Most specialists recommend that couples with no known reproductive health problems put a 12-month time limit on attempting to achieve pregnancy before seeking medical help, if pregnancy doesn't occur. Consultation with a specialist is recommended when first considering pregnancy (or if pregnancy isn't achieved after several cycles) for women age 35 or older, and for women who have menstrual or ovulatory irregularities, known tubal problems, a history of miscarriages or thyroid conditions.
Men with known sperm deficiencies or a history of infections should also consult a specialist.
After being diagnosed as infertile, a couple may want to use these strategies when beginning treatment:
- Consult a specialist early on.
- Educate yourself as much as possible about all aspects of infertility.
- Be assertive and ask questions.
- Know your options for treatment and what is financially and emotionally possible for you as a couple.
Fertility specialists are sub-specialists in the field of obstetrics and gynecology known as reproductive endocrinology. There are only about 600 board-certified reproductive endocrinologists in the U.S., compared to nearly 28,000 obstetrician/gynecologists.
Urologists with a sub-specialty in andrology are specialists who diagnose and treat male infertility.
Some ob/gyns may have gained significant on-the-job experience in treating infertility, combined with specialized coursework to enhance their knowledge. There are many fertility tests and treatments a competent ob/gyn can perform.
Fertility specialists are highly knowledgeable about all aspects of reproduction and treatment options. In addition, their office staff, hours and equipment are available exclusively to support infertility treatment.
Finding physicians who are board-certified in reproductive endocrinology - which means they completed extensive training and passed both oral and written examinations in the subspecialty - is one way to ensure that a health care professional is truly a specialist.
Questions to Ask a Specialist
When looking for a specialist to diagnose infertility, ask these questions:
- What is your training and how long have you been practicing?
- What is your center's clinical pregnancy rate?
- How many embryos does your center routinely put back? Centers that put back more than two or three may have good pregnancy rates, but they will also have high-order multiple pregnancy rates, which can be risky to both mother and babies.
- What are the center's success rates for different types of procedures, but most importantly, those that I may face? Figures should represent live birth rates, not just pregnancies initiated by the center.
- Is the center still working with the same laboratory and specialists as when the statistics were generated?
As with most medical evaluations, the process used to identify potential fertility problems should begin with the easiest, least expensive and least invasive approach possible. A specialist's choice of procedures will depend, in part, on the couples' medical and pregnancy history. An initial evaluation should include:
- medical histories of both partners, including questions about pelvic infections and sexually transmitted diseases (STDs)
- blood tests to evaluate a woman's hormone level
- an ovulation assessment, identifying not only if ovulation is occurring correctly and regularly
- an analysis of sperm and sperm function
- an x-ray assessment of the fallopian tubes and uterus, called a hysterosalpingogram
- Eighty-five percent of fertility problems may be diagnosed after an initial evaluation. In many cases, further testing may involve any of the following:
- a biopsy of the uterine lining to determine if it is responding to hormones released following ovulation
- a post-coital test, which assesses the compatibility of the cervical mucus and sperm
- laparoscopy, which is performed to determine if endometriosis is present. Laparoscopy is considered surgery and general anesthesia is typically used.
- a mucus-penentrance test, which evaluates whether sperm can move through the woman's cervical mucus, to help evaluate sperm function
- Falloposcopy is the visual examination of the inside of the fallopian tube. This procedure involves inserting a tiny flexible catheter through the cervical canal and uterine cavity into the fallopian tube.
Insurance coverage varies for these types of diagnostic procedures. While some plans may cover some tests and specialized treatments, many plans are far from comprehensive. Couples should consult their coverage to determine what specific tests will be covered during the diagnosis and treatment stages.
In addition to understanding the type of infertility problem testing has identified, it's critical that a couple understand the options that are available to them physically, financially and emotionally for attempting to achieve a pregnancy. In most cases, there are options-and usually two or three acceptable choices. While you will receive counseling about various options, ultimately it is your choice as to how to proceed.
Even the most fertile human couple does not necessarily conceive the first time sexual intercourse takes place. In fact, the chance of conception in any given month among fertile couples attempting to conceive is about 20 percent, or one chance in five. To avoid unnecessary testing and treatment, most health care professionals will not make the diagnosis of infertility until one year of unprotected intercourse has failed to result in pregnancy. Some cases, involving older couples or a history of infertility from previous marriages, may be diagnosed sooner and treated more aggressively.