Have you been trying to get pregnant without success? If you have made the decision that you are ready to have children and are excited about starting a family, waiting for that positive test can sometimes create anxiety and concern. You may begin to wonder if there is something wrong that is preventing a pregnancy. The medical community defines infertility as the inability to conceive despite 12 months of frequent and unprotected sexual intercourse. If it’s been a year or more for you, it is time to address your concerns with your doctor. However, as many as 50% of all healthy couples who have not conceived in their first 12 months, will experience a pregnancy within the next 12 months. So, don’t be overly worried, but make an appointment to see your OB/GYN to discuss what tests he or she may want to run, and if or when you should see a fertility specialist, or more specifically, a reproductive endocrinologist.
Is there a Difference Between a Reproductive Endocrinologist and a Fertility Specialist?
A fertility specialist is a doctor with expertise in the diagnosis and treatment of infertility. While all OB/GYN physicians can order initial testing if you are concerned about infertility, more than likely you will need to be seen by a reproductive endocrinologist. This is a sub-specialty of obstetrics and gynecology, so doctors who are board-certified in this area of medicine have completed 4 years of medical school, a 4-year residency program in OB/GYN, followed by a 3-year fellowship in reproductive endocrinology. Board certification means that after completing all the training, these physicians have completed both oral and written exams successfully, and are truly experts in diagnosing and treating infertility. What is unique about this specialty, is these doctors generally treat a couple and not an individual. Infertility can be the result of medical issues of the man, the woman, or both, and a reproductive endocrinologist is qualified to diagnose and treat both.
When Should I See a Specialist?
A good place to start if you have concerns about fertility is your OB/GYN. They will be able to order some testing and even begin some treatments. However, if these initial efforts are unsuccessful, your doctor will most likely refer you to a reproductive endocrinologist. Any time you have attempted to get pregnant for 12 consecutive months and are unsuccessful with traditional treatments, it would be appropriate to see a specialist. However, there are a few other situations where a reproductive endocrinologist would be the right choice for you. If you are 35 years or older and plan on attempting to get pregnant, it is a good idea to be evaluated for potential problems in advance. These are the years when your body will naturally be winding down reproductively so it is better to identify any potential roadblocks early on.
Additionally, if you have experienced three or more miscarriages in a row, you should see a specialist who may be able to identify a reason that you have been unsuccessful in carrying a pregnancy to term. Finally, if you have received a diagnosis that is known to cause infertility, like polycystic ovarian syndrome (PCOS), endometriosis, pelvic inflammatory disease (PID), undescended testicles, or low sperm count or motility, your best chance of conceiving a child will be in the care of a reproductive endocrinologist.
What Can I Expect from a Reproductive Endocrinologist?
While initial testing might be conducted by your primary OB/GYN, a more extensive evaluation should be completed by a specialist. It is recommended that testing begin when any couple is unable to conceive after 12 months of frequent, unprotected sexual intercourse. Testing should also be conducted on any woman 35 years of age or older who is attempting to get pregnant. Evaluation may also begin sooner in women with a medical history that puts her at risk for fertility problems such as ovarian surgery, smoking, severe endometriosis, or an autoimmune disease.
Remember that an infertility evaluation involves testing of both the man and the woman during the same time period. Because the cause of fertility difficulties can be a combination of factors, both will undergo a thorough review of medical history and an examination. Concerns of infertility can create strong emotions; therefore, psychological distress will always be evaluated as a possible contributing factor. Other portions of the evaluation that you can expect will include a semen analysis, a complete menstrual history, urine tests to evaluate presence of female hormones and to assess ovulation, sonograms to view the woman’s ovaries, uterus, and fallopian tubes, serial blood tests for female hormone levels, and thyroid function studies. If necessary, your specialist may also recommend a surgical procedure, called a laparoscopy, to view your reproductive organs.
Once the problem, or problems, is identified, a plan of treatment will be proposed. Lifestyle recommendations will always include no smoking, reducing caffeine and alcohol, and the participation in unprotected sexual intercourse every 2 days around the suspected day of ovulation.
Other treatments can include drug therapy, surgery, intrauterine insemination (the artificial introduction of sperm into the uterus or cervix to achieve pregnancy), or in vitro fertilization (eggs are retrieved from the ovaries, fertilized in the lab, and implanted into the uterus). Many of these treatments involve very personal decisions that are best made by a couple, under the guidance of a board certified expert in reproductive endocrinology.
If you are worried that you may have problems with infertility, or if you are 35 years or older or have a medical history that places you at risk, the caring experts at University OB/GYN Associates in Syracuse, NY, are here to address all of your reproductive concerns. Call (315) 464-5162 today or request an appointment online.
