When Should You See an Infertility Specialist and What Kind of Infertility Specialist Should You See?

The “diagnosis” of infertility can be devastating to a couple who has been trying for months to become pregnant.  It is extremely important that the appropriate treatment begin as soon as possible, especially if the female is in her mid-late thirties.

	Keith L. Blauer, MD

Obstetrician/gynecologists will often initiate the first treatment steps with products such as Clomid®.  This is sometimes done in the absence of a specific diagnosis or without semen analysis on the husband.  While a specific diagnosis is not always possible, it is important that the husband have a semen analysis prior to any treatment of the wife. It is also clear that Clomid® therapy beyond 6 months is rarely effective.

The female reproductive processes are complex involving several organ systems and intricate hormonal interactions.  There has been an explosion of knowledge over the last ten years and physicians must work constantly to stay abreast of the latest treatment developments.

Any physician with a medical degree can call him/herself a fertility specialist.  Some yellow page ads promote the vast infertility treatment experience of the physician with no mention of qualifications. One of the many questions you should ask of a potential fertility practice is: “Is your physician board certified in reproductive endocrinology and infertility?” You might also inquire where the training occurred and ask for a copy of their IVF success rate statistics.The success rates for top programs in the United States can be reviewed at the Center for Disease Control (CDC) Web site, although the data is dated by two years. All programs in the United States are required by law to submit their data to the CDC. Board Certified Reproductive Endocrinologists/Infertility Specialists are also usually a member of the Society for Assisted Reproductive Technology (SART) and submit their IVF success data for publication on their Web site (which is usually only dated by 1 year).

	James S. Heiner, MD

Reproductive endocrinologists/fertility specialists must first complete an accredited medical school program followed by four years of intense residency training in obstetrics and gynecology.  After successful completion of training in general OB/GYN, they must complete an additional two – three years of training in fertility, and other areas of reproductive endocrinology and reproductive surgery, at an approved Fellowship program. Reproductive endocrinologists are board certified in OB/GYN but very rarely deliver babies after their initial training.

The Fellowship training involves extensive clinical and research work.  Specialists work under the tutelage of fertility experts and learn the many facets of infertility diagnosis and treatment. They also gain experience in managing in vitro fertilization cycles and the use of drugs, such as FSH.  Additionally, they are trained in the latest microsurgical and laparoscopic surgical techniques. Once the fellowship training is completed, a rigorous 3 hour written exam must be passed. Following successful completion of the written exam a case list covering 1-2 years of patient care (including outcomes) must be submitted for professional review and an oral exam must be passed. A “thesis” covering original work in the area of reproductive endocrinology and infertility must have been published in a peer review journal and the results must be explained and defended during the oral exam.

If you went to your general practitioner (GP) or family physician (FP) and were told you had a brain tumor, you would probably seek the care of a neurosurgeon.  Even though the GP/FP is competent and understanding, he/she usually does not have the training needed to effectively and efficiently manage your disease.  The same is true for infertility and in most cases a trained specialist should be consulted.

Interestingly, studies show that total treatment cost is usually less when care is delivered by a trained fertility specialist.  This is because they don’t waste valuable time and money on ineffective treatments such as extended Clomid® therapy. They also use the technology most likely to produce pregnancy while considering personal factors such as cost, age of the woman, length of time the couple has been trying to conceive, etc.  Patients managed by a reproductive endocrinologist/infertility specialist are much more likely to ultimately become pregnant.  In fact, studies demonstrate that more than 90% of those who seek specialist care will become pregnant if they are willing to use the technology and fertility treatment options that are currently available.