OB-GYN or reproductive endocrinologist (RI)? "As long as your regular OB is moving along at a pace you're happy with and doing the appropriate tests, you can stay with her initially," says Dr. Carolyn Maud Doherty, a RI and co-author of The Fertility Handbook.
"The difference in seeing an OB-GYN is that they usually do a very broad-stroke approach, but they aren't skilled in the nuances of infertility," says Dr. Gloria Richard-Davis, a RI in New Orleans. "...OB patients take priority while fertility takes a back seat."
Make sure previous fertility tests and other tests are sent to the specialist. Try to take them ahead of time so your doc can review the results before your first visit. Have other medical problems? Grab those records too.
It's also a good idea to talk to relatives about a family history of infertility, Dr. Doherty explains. (Did your mother or mother-in-law have miscarriages? Did your mother or sisters have a history of fibroids or endometriosis? Does your brother-in-law have a history of infertility?)
"That first visit is primarily an information-gathering session," Dr. Richard-Davis says. "Still, by the end of the visit, we come up with some kind of management plan—whether it's setting up tests or, if we know the reason for infertility, a plan for treatment."
To help rule out hormonal problems, fibroid tumors, ovarian cysts, and, in some cases, endometriosis, this should be performed on the day of the LH surge. A second ultrasound a few days later can confirm that an egg was actually released, ruling out LUF syndrome.
Depending on the diagnosis, either surgery or oral drugs are the first attempts to help the couple achieve pregnancy. If that doesn't work, more powerful, injectable fertility drugs are sometimes tried, followed by artificial insemination and finally IVF.
Dr. Richard-Davis says about 30 to 40 percent of the time infertility is caused by ovulation issues; 40 percent of the time it's due to sperm factors; 10 to 15 percent of cases it's is caused by tubal abnormalities; and 10 percent of the time there is no explanation.