Your OB-GYN can start an infertility evaluation but most likely doesn’t have the specialization to do the most up-to-date review – and can’t treat all the problems that may be causing your infertility
We’re all familiar with medical specialists. We use them for a spectrum of medical conditions and ailments, from broken bones (orthopedists) to skin rashes (dermatologists). Typically we choose a medical specialist when we have a problem that may be out of the scope of our primary doctor’s care. I am a specialist: an OB-GYN, and I have a sub-specialty board certification in reproductive endocrinology & infertility (REI).
National Infertility Awareness Week is April 22-28 this year. So it’s a good time to raise awareness about the importance of identifying infertility as a condition that needs specialized, expert care. That’s why I recommend that those struggling to get pregnant seek out the help of a reproductive endocrinologist or REI.
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When a person can’t get pregnant, it is common for that individual to perceive it as a personal shortcoming or failure, even though that’s absolutely not the case. Infertility is a disease that can be managed and treated, just like any other.
The first step to acknowledging your infertility as a medical condition is to seek the right kind of help. If your fertility is broken, you would want to see a specialist, wouldn’t you? OB-GYNs have a wider focus of problems they take care of, from pregnancy and delivery to abnormal Pap smears, whereas an REI focuses mainly on diagnosing and treating infertility.
The REI designation belongs to an OB-GYN who is further trained as an REI or as a reproductive endocrinologist (much of reproduction is related to the endocrine system that secretes and regulates hormones).
“To receive that REI specialization, we OB-GYNs complete an additional three years of training specifically in understanding, diagnosing and treating infertility in all its various forms.”
Most of us complete both oral and written Board examinations to become certified in this specialty, which provides additional evidence of quality. It takes seven years of training beyond graduating from medical school, plus a minimum of two more years of collecting cases for examination, to make a board-certified REI.
REIs, unlike OB-GYNs, are also required to keep up with infertility research and advances in clinical procedures. To maintain our Board certification status, we must do a series of maintenance activities, which may include a written examination every six years to make sure we’re keeping up.
So after all of that, REIs like myself can confidently say: Bring it on, infertility, we’re ready.
When is it time to see an REI or reproductive endocrinologist?
Here’s the American Society for Reproductive Medicine’s (ASRM’s) guideline for when to seek help for infertility: “The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age, or physical findings dictate earlier evaluation and treatment.” For women older than 35, ASRM and University of Colorado Advanced Reproductive Medicine suggest seeing a specialist after six months of trying.
Before you come see anyone about your fertility, you want to make sure you’re doing everything right in the natural reproductive process. But if you are doing things like having intercourse on a regular basis and timing it to predicted ovulation, and still not getting pregnant, then it’s time to bring in professional help.
So, do you see an OB-GYN first? Or do you go to a reproductive endocrinologist or an REI for an evaluation?
The American College of Obstetricians and Gynecologists says of infertility evaluation, “Your obstetrician–gynecologist (ob-gyn) usually will do the first assessment. You also may choose to see a specialist. Infertility specialists are ob-gyns with special training in evaluating and treating infertility in women and men.”
Much of what my fellow OB-GYNs will do in an infertility evaluation is the same as what I would do – at first. OB-GYNs can do a physical exam and talk to the couple about their medical histories. They can test a woman’s ovarian reserve, test for hormone balance and perform imaging procedures as appropriate, including hysteroscopy, hysterosalpingography and laparoscopy.
Let’s qualify this by saying that not all OB-GYNs are trained to perform infertility evaluations, and not all want to do infertility evaluations and treatments. In fact, most of my patients are referred to me by OB-GYNs. After speaking with a patient about infertility concerns, most OB-GYNs recognize that a patient will be best served by seeing a specialist for treatment.
An REI or reproductive endocrinologist performs these kinds of infertility evaluations all the time. And usually they practice nothing but infertility medicine. They are also aware of the latest research, testing and advances in fertility medicine, which can inform their diagnoses and their recommendations for next steps.
REIs’ focused training in infertility makes us best prepared to look for the less than obvious clues of infertility, to put all the pieces of what can often be a puzzle of uncertainties together. About 20 percent of infertility diagnoses are “unexplained infertility,” meaning we can’t pinpoint the cause. An REI can provide guidance based on the very latest information when the way forward is not clear.
However, be warned: REIs are not going to deliver your baby once we make a diagnosis and help you get pregnant. In fact, once you have conceived we send you back to your OB-GYN – because they are the specialists in delivering babies.
The male factor wildcard
Then there’s the guy. It’s a common misconception that women are the primary source of infertility in heterosexual couples. But ASRM states that male factors contribute to half or more of all cases of infertility. The male is the sole cause in 20 percent of infertility cases and a contributing cause in another 30-40 percent. That’s why our practice always wants the male partner in a couple to participate in the infertility evaluation from the start.
If I determine that the male is a likely factor, I can conduct a semen analysis to find out more information and pinpoint a cause. An OB-GYN will often refer the male to a urologist for that test. Poor sperm quality is a frequent cause of male infertility, but not the only one.
At-home semen analysis tests are available, but we caution that they only consider the one aspect of sperm count. That isn’t enough, and the tests’ sperm count is only a rough estimate anyway, which an andrologist would need to verify under the microscope.
We have an andrology lab on site that evaluates male semen. We can tell if there is enough sperm count in the semen. We can evaluate if sperm have adequate movement (motility) to get to that egg in the fallopian tube. We can tell if the sperm have a normal shape (morphology), which affects their ability to fertilize the egg. We can also assess for erectile dysfunction that may prevent the sperm from going anywhere.
A reproductive endocrinologist is trained and experienced in all facets of infertility, not just the female part. And with the male playing a role in half or more of all infertility cases, it’s essential that infertility is not designated as solely a women’s health concern. Seeing an REI allows a couple to address all possible sources of infertility from the start, without having to visit multiple doctors.
Infertility-focused practice gets you closer to success
Research shows that the increased training and focus on infertility of an REI results in fewer mistakes, better communication between doctor and patient, and better outcomes for those who need assisted reproductive technologies. These include the more complicated treatments of in vitro fertilization (IVF), cryopreservation, intracytoplasmic sperm injection (ICSI) and others.
Those treatments are the things we do all the time – the things we are specifically trained to do. So are infertility evaluations. And practice gets you closer to perfect in reproductive medicine.
You can bet that everything I learn in my patient-care experiences and in my never-ending training, I put to use for every one of my patients. While every person’s situation is different, my expertise helps me tackle even the most unique medical and diagnostic challenges.
If you’re met with the daunting challenge of infertility, you deserve the latest, evidence-based infertility medicine an REI can bring to your situation. We’re here to partner with you and help you find the right treatment. Because you deserve to have the family you want.
You deserve success.