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Once a couple has been trying to conceive for 12 months or more, it may be time to seek help for infertility. Where should you go for diagnosis and treatment?

"Infertility" is defined as not achieving pregnancy after having regular unprotected intercourse for 12 months. That sounds pretty straight forward, but finding out why pregnancy is not occurring is a whole lot harder than applying this catch-all term. Infertility has a great number of different potential causes, after all, and many couples who just aren't seeing that positive pregnancy test have no idea why.  

Infertility can be attributed solely to the female partner in around 40 percent of all cases, to the male partner in approximately 30 percent of cases, and to both partners around 20 percent of the time. That leaves a full 10 percent for whom cause of infertility remains "idiopathic", or unclear. 

Couples themselves may have certain pointers. Women who have irregular menstrual cycles or are obese or underweight might well already believe that these factors are the reason they're not pregnant yet. Those who were already diagnosed with conditions that can lead to infertility — like polycystic ovary syndrome (PCOS), endometriosis, or tubal damage — have even more of a clue. Men, too, might be aware that they had mumps, have undescended testicles, had a sexually transmitted disease that could interfere with fertility, or dealt with a hernia. 

While medical history and physical symptoms may point a couple in the right direction, diagnosis is still a complex process — and diagnosis is the first step towards treatment that will hopefully result in a healthy pregnancy and baby. So, where should you start if you are part of a couple that has been trying to conceive for 12 months or longer (or six months if the female partner is over 35)? Which kind of doctor should you see?

Which Kind Of Doctor Should You Approach About Infertility?

Most women see an obstetrician/gynecologist (OBGYN) for their general gynecological care, including contraceptive needs and preventative checkups. OBGYNs do play a role in the diagnosis and treatment of certain causes of infertility as well. If your problem is anovulation, your OBGYN can prescribe clomiphene citrate — more commonly known as Clomid — to get you ovulating. OBGYNs can also perform intrauterine insemination for couples that aren't dealing with a very low sperm count. 

Urologists are something like the male equivalent of OBGYNs. Besides treating issues relating the kidneys, bladder, and urinary tract they're also there for problems specific to the male reproductive system. A urologist can perform a semen analysis, check for varicoceles or varicose veins in the scrotum, and look into a man's hormone levels. Andrologists may also come into the picture during the diagnostic process. These doctors focus on hormonal conditions in men. 

Once you and your partner have seen an OBGYN and a urologist respectively, it may be time to see an infertility specialist, a reproductive endocrinologist. 

Reproductive endocrinology (RE) is a sub-specialty of obstetrics and gynecology. A reproductive endocrinologist completes four years of medical school, a four-year residency in obstetrics and gynecology, and then a three-year fellowship specifically to become a fertility specialist.

A reproductive endocrinologist deals with the full spectrum of fertility disorders. Their work includes dealing with endometriosis, PCOS, hypothalamic pituitary dysfunction, infertility due to problems with the fallopian tubes, congenital uterine disorders and fertility preservation, but also male factor infertility. These fertility specialists are responsible for offering IVF treatment, and the best thing about them is that they can treat both men and women.

Ultimately, reproductive endocrinologists will offer couples with more complex fertility problems the best chance of achieving pregnancy and having a baby.
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