The obstetrician/gynecologist (OB/GYN) serves as a primary provider for women’s reproductive health, offering guidance throughout the journey of trying to conceive. While they are not fertility specialists, they are the initial and most accessible resource for individuals and couples beginning their family-building efforts. An OB/GYN can initiate health optimization, provide basic fertility evaluations, and offer certain entry-level treatments. Fertility concerns are common, affecting an estimated 10 to 15 percent of couples in the United States, and the OB/GYN is the starting point for addressing these concerns.
Preconception Health and Optimization
Maximizing the chances of natural conception involves a comprehensive preconception health assessment performed by an OB/GYN. This consultation is a proactive measure that should ideally occur before a patient begins actively trying to become pregnant. During this visit, the physician reviews the patient’s and partner’s complete medical and family histories to identify any hereditary or chronic conditions that might affect pregnancy outcomes.
The evaluation includes discussion of lifestyle factors, which are often modifiable to improve reproductive health. This involves counseling on achieving a healthy body mass index (BMI) through diet and exercise, as being significantly overweight or underweight can interfere with ovulation. Patients are advised to cease smoking and limit alcohol and caffeine intake, as these substances can negatively impact conception.
A focus is placed on ensuring the patient’s nutritional status and immunity are optimized. Physicians recommend starting daily supplementation with at least 400 micrograms of folic acid before conception to reduce the risk of neural tube defects. The OB/GYN also confirms up-to-date immunizations, such as the rubella and varicella vaccines, to protect against infections that could harm a pregnancy.
Initial Fertility Evaluation and Basic Management
When conception does not occur naturally after a certain period, the OB/GYN transitions to an initial fertility investigation. For women under 35, this workup typically begins after 12 months of regular, unprotected intercourse, and after six months for women 35 and older. The evaluation is designed to identify the most common causes of difficulty in conceiving, which can be traced to female factors, male factors, or a combination of both.
For the female patient, the evaluation primarily focuses on confirming regular ovulation and assessing ovarian reserve. Blood tests are ordered to measure hormone levels at specific points in the menstrual cycle, such as progesterone levels around day 21 to confirm ovulation. Other hormonal panels may include tests for thyroid-stimulating hormone (TSH) and prolactin, as imbalances in these hormones can disrupt the ovulatory cycle. The OB/GYN may also check levels of Follicle-Stimulating Hormone (FSH) and Anti-Müllerian Hormone (AMH) to gain insight into the ovarian reserve.
Assessing the male partner through a semen analysis is a critical step, which the OB/GYN requests to be performed at a specialized laboratory. This test evaluates the concentration, motility, and morphology of sperm, as male factors contribute to approximately one-third of all infertility cases. Imaging studies may also be ordered, such as the hysterosalpingogram (HSG), which uses an X-ray with dye to check if the fallopian tubes are open and if the uterine cavity is normally shaped.
If an ovulatory issue is the primary problem, an OB/GYN can often initiate basic medical management. This typically involves prescribing oral medications like clomiphene citrate or letrozole to stimulate the ovaries to produce and release eggs. This entry-level treatment is monitored using blood tests or ultrasound to confirm a proper response, helping to time intercourse effectively and increase the probability of conception.
Defining the Limits of Care and Specialist Referral
While an OB/GYN can manage the initial fertility workup and simple ovulatory issues, their scope of practice has distinct boundaries. They generally do not perform advanced reproductive technologies (ART), which are the domain of a Reproductive Endocrinologist and Infertility Specialist (REI). Advanced treatments like In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), or complex surgical procedures are not typically offered by a general OB/GYN.
The transition from the generalist to the specialist occurs when the complexity of the case exceeds the scope of basic care. An immediate referral to an REI is warranted for patients with known conditions that severely compromise fertility, such as blocked fallopian tubes, severe male factor infertility, or a history of recurrent pregnancy loss. Patients over 35 should also be referred if they have not conceived after six months of trying, as time is a limiting factor.
An OB/GYN will also refer patients who have failed to conceive after a few cycles (typically three to six) of basic oral ovulation induction treatments. This failure suggests an underlying issue that requires the specialized diagnostic tools and expertise of an REI. The REI has completed additional fellowship training and can offer more intensive treatments, including injectable hormones and ART procedures.