If you’re under 35 and you and your partner have been trying to conceive through regular, unprotected sex for up to a year (six months if you’re over 35, and three months if you’re 40-plus), your ob-gyn will typically recommend you make an appointment with a fertility specialist, known as a reproductive endocrinologist (RE). But don’t stress yet—one in six couples seeks medical intervention to help them conceive. An RE is an ob-gyn who has completed an additional three years of training to learn how to identify infertility factors and suggest and implement methods that will hopefully help you get pregnant.
Your ob-gyn will likely help you start your search for an RE, but you can also ask friends, family or colleagues for a trustworthy recommendation. When considering your options, an RE’s or a fertility center’s in vitro fertilization (IVF) success rates should be taken into account (most clinics in the US report their statistics annually to the Society for Assisted Reproductive Technology, or SART), but they shouldn’t be the only factor in your decision. “Success rates are tough since there are many ways to evaluate success,” says Edward J. Nejat, MD, MBA, FACOG, a New York–based reproductive endocrinologist. “Of course, taking home a baby is the most common definition of success, but often the publicized success rates are just limited to IVF, and there are ways to manipulate statistics.”
What’s not always included in those statistics, Nejat says, is whether the latest assisted reproductive technologies (ART) are available, how aggressive simulation protocols are, how many embryos are transferred on average (many clinics now do single rather than multiple embryo transfer), or how often fertility clinics turn away patients, which unfortunately sometimes happens if a patient has a poor prognosis and a center doesn’t want their its statistics to be negatively affected. Make sure to look beyond the numbers and spend time researching what services each fertility center provides, along with news stories about the centers’ research, practice and methods.
Once you choose an RE and set up an appointment, gather your past medical records—and your partner’s—to bring with you. At the appointment, which will last about an hour, the doctor will try to get a comprehensive medical and social picture of you both individually and as a couple by asking a variety of questions: how long you’ve been trying, if you’ve been using any timing methods to track your ovulation, whether you smoke or consume drugs or alcohol and even what you do for a living. She’ll also want to know about your medical history, including past surgeries, whether you’ve been pregnant before, and if anyone in either of your families has had any known infertility struggles. You may want to bring a list of your own questions to ask about the differences between treatment options, side effects and risks of various fertility drugs and treatments, where testing and procedures will be done (not all fertility clinics offer in-house services), and how often you’ll be expected to visit the clinic.
The intent of this first meeting is to make sure a woman is ready for a healthy pregnancy, Nejat says. The RE’s office will typically draw your blood, perform uterine testing, and suggest a semen analysis for your partner (some smaller facilities don’t have this capability, so they’ll schedule it for him elsewhere). During the evaluation, you can also expect a transvaginal ultrasound, which will help the RE spot any potential irregularities in your uterus and ovaries. And depending on your medical history, the RE may also suggest ovarian reserve testing (ORT), which estimates the quantity and quality of a woman’s eggs. “While female age is still the best predictor of reproductive success, ORT can give a sense of whether or not a couple should start aggressively pursuing fertility treatments,” Nejat says.
Once you get the results from these preliminary tests, you’ll schedule a follow-up appointment to evaluate all your treatment options (including deciding against treatment) and the likelihood of success for each, while continuing to have regular intercourse at home, Nejat says. It’s also important to keep in mind that although these initial appointments are generally covered by insurance, many treatment plans, such as hormone injections, and ART, including intrauterine insemination (IUI), IVF, comprehensive chromosome screening (CCS) and third-party reproductive services (egg, sperm or embryo donation, or surrogacy) that the RE might eventually suggest are not, so find out what your insurance does and doesn’t cover.
The Bump Expert: Edward J. Nejat, MD, MBA, FACOG, a New York–based reproductive endocrinologist; associate medical director, reproductive endocrinology & infertility specialist, at Neway Fertility in New York City