One of the most important decisions an infertile couple will face is when to see a fertility specialist.  Many women undergo “first level” treatments, such as Clomid, administered by their obstetrician/gynecologists (OB/GYNs).  Sometimes these treatments are prescribed in the absence of a complete fertility workup or without a male semen analysis. Almost half of all infertile couples will have a male infertility component making the semen analysis indispensable.

Most OB/GYNs today focus on obstetrical care, not infertility.  There has been an explosion of knowledge in the fertility field, and it is difficult to stay abreast of advances. Reproductive Endocrinologists/Infertility Specialists (REI’s) undergo years of advanced clinical and research training in infertility and other endocrine disorders. Their focus on infertility enhances their ability to stay current on all innovative treatments.

After graduating from medical school, reproductive endocrinologists, fertility specialists must complete a residency in obstetrics and gynecology and achieve board certification. This is true even though the vast majority will never provide obstetrical care or deliver a baby. The residency is followed by completion of a three year Fellowship program in Reproductive Endocrinology/Infertility at an accreted university. This training involves extensive clinical work in assisted reproductive technologies, experience in delicate microsurgical techniques, and all other aspects of the diagnosis and treatment of infertility.

Deciding to seek the services of a fertility specialist is no different than any other therapy area requiring specialty training. For example, suppose someone visits his/her General Practitioner and is told that a quadruple bypass is needed.  Most likely the patient will select a cardiothoraxic surgeon to perform the surgery, not a General Practitioner. Infertility is somewhat different because the General Practitioner would never attempt heart surgery whereas some Generalists or Ob/GYNs "dabble" in fertility treatment.  

Many years ago, prior to the wide availability of fertility specialty services, some OB/GYNs provided fertility treatment services. These services ranged from surgery, or Clomid, to the administration of FSH and in rare cases, IVF.  Oftentimes, high order (>3) multiple births resulted from IUI cycles monitored by these physicians.

Since fertility specialty services are now available throughout most of the USA, the vast majority of OB/GYNs have ceased to provide fertility services beyond Clomid. Those that still do are usually affiliated with an IVF clinic and serve as satellite treatment centers.

Some patients delay specialty care because of cost concerns. Studies demonstrate that specialty care usually results in lower overall treatment costs. This is because money and time are not wasted on treatments that don’t work, such as more than three cycles of Clomid. IVF is expensive; however, the vast majority of patients seeking specialty care will not require this procedure to achieve pregnancy. Some studies report that greater than 80% of couples who seek specialty care will conceive without IVF.

The first mistake many couples make is to rely on the Yellow Pages for a fertility specialist recommendation. Unfortunately, an MD can include him/herself as an infertility specialist in the Yellow Pages even though they have no advanced training.

Most fertility centers have a Web site and this is a good place to start. First, learn if the fertility specialists are board certified in reproductive endocrinology and infertility. If this is not clearly delineated on the web site, call them for more information.

Other sources include the Society of Assisted Reproductive Technologies (SART) which lists practices and physician qualifications. Also, the Centers for Disease Control in Atlanta currently maintains the success rate statistics for reporting practices. If a site does not report to SART, it is important to learn why.  Unfortunately, the SART data is dated by two years because of reporting requirements.

Careful evaluation of potential practices will greatly increase the likelihood of pregnancy success and help control treatment costs.

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