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.
Keeping records of your basal body temperature and the results of ovulation predictor kits can also be beneficial in evaluating your fertility, Dr. Richard-Davis says. Take them with you to the appointment.
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?)
During the first visit, women can typically expect to answer a health and family history questionnaire, discuss their monthly cycle, and have a physical exam, possibly with a pelvic ultrasound.
"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."
Most couples can expect lots of tests during the process. Let's go over the tests the fertility specialist will probably recommend...
Similar to a pap smear that takes place shortly after intercourse, this test can determine if the sperm can penetrate and survive in the cervical mucus. It's best to do this just before ovulation or you may get a false result.
A quick in-office procedure where the doctor takes a small sample of the lining of the uterus to assess the quality of the woman's uterine lining and also determine whether she is ovulating.
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.
Including follicle stimulating hormone (FSH), prolactin,
progesterone, testosterone, luteinizing hormone, and estradiol tests, these help rule out infertility causes such as polycystic ovarian disease (PCOS), premature ovarian failure, and thyroid problems.
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.