An Obstetrician-Gynecologist (OBGYN) can assist with fertility issues. As the primary healthcare provider for women’s reproductive health, the OBGYN is the first point of contact when conception difficulties arise. They are trained to evaluate the initial causes of challenges and coordinate the first steps of investigation and basic treatment. The OBGYN initiates a preliminary fertility evaluation, ruling out common causes of infertility and establishing a clear diagnostic path before considering specialized care.
The Initial Fertility Assessment
The first consultation involves a detailed intake of medical and reproductive history for both partners. The physician establishes how long the couple has been engaging in regular, unprotected intercourse to determine if the situation meets the medical definition of infertility. Questions focus on the regularity of the woman’s menstrual cycle, including length and flow, and any history of previous pregnancies or miscarriages. The review also addresses lifestyle factors, such as diet, exercise, tobacco and alcohol consumption, and current medications or supplements.
A physical examination is performed to check for signs of underlying conditions that could affect fertility. This includes a pelvic exam to check for structural abnormalities in the uterus or ovaries, and a general health check for signs of hormonal imbalance, such as excessive hair growth or thyroid issues. The initial assessment aims to create a complete picture of the patient’s reproductive landscape, identifying obvious issues like a history of pelvic inflammatory disease, uterine fibroids, or endometriosis.
Diagnostic Testing Performed by an OBGYN
Following the initial assessment, an OBGYN orders and interprets a range of specific diagnostic tests to investigate potential causes of infertility. Hormonal blood work is standard, often including tests for Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), Prolactin, and Thyroid-Stimulating Hormone (TSH) to assess ovarian function and endocrine health. Progesterone levels are measured in the second half of the cycle to confirm that ovulation is occurring normally.
Imaging studies, such as a transvaginal ultrasound, are also routinely performed to visualize the uterus and ovaries. This ultrasound detects structural issues like ovarian cysts, uterine fibroids, or endometrial polyps that might interfere with conception. The ultrasound can also estimate ovarian reserve by counting the number of small follicles present, known as the Antral Follicle Count. For the male partner, the OBGYN typically refers for a semen analysis to assess sperm count, motility, and morphology.
Non-Specialist Treatment Options
If initial testing reveals a manageable issue, an OBGYN provides several non-specialist interventions. Lifestyle modifications are often the first step, including guidance on achieving a healthy body weight, improving diet, and eliminating habits like smoking, which impair fertility. The physician also offers precise guidance on timing intercourse based on the woman’s cycle and ovulation tracking methods.
When the issue is identified as an ovulatory dysfunction, the OBGYN prescribes oral medications for ovulation induction. Clomiphene Citrate (Clomid) and Letrozole are the most common first-line treatments, working by stimulating hormones that encourage the ovaries to release eggs. These treatments are monitored by the OBGYN to ensure proper ovarian response and minimize the risk of multiple pregnancies.
When to Transition to a Fertility Specialist
The transition from an OBGYN to a Reproductive Endocrinologist (RE) is determined by specific medical and time-based criteria. For women under 35, the standard recommendation is a referral after one year of unsuccessful, regular, unprotected intercourse. This timeline is shortened for women 35 years or older, who should be referred after only six months of trying, due to the natural decline in egg quality and quantity with age.
A referral is also warranted immediately if the initial workup reveals complex diagnoses outside the scope of general OBGYN practice. These include severe male factor infertility, tubal blockages confirmed by testing like a hysterosalpingogram, or a history of multiple recurrent miscarriages. Since advanced treatments like Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF) are performed by REs, patients who have failed several cycles of oral ovulation induction with their OBGYN transition to the specialist for the next level of care.