together with the eggs in a dish in the laboratory. In those situations, a single sperm can be injected into an egg and accomplish fertilization.
Prior injuries or fertility-related diagnoses
Things like endometriosis, prior tubal pregnancies, scar tissue, these are all factors that can affect the fallopian tubes. And most low-level fertility treatments are not very effective in treating tubal factors. If a woman has severe endometriosis, has had prior surgery, has had multiple tubal pregnancies, this is a time that she should promptly see a fertility specialist to be given accurate statistics for a surgical treatment of these situations versus in vitro fertilization, which in general is far more effective.
No advancement in your fertility treatment
It is very important to realize that you are in control of the process. It’s your body and it’s your future fertility, and you need to be an advocate for yourself.
If you’re seeing a general OB/GYN and you feel that time is moving on and you’re not getting your questions answered or getting appropriate testing done or treatment, then it’s important to take control of the situation. Your future fertility is more important than your OB/GYN’s feelings. They’ll be happy to see you back pregnant if you go on to a fertility specialist and then come back to them once you’re pregnant.
The bottom-line message I would say is that with modern fertility treatment, we can help many, many women get pregnant, and it’s important to get prompt treatment and diagnostic testing. With prompt, appropriate treatment, fertility specialists can help many patients have that family that they have hoped for.