Do I need a Fertility Specialist?

What is a Fertility Specialist?

A fertility specialist is an obgyn with special training in infertility and reproductive endocrinology. Ideally, an infertility specialist devotes most of his time to treating infertility. Most gynecologists have some basic training in infertility during their residency years. They are able to perform the basic evaluation and some forms of treatment.

If a gynecologist wants to specialize in infertility, he or she must complete three more years of training in a fellowship of reproductive endocrinology and infertility. After completing the fellowship, the physician is board-eligible. Some reproductive endocrinologists then complete two more years of written and oral exams. If they pass the exams, they are then board certified. This certification is the highest level of achievement in the field of infertility.

Some reproductive endocrinologists have special training and expertise with infertility surgery. Most gynecologists can perform laparoscopy and hysteroscopy for diagnosis. However, it requires special skills for the gynecologist to perform corrective procedures during laparoscopy and hysteroscopy.

When Should I See a Fertility Specialist?

Patients are often confused about the appropriate time to see a specialist. There are many factors to be considered before making the decision to see a specialist. Some factors to be considered are age, tubal disease, and low sperm count.

Age is the most important cause of infertility.

Many women get pregnant in the first three to six months after stopping contraception. If your cycles are regular and you are under 35 years of age, seek assistance from your OB-GYN or a reproductive endocrinologist and infertility specialist after 12 months of trying to conceive. If you are over 35 years of age, begin infertility testing after trying to conceive for six months. If you are over 39 years of age, begin infertility testing within three months. If your cycles are not regular, seek immediate assistance.

Block Tubes

If the fallopian tubes are blocked, a specialist should be consulted before proceeding with treatment such as surgery. Surgery of a damaged tube is often not successful, and can increase the chance of a tubal pregnancy. In vitro fertilization can be a much more successful treatment and no surgery is necessary. If the fallopian tubes are plugged at the end and filled with fluid, called a hydrosalpinx, surgery is appropriate prior to IVF.

Consultation with a specialist can determine the appropriate procedure. Expert assessment can help prevent an unnecessary second surgery to perform the appropriate procedure.

Patients should see a specialist as soon as possible if sperm count is low or zero. Inseminations, fertility pills, and surgery are usually not successful. These unnecessary medications and procedures can waste your time and money.

Proper identification of the cause of infertility is crucial to the most cost effective and timely treatment. Infertility specialists can help you avoid unnecessary procedures, such as laparoscopy when no symptoms of endometriosis or history of infection is present, and avoid tests of limited usefulness.

Specialists are able to evaluate simpler treatments and fine tune them to make them more effective. For example, specialists can monitor ovulation with Clomid with ultrasound and blood tests. Vaginal ultrasound can be used to assess follicular development and endometrial pattern and thickness. Blood tests assess ovulation by measuring progesterone. Intrauterine inseminations can be done to bypass hostile mucus caused by clomiphene. Specialists can also decide when to stop a particular treatment and proceed to other treatments.

Fertility Tests an Obgyn can Perform

The following tests can be performed by your primary care physician or gynecologist prior to consulting a specialist.

These tests help the specialist evaluate specific situations:

  • Day-3 FSH (follicle stimulating hormone) and Estradiol (day 2, 3, or 4 are also acceptable)
  • TSH, thyroid stimulating hormone
  • Prolactin
  • Progesterone seven days prior to menses
  • Semen analysis
  • Hysterosalpingogram (HSG) or documentation of tubal status