Fertility doctors, also known as reproductive endocrinologists and infertility specialists (REIs), are medical professionals who help individuals and couples achieve pregnancy. They evaluate, diagnose, and treat conditions affecting reproductive health in both men and women. Their purpose is to identify the underlying causes of infertility and provide specialized medical and surgical interventions to improve conception chances.
Their Specialized Role
Reproductive endocrinologists undergo extensive training beyond general obstetrics and gynecology. After a four-year OB/GYN residency, they complete an additional three-year fellowship in reproductive endocrinology and infertility. This advanced training provides them with in-depth knowledge of the hormonal functioning of the reproductive system and the specialized surgical techniques for fertility treatment.
Unlike a general gynecologist, fertility doctors specialize in diagnosing and treating conditions that directly impact the ability to conceive. Their expertise extends to both male and female reproductive issues, allowing them to create individualized treatment plans. This distinct specialization ensures that patients receive highly focused care for complex fertility challenges.
Uncovering Infertility Causes
The diagnostic process undertaken by fertility doctors involves a comprehensive evaluation for both partners to pinpoint the specific factors contributing to infertility. For women, initial assessments often include a detailed medical history, focusing on menstrual cycle regularity, past pregnancies, miscarriages, and any history of pelvic pain or infections. Blood tests are routinely performed to check hormone levels, such as progesterone to confirm ovulation, and anti-Müllerian hormone (AMH) or follicle-stimulating hormone (FSH) to assess ovarian reserve, which indicates the potential number of eggs remaining.
Imaging studies like transvaginal ultrasounds are used to visualize the uterus and ovaries, identifying structural issues such as fibroids, polyps, ovarian cysts, or endometriosis. A hysterosalpingogram (HSG) or saline sonohysterogram may be performed to check if fallopian tubes are open and to assess the uterine cavity for abnormalities. In some cases, a laparoscopy, a minimally invasive surgical procedure, might be recommended to directly visualize pelvic organs and treat certain conditions.
For men, the diagnostic workup typically begins with a physical examination and a thorough medical and sexual history. A semen analysis is a primary test, evaluating sperm concentration, motility (movement), and morphology (shape), as well as semen volume and the presence of white blood cells. If semen analysis results are abnormal, further tests may include blood tests to check hormone levels like testosterone, FSH, and LH, which regulate sperm production. Imaging tests, such as a scrotal ultrasound, can identify structural issues like varicoceles or blockages, and genetic testing may be considered for very low sperm counts.
Fertility Treatment Modalities
Once the causes of infertility are identified, fertility doctors offer a range of treatment options tailored to the specific diagnosis. Ovulation induction involves using medications to stimulate egg development and release, or to increase the number of eggs matured in a cycle. Oral medications like clomiphene citrate or letrozole, or injectable hormones such as FSH and hCG, encourage follicle growth and trigger ovulation. This treatment is monitored with ultrasounds and blood tests.
Intrauterine insemination (IUI) is a less invasive treatment where prepared sperm are placed directly into the uterus around ovulation. This procedure bypasses the cervix, increasing fertilization chances. IUI can use a partner’s or donor sperm and is often combined with ovulation-inducing medications.
For more complex cases, in vitro fertilization (IVF) is a highly effective assisted reproductive technology. IVF involves stimulating the ovaries to produce multiple eggs, which are then retrieved and fertilized with sperm in a laboratory setting. The resulting embryos are cultured for a few days before one or more are transferred into the woman’s uterus. This process can address various issues, including blocked fallopian tubes, severe male factor infertility, or unexplained infertility.
Pathways to Consultation
Determining when to consult a fertility doctor depends on several factors, including age and duration of trying to conceive. General guidelines suggest seeking an evaluation if a woman under 35 has been trying to get pregnant for 12 months without success. For women aged 35 or older, this timeframe is typically reduced to six months due to the age-related decline in female fertility.
Certain medical conditions or histories also warrant an earlier consultation, regardless of how long conception has been attempted. These include irregular or absent menstrual periods, a history of two or more miscarriages, known conditions like polycystic ovary syndrome (PCOS) or endometriosis, or a male partner with known sperm issues or sexual dysfunction. Individuals with a history of pelvic infections, previous abdominal surgeries, or severe menstrual pain may also benefit from early specialist evaluation. Consulting a fertility specialist can provide personalized guidance and access to advanced diagnostic and treatment options.