A general gynecologist often serves as the initial healthcare provider for individuals facing challenges trying to conceive. They can perform foundational evaluations to understand potential fertility issues and determine if further specialized care is necessary.
Initial Fertility Assessments by Your Gynecologist
Your gynecologist can conduct several diagnostic steps to assess fertility. This starts with a thorough review of your medical history, including menstrual cycle regularity, past pregnancies, medical conditions, and current medications. A physical examination is also part of this initial assessment.
To evaluate ovarian function and hormonal balance, your doctor may order blood tests. These often include Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) levels, involved in egg development and ovulation. Thyroid-stimulating hormone (TSH) and prolactin levels are also tested, as imbalances can affect menstrual cycles and ovulation.
Further assessments can involve a pelvic ultrasound to visualize the uterus and ovaries. This helps identify structural issues like fibroids, polyps, or ovarian cysts that could impact fertility. Additionally, a gynecologist can arrange for a semen analysis for the male partner, which is a fundamental test to evaluate sperm count, motility, and morphology. These initial tests provide a foundational understanding before considering more advanced investigations.
When to Discuss Fertility with Your Doctor
Consult your gynecologist about fertility concerns if pregnancy has not occurred after one year of regular, unprotected intercourse for women under 35. If you are 35 or older, this timeframe shortens to six months.
Certain risk factors or symptoms warrant an earlier discussion with your doctor. These include very irregular or absent periods, suggesting ovulation problems. Known reproductive conditions such as Polycystic Ovary Syndrome (PCOS) or endometriosis, or a history of pelvic inflammatory disease, also warrant immediate consultation. If known male factor issues exist, seek prompt medical guidance.
Understanding When a Fertility Specialist is Needed
While a general gynecologist performs initial fertility checks, a Reproductive Endocrinologist and Infertility (REI) specialist possesses advanced training in diagnosing and treating more complex fertility challenges. An REI is a sub-specialty of obstetrics and gynecology, with additional fellowship training focused exclusively on reproductive medicine. They are equipped to handle intricate hormonal imbalances, structural issues, and genetic factors affecting conception.
A referral to an REI specialist is typically made if initial assessments by the gynecologist uncover complex underlying issues. This includes situations where basic treatments have not been successful. REIs perform advanced diagnostic procedures, such as a hysterosalpingography (HSG) to check the patency of fallopian tubes, or diagnostic laparoscopy to identify conditions like endometriosis or adhesions.
They also manage assisted reproductive technologies (ART) like In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI), which involve more intricate procedures to facilitate conception. Specialists additionally address recurrent pregnancy loss and complex male factor infertility, providing comprehensive care tailored to specific needs. Your gynecologist serves as an initial point of contact and can facilitate the referral process to specialized care when appropriate.