WHEN SHOULD YOU CONSULT A FERTILITY SPECIALIST?
The American Society for Reproductive Medicine defines infertility as the inability to conceive after one year of unprotected intercourse. In women aged 35 and older, this time is often shortened to six months.
Infertility specialists undergo years of advanced training specifically dealing with the cause of, and treatments for, infertility. Fertility specialists must first complete a four year residency in Obstetrics and Gynecology and most attain their board certification in Ob/Gyn.
After completing the Ob/Gyn residency and board certification testing, the fertility specialist must complete a three year fellowship program in Reproductive Endocrinology and Infertility (REI) at a teaching/medical center. During this training, he/she learns the many facets of infertility causes and treatments and must demonstrate proficiency in delicate microsurgical and laparoscopic surgical techniques. The Fellow in REI works under the tutelage of respected leaders in reproductive medicine.
Infertility is a very complex condition with a myriad of causes. Like any subspecialist, fertility specialists focus their clinical work, additional advanced training, and literature reviews on infertility. Just as it is unlikely for a general practitioner to “keep up” with the advances in neurosurgery, it is difficult for a generalist to stay abreast of all the important and exciting advances in reproductive medicine.
The “one year benchmark” for referral is a useful general rule but there are many cases when a fertility specialist should be consulted sooner. For example, if a woman has a “known cause” of her infertility, such as PCOS, she should see a specialist immediately. In many cases, the initial diagnostic tests ordered by the Ob/Gyn will point to conditions that usually are managed by an infertility specialist, such as damaged or blocked fallopian tubes.
Another reason to consult a fertility specialist quickly is the presence of moderate to severe male factor infertility. Advanced reproductive technologies such as IVF with ICSI, may be the “first line” treatment for severe male infertility.
A patient’s failed response to Clomid is a reason to refer to a fertility specialist. Numerous clinical studies demonstrate that Clomid treatment is most likely to succeed in the first three or four ovulatory cycles and treatment beyond six cycles is not recommended. Extensive use of Clomid is generally a waste of time and money. If a woman has not conceived after three to six months of Clomid treatment, she should see a fertility specialist.
One of the initial fertility treatments may be intrauterine insemination (IUI) with FSH drug stimulation. Stimulated IUI cycles must be administered and monitored by a fertility specialist. In fact, the physician information sheet for these products specifically states that they should only be administered by a fertility specialist (reproductive endocrinologist).
Women aged 35 and over should see a specialist much sooner than younger women. This is because fertility can decline precipitously and there may not be more conservative treatments.
Two other findings have been stated in many peer-reviewed medical journal articles. First, treatment by a fertility specialist has been shown to be more likely to produce a health pregnancy in a short period of time. Second, this treatment is usually less expensive. We try to control expense by not repeating treatments multiple times when the chances of pregnancy are low, such as repeated Clomid/Letrozole cycles.
It is a common misconception that women who see a specialist will become IVF patients. Actually, the percentage who will eventually require IVF is less than 20% dependent upon the practice profile (patient age, tertiary referral center, etc.). The vast majority of women become pregnant using less expensive treatment techniques.
Another important aspect of seeing a fertility specialist is that a dedicated program is open for treatment 7 days a week. If your doctor is only available 5 or 7 days a week, there is no way to offer appropriate care. For instance, if you are doing IUI then more than 20% of the time you will miss the opportunity to conceive if you ovulate on a weekend.
The choice to see a specialist should be based upon who is the best trained and therefore the most likely to help couples realize their dreams of children. If you internist told you that you needed brain surgery you would probably consult a neurosurgeon, not a general practitioner who has an interest in the subject. The choice to see a fertility specialist is no different.
The most important thing to remember as you consider consulting with an infertility s pecialist is that you are not alone. Infertility is more common than you may think and our goal is to get the necessary information so that you can make the best treatment decision to help you start your family.