Infertility Specialist -Overview

An infertility specialist should be consulted early in the course of infertility treatment. The American Society for Reproductive medicine defines infertility as the inability to become pregnant after one year of regular intercourse in women less than thirty-five years of age. Most infertility specialists shorten this time to six months in women aged 35 and older.

Infertility specialists complete residency training in obstetrics and gynecology. After this training, they are required to complete an accredited Fellowship program in reproductive endocrinology and infertility. The Fellowship is usually completed within three years and includes extensive research and clinical experience in infertility.

Infertility specialists are not always consulted initially and the obstetrician/gynecologist may be the first physician to prescribe infertility treatments. In many cases, initial tests such as day three hormone evaluations, will be ordered. When the problem is irregular ovulation, first line medications, such as Clomid , may be tried.

Infertility specialists usually prescribe Clomid for only three to six ovulatory cycles and if unsuccessful move to other treatments. Unlike fertility specialists, some generalists prescribe Clomid for much longer periods. Success rates data clearly demonstrate that pregnancy is most likely to occur during the first three ovulatory cycles and effectiveness declines thereafter. Furthermore, continued use of Clomid can lead to an increase in unwanted medication side effects.

Infertility specialists usually confirm ovulation using methods such as ultrasound, progesterone levels, and others. A semen analysis will always be ordered prior to female treatment to confirm acceptable sperm quality and quantity. We sometimes see couples where the semen analysis was not ordered yet female treatment began.  This is very unfortunate especially when male factor infertility is discovered meaning female treatment alone could not be successful.

Infertility specialists order the fertility tests necessary to rule out the major causes of infertility. Clomid may be a reasonable "first step" to the evaluation and treatment of infertility in younger women. However, there could be other factors contributing to the couple's infertility and simply prescribing Clomid may not lead to pregnancy. For example, women may also have endometriosis, partial obstruction of the fallopian tubes, uterine fibroids , or any number of other conditions. It is unlikely that Clomid, or other medications will be effective until these other coexisting conditions are identified and treated.

An infertility specialist, reproductive endocrinologist (RE) should always be consulted when the female is aged 35 or older or when a condition such as PCOS is suspected. Fertility can decline very rapidly in this age group and there is often no time for a "trial" therapies. A woman is born with all the eggs she will ever have and at puberty begins to ovulate. As women age, so do their eggs resulting in a higher incidence of fertilization failure, miscarriage, and genetic errors. Eventually, older women experience ovarian failure where their eggs have lost their ability to fertilize and develop. The best option for these women is donor egg IVF.

Infertility specialist treatment is usually more cost effective (less expensive) and increases the chances of conception.  This is partly because the diagnostic workup is more thorough and time and money are not wasted on ineffective treatments. Specialists also move couples rapidly through treatment depending upon their specific diagnosis. For example, if the problem is anovulation, the reproductive endocrinologist may prescribe three months of Clomid but will likely quickly advance the patient to treatment with FSH and intrauterine insemination, or another therapy such as IVF.

Infertility specialists treatment does not always involve advanced reproductive technologies, such as IVF. In general, up to 80% of patients will achieve pregnancy without IVF or other ART procedures. IVF is the most cost effective first line treatment in some cases, such as severely damaged fallopian tubes.

The infertility specialists at Huntington Reproductive Center focus on the evaluation and treatment of infertility. Our physicians always recommend the therapy most likely to result in pregnancy while considering other factors, such as cost.