Who Should See a Specialist?
Couples who are having trouble with conception often go on to seek the help of a fertility specialist. What can these doctors do for you, and how can you find one? Here are some common questions -- and answers.
Couples seek specialized fertility treatment for many reasons, but there are some general factors that they (and their doctors) typically weigh:
- A woman under 35 has been unable to get pregnant after one year of regular, unprotected intercourse.
- A woman has had a history of three or more miscarriages.
- A woman needs microsurgery or treatment for endometriosis or a blockage or scarring of her fallopian tubes.
- A woman who ovulates irregularly (or not at all) hasn't responded to previous drug treatment.
- A couple has a known risk factor, such as a history of genital infections or pelvic inflammatory disease, a DES mother (a mother who took diethylstilbestrol, a synthetic form of estrogen, during pregnancy), irregular periods, undescended testicles, etc.
- A man's semen analysis shown a low sperm count, poor motility (movement), or poor morphology (structure).
- A couple is considering assisted reproductive technologies, such as in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT).
- A couple has "unexplained infertility" (their basic tests have come back normal, but they haven't had luck in conceiving).
Are There Specialists for Men and Women?
Men with fertility problems are best served by either a urologist or an andrologist. Urologists are trained in the evaluation and treatment of disorders of the kidneys, urinary tract, bladder, and male reproductive organs, and have at least two years of general surgical training. A urologist will usually perform a semen analysis, look for varicoceles (varicose veins in the scrotum), check hormone levels, and order lab tests to check on the quality of sperm. An andrologist is either a medical doctor or laboratory specialist who may have earned a PhD in biochemistry, endocrinology, or physiology. These doctors focus on the physiologic, hormonal conditions that affect male infertility.
If a woman has fertility issues that can't be addressed by her primary physician, she can see a reproductive endocrinologist (RE) -- a doctor specializing in the treatment of hormonal disorders that affect reproduction. REs have completed at least two years of training beyond their ob-gyn residency and have passed oral and written exams.
Depending on the nature of her problem, a woman might also need to see a reproductive surgeon. These ob-gyns are trained to treat anatomical problems, such as tubal obstruction, endometriosis, and uterine abnormalities, as well as other reproductive-organ disorders that require surgery.
How Do We Find One?
Before locating a fertility specialist who can address your particular needs, you may need to do some groundwork. Here are a few ways to get started:
- Ask your primary-care physician, ob-gyn, or urologist for a recommendation.
- Check with your local medical society for names of specialists in your area.
- Contact the directors of private fertility clinics as well as those at nearby medical schools or hospitals.
- Ask a friend for a recommendation (but be sure to check out the doctor yourself).
- Look in the phone book for doctors who limit their practice to fertility services.
- Contact the American Society for Reproductive Medicine or RESOLVE: The National Infertility Association for referrals to specialists in your area.
Contact the American Medical Association or the American Board of Medical Specialties to learn more about your potential doctor's credentials.
What Questions Should We Ask?
During your first visit (which both partners should attend), you'll want to get a sense of how the practice is run, what services the doctor provides, the hours of operation, and the fee structure or payment plan. Here are some general questions to ask:
- Does the doctor or his nurse have a call-in time when we can bring up questions or concerns?
- Will we be seeing only one doctor or several doctors in a group practice?
- Are the lab and ultrasound offices open on weekends and holidays?
- Can procedures such as inseminations be done on the weekends if needed?
- Which hospital (or hospitals) is the doctor affiliated with, and what types of operating privileges does she have?
- Does the doctor perform assisted reproductive technologies, such as IVF and GIFT? If so, are they done at the office or at a different location?
- If the doctor does IVF, is the clinic a member of the Society of Assisted Reproductive Technologies?
- What percentage of live births and multiple pregnancies have resulted from the doctor's treatments?
- What other services, such as support groups or counselors, does the doctor's office provide?
- What are the costs involved, and are there payment plans? Which insurance is accepted?
Sources: The Couple's Guide to Fertility by Gary S. Berger, MD, Marc Goldstein, MD, and Mark Fuerst (Broadway Books); The Fertility Sourcebook by M. Sara Rosenthal (Lowell House); RESOLVE: The National Infertility Association
Originally published in July, 2002.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.