Choosing The Right Doctor For Infertility

"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. 

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. 

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.

See Also: Infertility Medical Conditions in Men

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.

How Do You Choose A Fertility Clinic?

Once you know you are going to be seeing a reproductive endocrinologist, you and your partner have even tougher questions ahead of you.

Before you go ahead and select a fertility clinic, here are some things you'll want to discuss:

• Are we willing to undergo invasive tests, and ultimately possibly invasive treatment that could include strong medications with unpleasant and sometimes dangerous side effects?
• How far are we willing to go to have a biological child?
• Are there other options, such as adoption, we should look into as well?
• Can we afford fertility treatment? What might the cost ultimately be, and where does the limit lie for us?

Selecting The Right Clinic

Before you can choose the right fertility clinic for you, you'll first have to define what "right" means. There are essentially three factors to consider: success rates, cost, and the quality of care. 

Finding the success rates of individual fertility clinics in the United States is not complicated. While clinics may provide you with this information either on their websites or during a consultation, the federal database kept by the  Centers for Disease Control and Prevention (CDC) is a very valuable tool that enables you to compare the success rates of clinics around the US.

You will easily be able to find information on the overall success rate, defined as a live birth after treatment, for any given procedure — intrauterine insemination, IVF, and intracytoplasmic sperm injection (ICSI) to name examples. Beyond that, you will want to look at how successful a particular clinic is in treating women in your age group. 

Cost is another factor you will want to consider, and that includes insurance options.

To find out if you live in one of them, you can visit the website of RESOLVE, the national fertility association. Your insurance options may affect the clinic you choose. Those who are not covered for infertility treatment and will financing the treatment themselves might also want to look into payment plans offered by fertility clinics. Do be aware that these plans may not come with favorable interest rates, and that a bank loan can be a less expensive choice. 

See Also: Infertility Medical Conditions in Women

Finally, you'll want to get a feel for your clinic and decide whether you feel at ease there. Some of the things you will look for are bound to be matters of individual preference — do you like the doctors and the clinic, and is the clinic anywhere near your home? Some questions that may help you make a better decision include:

• Where did the doctors you will be seeing study?
• How long has the staff — including doctors, technicians and the medical director — been working at the clinic?
• Which procedures are available? How many patients does the clinic have and how many cycles are performed each year?
• What procedures for preventing mistakes such as embryo mix-ups or using the wrong semen sample are in place?
• What is the clinic's view on treating post-menopausal women? Are there age limits? How many embryos are generally transferred during an IVF cycle? What does the clinic think of single-embryo IVF? These questions will give you an insight into how ethical the clinic is.