Breaking Up with Your Gynecologist

Why It’s Time to See a Reproductive Endocrinologist

If you’re like most women in their fertile years, your gynecologist is your go-to doctor.  For many women, the gynecologist is the only doctor they see regularly.  This is the physician who checks your reproductive system, provides birth control, helps you deal with UTIs and STIs, and cares for all parts of your reproductive system.  But if you’re TTC, it may be time to move on to a fertility specialist, a reproductive endocrinologist who focuses only on conception. Reproductive endocrinologists (REs) are fertility specialists who have completed fellowships in both OB/GYN and reproductive endocrinology and fertility.  They have state-of-the-art expertise in fertility treatment and can do the specialized testing necessary to create the optimal plan to help you get pregnant.  Many REs conduct research, participate in clinical trials, and are faculty members in reproductive endocrinology at medical schools, helping to advance the science and practice of assisted reproductive technology. They are the physicians who keep up with all the advances in this fast changing field that OB/GYNs do not have the time nor expertise to incorporate into their practice. But how do you know when it’s time to make a change?

You’ve Been TTC for a While Without Success

Unless they have a known medical issue, most women under 35 will be able to get pregnant within a year of having unprotected sex.  If you’re under 35 and have been trying unsuccessfully for a year, or 35-38 and have been trying for 6 months, or 39+ and have been trying for 3 months, it’s time to visit a reproductive endocrinologist.   Age is not your friend when you’re TTC.  As women get older their eggs age, egg quality diminishes and they become less fertile.  The decline in fertility accelerates significantly around age 38, and many women can’t get pregnant naturally by age 42.  It’s important to get a comprehensive fertility evaluation and find out if there are factors preventing you from conceiving which can be treated, instead of wasting months trying solutions which may not be effective.  REs are familiar with advances in the field and see many hundreds or thousands of patients with infertility problems.  They can give you access to cutting-edge breakthroughs in fertility treatment in a way your gynecologist never can.

You’ve Had Clomid Treatment and Didn’t Get Pregnant

Maybe your OB/GYN has tried Clomid or Clomid and IUI to help you conceive.  Most women who are going to conceive with Clomid will do so within three months (three attempts), and if they don’t conceive within six months, they are very unlikely to succeed.  The American Society for Reproductive Medicine recommends using Clomid for no more than six months. If you’ve tried it for three attempts and it hasn’t worked, don’t waste more time, especially if you are over 35.  There may be reasons why your body is not ovulating regularly even with Clomid stimulation, such as PCOS, polycystic ovarian syndrome. If you are ovulating, you may have diminished ovarian reserve, which means the quality and quantity of your eggs is poor.  Blockages in your fallopian tubes may keep the eggs from traveling to your uterus to be fertilized.  A fertility specialist will do comprehensive testing and evaluation to help determine what’s causing your fertility problems.    Blood tests such as day 3 follicle stimulating hormone (FSH), clomiphene citrate challenge, and anti-Mullerian hormone (AMH) can evaluate your ovarian reserve and help predict how well your body will respond to fertility drugs.  If you have some of these issues, it doesn’t mean you can’t get pregnant.  Your fertility specialist can use other fertility medications in addition to or instead of Clomid to stimulate your ovaries to produce eggs, depending on what your body needs.  IVF can be successful because the egg is fertilized by sperm in the lab, which avoids issues with blockages in the fallopian tubes and problems with sperm swimming to and penetrating the egg (if ICSI is used).  Fertility centers have had success with IVF even when a woman’s ovarian reserve is poor, as long as two or three quality embryos can be produced.

It Takes Two (an Egg and a Sperm Cell)

Remember, infertility is not just a “female problem.”  In up to 40 percent of all infertility cases, male factor infertility is present, either alone or in combination with the female partner’s fertility issues.  This is something your gynecologist cannot help with.  A reproductive endocrinologist will prescribe testing for your male partner as well as yourself.  The basic test is semen analysis, which measures quantity of sperm, their ability to swim (motility), and their shape. Many fertility centers have andrology labs to do testing and evaluation.  An RE may refer the male partner to a urologist who specializes in male infertility for treatment if it’s needed.

History of Miscarriages

If you’ve had two or more miscarriages, you may have recurrent pregnancy loss.  This is a condition where you lose pregnancies before 20 weeks.  A reproductive endocrinologist can dig into the causes, which may include chromosomal abnormalities in the eggs or lifestyle choices like smoking and drinking too much, or a combination of these factors.  An RE can provide genetic testing like preimplantation genetic screening (PGS) as part of an IVF cycle, so the healthiest embryos are transferred, improving your chance of success.