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The Path to Parenthood: When to Turn to a Fertility Specialist

Extend Fertility | July 27, 2021

If you’ve been on a path to conception and doing all the “right” things —like tracking ovulation to find your fertile window and ensuring your partner (if you have one) is taking steps to improve their sperm health—you may be wondering: when is it time to get some extra help? Here, we’ll answer your questions about which doctor to see when you’re trying to get pregnant, what a fertility doctor does, and when to see a fertility specialist.

What Is an RE Doctor?

A fertility doctor is called a reproductive endocrinologist (RE). REs have a thorough knowledge of the anatomy and function of the female reproductive system and endocrine (hormone) system, and knowledge of the male systems, as well. This expertise allows REs to diagnose and comprehensively treat infertility, polycystic ovary syndrome (PCOS), or abnormalities of the reproductive system, and perform fertility preservation procedures like egg freezing and embryo freezing. They are the only doctors trained in providing fertility treatments using assisted reproductive technologies (ART).

What’s the Difference Between an OB/GYN & an RE?

The primary difference between an obstetrician/gynecologist (OB/GYN) and a reproductive endocrinologist is the length and type of their education and training. They start at the same point: medical school and a residency in obstetrics and gynecology. After that, to become an RE, a doctor must do three years of additional training—a fellowship in reproductive endocrinology and infertility—to practice fertility medicine. While OB/GYNs take one board exam (for obstetrics and gynecology), REs take two (the OB/GYN board exam, plus another for reproductive endocrinology and infertility). Learn more.

What Doctor to See When You’re Aiming for Pregnancy

If you are trying to get pregnant with no known fertility issues, you should start by seeing your OB/GYN. Establishing care prior to your pregnancy is important, so if you don’t already have an OB/GYN, you should consider setting up a “preconception” visit with a new doctor. This visit can help you prepare for conception and pregnancy by screening for illness or infections that may interfere with getting pregnant, getting you the appropriate vaccines, and ensuring that you have all the resources—like prenatal vitamins—necessary for a healthy baby.

When to See a Fertility Specialist

You should seek care from a fertility specialist if:

  • You’re under 35 and you’ve been trying to conceive for more than 12 months
  • You’re over 35 and you’ve been trying to conceive for more than 6 months
  • You have experienced recurrent pregnancy loss
  • You have a known fertility issue, such as PCOS or endometriosis, or it’s not possible for you to get pregnant naturally
  • You are interested in preserving your fertility with egg or embryo freezing
  • If you are having cycles that are either shorter than 24 days or longer than 35 days or skipping cycles entirely

The recommendation changes from 12 months to 6 months after age 35 because female fertility declines with age, and the decline steepens in the mid-to-late-30s. So, after age 35, time becomes even more valuable.

Remember: these are guidelines, not rules. If you have a known fertility issue, such as PCOS or endometriosis, or you’ve done fertility testing on your own or with your OB/GYN that suggested you may have difficulty conceiving naturally—for example, if you’re not ovulating or your male partner has low sperm count—it may be helpful to see a fertility specialist sooner rather than later.

Why See a Fertility Specialist After Miscarriage

If you’ve had a miscarriage, that doesn’t necessarily mean you have a fertility issue or need the help of a fertility specialist. Pregnancy loss is common; approximately 15–25% of known pregnancies end in miscarriage. The majority of patients who have experienced a miscarriage will go on to have a healthy pregnancy.

However, if you are experiencing recurrent pregnancy loss (defined as two or more consecutive miscarriages), you may want to see a fertility specialist. There are options to help increase your chances of a healthy pregnancy, including IVF with genetic testing, supplemental hormone support, and more.

What You Can Do if You Aren’t Getting Pregnant Naturally

Some patients know from the get-go that they won’t be able to conceive naturally, and should see a fertility specialist right away.

LGBTQ couples are a great example. Same-sex couples will need the assistance of a third party (donor sperm or a surrogate) and may decide to seek care from a fertility specialist in order to increase their chances of conceiving. Learn more about LGBTQ fertility options.

Other examples of patients who can’t get pregnant naturally include those who have had a tubal ligation (“tubes tied”), those who have had their fallopian tubes removed, and those with certain congenital or genetic disorders.

When to See a Fertility Specialist if You’re Not Actively on a Path to Conception

Some patients will see an RE not because they want to get pregnant right away, but because they want to preserve their fertility options for later. Egg freezing or embryo freezing are amazing options for those who are concerned about age-related infertility or those who are about to undergo medical treatment that may impact their fertility, such as cancer treatment or gender affirmation treatment.

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