When to See a Fertility Specialist
How to Choose a Good Fertility Doctor
Page author Richard Sherbahn MD
What is the definition of infertility?
In 2008, the American Society of Reproductive Medicine released a revised definition of infertility.
- Infertility is a disease, defined by the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse.
- Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35.
How to choose a fertility specialist for testing and infertility treatment
If you are being treated, or considering seeking infertility treatment, it is appropriate to start with either a good general gynecologist or with an infertility specialist - also referred to as a reproductive endocrinologist.
Some general gynecologists are very good at the initial fertility evaluation and very basic infertility treatment. However, you should know about your doctor's training and experience.
- Many women think they are being treated by a fertility specialist when they are not
- You should know whether your doctor is a fellowship trained fertility specialist
- If you do not know, ask whether he/she did a fellowship in Reproductive Endocrinology and Infertility
- A fellowship is 3 additional years of specialized infertility training after the doctor completes 4 years of Obstetrics and Gynecology residency training
If your physician is a general gynecologist, you should ask at what point he/she will refer you to an infertility specialist. In general, you should be referred to a fertility specialist either immediately - or after up to 6-12 months of treatment with the gynecologist. This will also depend on the female partner's age and the cause of the infertility.
- Some cases should be referred to a specialist immediately
When to see a fertility specialist?
There are several criteria for immediate referral to a fertility specialist doctor, who are also referred to as Reproductive Endocrinology and Infertility specialists:
- Female age of about 38 or older
- Blocked fallopian tubes at any age (1 or both tubes blocked)
- Other tubal problems at any age - such as more than one tubal ectopic pregnancy
- Moderate or severe endometriosis at any age
- Significant male factor - sperm count under 10 million per ml or sperm motility under 40%
- Ovulation problems such as polycystic ovary syndrome, PCOS treated with 3 to 6 months of Clomid without conception at any age
- Abnormal ovarian reserve tests, such as elevated day 3 FSH level at any age
- It does not have to be expensive to be treated by an infertility specialist. The cost depends on the fertility treatment you need.
If you are already seeing a fertility specialist doctor and are considering in vitro fertilization (IVF), ask him or her for:
- IVF pregnancy success rates per egg retrieval and per embryo transfer
- Are they giving you initial pregnancy rates, ongoing pregnancy rates or live birth rates?
- Get IVF success rates in writing. You should ask for their most recent CDC and/or SART IVF success statistics - links to the most recent reports are on our IVF success rates page. Compare IVF clinic success rates with these reports.
- His or her individual success rate over the past year for all IVF procedures performed
- His or her individual success rate for cases with fertility problems similar to yours
Fertility Treatment Cost Issues
Costs for fertility treatments vary considerably. Make sure you know how much the treatment will cost, and how much your insurance will cover. If they say that "IVF costs $12,000", make sure that you know exactly what that means:
- Does it include all physician fees?
- Does it include all costs for ultrasound and blood monitoring?
- Does it include all facility costs?
- Does it include all anesthesia fees?
- Are there any other costs (other than medication) that are not included in the price for an IVF cycle?
- Ask for a copy of their fee schedule for IVF services
If you do not get satisfactory answers to all of these questions, go somewhere else for your fertility treatment.
- Shopping for an IVF program should be very different from shopping for a car. A Jeep is a Jeep - no matter where you buy it.
- However, IVF at a center with low pregnancy success rates is unlikely to result in success. Be an informed consumer - ask these questions and get straight answers.