Fertility specialists are typically gynecologists or urologists who've had additional training to deal with issues surrounding the reproductive organs. There are a variety of reasons your doctor may refer you to a fertility specialist, some of which include:
- Difficulty conceiving for more than six months if you're age 35 or older, or for more than a year if you're younger.
- Having had two or more miscarriages.
- Just starting to try to conceive with known risk factors or symptoms of infertility, such as irregular cycles, genetic conditions, or prior sexually transmitted infections (even if already treated).
- Men or women with a cancer diagnosis needing guidance on how to preserve fertility before treatments, or those ready to conceive after treatments.
- Men or women interested in permanent birth control options, like tubal ligation or vasectomy.
While your primary care physician or gynecologist may be able to begin the process of evaluation, and even prescribe basic treatments like Clomid, you may need to see a fertility specialist for beyond-the-basics testing and treatment.
Kinds of Doctors who Specialize in Fertility
Reproductive endocrinologists (sometimes referred to as REs) are what most people think of as fertility specialists. A reproductive endocrinologist is a gynecologist who has additional training in infertility and fertility treatment; they treat both male and female fertility issues.
Reproductive endocrinologists manage, carry out, and prescribe a variety of fertility tests and treatments, including IUI and IVF. When outside specialists are needed in a particular case, the reproductive endocrinologist is usually the primary consultant. They can also help cancer patients with fertility preservation, working with an oncologist to coordinate fertility preservation prior to the start of fertility-threatening cancer treatments.
Andrologists are urologists who have completed additional training in male fertility. Andrologists may evaluate and treat male fertility issues alone, or along with a reproductive endocrinologist. They may look further to find the cause for low or absent sperm counts and—if possible—treat the problem, so the couple can conceive without IVF. An andrologist can also perform testicular biopsy for use in testicular sperm extraction (TESE). She or he also treats reproductive infections, erectile dysfunction, testicular torsion, and undescended testes.
Another kind of fertility specialist is a reproductive surgeon. While reproductive endocrinologists also perform surgery, reproductive surgeons have even further training in surgical procedures, and may treat patients for issues beyond trying to have a baby. For example, reproductive surgeons may remove fibroids or surgically treat endometriosis. A reproductive surgeon may also perform or reverse vasectomies and tubal ligations, and his/her primary training may be in gynecology or urology.
Reproductive immunologists combine the knowledge of immunology and reproductive medicine. A reproductive immunologist may be consulted in cases of recurrent miscarriage, unexplained infertility, or unexplained repeated IVF failure. They may also be consulted if the woman has endometriosis or an autoimmune disease, like lupus or rheumatoid arthritis. Reproductive immunologists may be physicians or scientists, and usually work with a reproductive endocrinologist to treat infertile couples.
Fertility Specialists and Fertility Clinics
Most fertility clinics are directed by a reproductive endocrinologist or a team of reproductive endocrinologists. Some, but not all, clinics have an on-staff andrologist. Reproductive immunologists are even less likely to be on staff, but that doesn't mean they won't collaborate with one in special cases. (However, some aspects of reproductive immunology are new, and not every fertility specialist is on board with the latest immunology-based treatments.)
In addition to fertility doctors, a fertility clinic may also have nurses trained and experienced with reproductive medicine, embryologists, sonographers, and other lab technicians on staff. Some clinics may also have acupuncturists, nutritionists, and counselors. Besides medical specialists, clinics usually have financial advisers who will help you understand payment options and deal with your insurance (if applicable).
Having a huge staff doesn't make a clinic great, just like having a small staff doesn't make a clinic less-than-great. When choosing a fertility clinic, you need to take into consideration your specific fertility needs and situation. For example, some clinics refuse to work with women over 40 unless they agree to use donor eggs from the start, while other clinics specialize in helping women over 40. Another example may be if you're dealing with male infertility, in which case a clinic with an andrologist on staff would be ideal.
Before you choose a fertility clinic, be sure to meet the staff and take time to interview your potential doctor. Find out if the staff is experienced with your fertility problems, and how they plan to work with you. If you decide to pursue testing and treatments, you may be working closely with the clinic staff for a long time—so you want a staff that not only cares, but also knows how to best help you.
More on getting help with infertility:
- Quiz: Do I Have Infertility Symptoms?
- Talking to Your Doctor About Getting Pregnant
- When Should You Seek Help for Getting Pregnant?
- Why Can't I Get Pregnant if I'm Healthy?
- How to Have a Baby When You've Been Trying for a While
- Fertility Treatments
- Causes of Infertility
- Take a Fertility Quiz
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Finding the Right Doc for Male Factor Fertility Issues. PreSeed.com. Accessed November 11, 2012. http://www.preseed.com/news/finding-the-right-doc-for-male-factor-fertility-issues
Pelvic and Reproductive Surgery. Penn Medicine. Accessed November 11, 2012. http://www.pennmedicine.org/fertility/patient/clinical-services/pelvic-reproductive-surgery/
Reproductive immunology. Human Fertilisation & Embryology Authority. Accessed November 11, 2012. http://www.hfea.gov.uk/fertility-treatment-options-reproductive-immunology.html
What does a reproductive endocrinologist really do? Fertility File. Accessed November 11, 2012. http://fertilityfile.com/2008/02/24/what-does-a-reproductive-endcrinologist-really-do/