If you’re been struggling to conceive for several months or know you’ll need treatment to be able to conceive, it’s time to get help from professionals. These doctors and specialists will be your go-to team to help you figure out what’s going on and your next steps. 

Who are the medical professionals I can reach out to?

Depending on your situation and stage of the journey, here are key team members to know, and what their specialties are:

• Andrologists: Physicians who specialize in male reproductive health. These doctors typically work in andrology labs, which offer diagnostic tests to help doctors determine causes of male factor infertility. Because they work in labs, you likely won’t deal with an andrologist directly. 
• Obstetrician/gynecologists (OB/GYNs): The go-to doctors for women’s reproductive health, from yearly check-ups all the way through labor and delivery. They’re a good place to start your fertility journey, and if you need care that extends beyond what their practice covers, they’ll refer you to a fertility clinic.
• Reproductive endocrinology and infertility (REI) doctors: Board-certified doctors who specialize in infertility. They often work in fertility clinics and treat patients directly. 
• Reproductive urologists: Board-certified doctors who train in infertility and specialize in male factor infertility diagnoses.
• Fertility specialists: This is a catchall term that can include reproductive endocrinologists, andrologists, and advanced staff at a fertility clinic.

What’s the difference between an OB/GYN and an REI? 

REIs can run a lot more diagnostic tests from their office, like a semen analysis, HSG, hysteroscopy & more. They have more experience interpreting the results, and overall, it's just more likely that they've seen patients like you. REIs can also treat men and women, whereas OB/GYNs treat women exclusively.

REIs can also offer a full range of fertility treatments, which won't be available to you at your OB/GYN, like IVF treatment. Our take: If you know you’ll need treatment, it's better to see an RE that you like sooner rather than later.

And for those with male factor infertility, it actually may be better to consult a reproductive urologist over an REI. Urologists work directly with men and are experts in diagnosing and addressing male factor fertility concerns. They can work collaboratively with REIs to help come up with a plan for both partners. 

When should I see a doctor?

According to the American Society of Reproductive Medicine’s official guidelines, women under 35 should see a doctor after 12 months of well-timed intercourse without conceiving a child, and women over 35 should see a doctor after 6 months of trying without conceiving.

There are situations when it’s best to see a doctor earlier, including if any of the following apply to you: 

• Family history of infertility or early menopause
• 3 months of irregular periods, or no period at all 
• Past chemotherapy, which can impact the reproductive organs
• More than one miscarriage that you’re aware of (Note: Many people miscarry without even knowing they’re pregnant.)
• Suspected, or diagnosed, endometriosis
• Prior surgery on the uterus or ovaries
• Female history of appendicitis
• For men only: Medical history that includes a groin injury, surgery for a hernia, or exposure to substances like asbestos, pesticide, or formaldehyde

Suggestion: Get an appointment on the books a little early. You can always cancel if you don’t need it.

If you’re flexible about the doctor you see for treatment, you’ll have more options and may be able to be seen quickly, but if you need to see a specific provider for your particular case, you might have to wait — in fact, some doctors don’t have appointments available for new patients for several months. 

If you’re considering treatment, it’s worth making an appointment for several months out if you need to see a specialist with a long waiting list. You can always cancel your appointment if you don’t end up needing it or decide it’s not the right time to go through treatment.

Do I need a referral to work with any of these doctors, or can I just make an appointment directly?

It depends on the doctor and the specialty! You can call and schedule appointments with REIs and OB/GYNs anytime.

You’ll need a referral to see some specialists, like a urologist, because you’ll usually do tests first and be referred to a specialist if your test results come back abnormal.

That said, sometimes a referral can help you get an appointment on the books sooner, even for an REI. It’s always worth asking your primary care doctor or OB/GYN for a referral if you’d like to be seen sooner rather than later. 

What does insurance generally cover?

Irritating answer: It depends. Some plans will cover a surprising amount of diagnostic testing, so it’s worth checking with your insurance about coverage before starting the process or asking your clinic’s finance department.

But there is a plus: You don’t have to figure out your insurance coverage by yourself. Fertility clinics have a dedicated billing department with insurance specialists, and they’re there to help make the most out of your coverage. They’re experts in understanding and navigating the healthcare system, and they’ll be able to tell you what is and isn’t covered in your specific health care plan.

What kinds of tests happen at a consultation? 

A first appointment generally starts with a one-on-one conversation with your doctor about your medical history, goals, and timeline. After you talk, you’ll go back to an exam room for a series of tests and scans.

Your test results help you and your doctor a) understand your fertility; b) assign a diagnosis, if needed; and c) create an action plan. 

“I wish someone had told me that…”

There’s no need to dress up for your consultation and every clinic visit — we recommend wearing a short sleeved top and bottoms that are easy to put on and take off. Here’s why: You can expect to have a transvaginal ultrasound and to have at least one vial of blood taken at every visit. 

There’s usually no need to fast before your appointment, but you can always ask your nurse beforehand to be sure. 

Blood tests 

At your first visit, a nurse will take several vials of blood and run lots of tests. Here’s an overview of the tests that might apply:

AMH (anti-Müllerian hormone)

What it does: Estimates egg quantity

What it tests: Hormone levels of dormant follicles in the ovaries that house eggs

What the results tell your doctor: A high AMH means there are many follicles left on the ovaries, and a low AMH means there are fewer.

FYI: AMH levels typically don’t change a lot during the menstrual cycle, so it can be tested anytime without shifting substantially. That said, if you’re taking hormonal birth control, your AMH level may show up as lower than it actually is. Tell your doctor if you’re on birth control. 

FSH (follicle stimulating hormone)

What it does: Estimates egg quantity

What it tests: A hormone released by the brain that signals ovarian follicles to grow and develop. If an ovary is working properly, it only needs a small amount of FSH to signal a dominant follicle to grow. If that ovary isn’t working properly, it will take more FSH to kickstart a dominant follicle to begin maturing an egg — that means a higher level of FSH is needed (and found) in the bloodstream.

What the results tell your doctor: A high FSH (more than 10) is associated with a lower number of eggs retrieved in an IVF cycle.

Ultrasound tests

Your doctor will perform a transvaginal ultrasound to check the structure of your reproductive system and to see the number of visible egg follicles. They’ll be able to tell when you’ll ovulate next based on this visual, which is kind of a trip. 

AFC (antral follicle count)

What it does: Counts the number of follicles in your ovaries, which can indicate how many eggs might be released for egg collection.

What it tests: How many follicles are mature, which can indicate how many you’ll be able to stimulate with hormonal medication.

What the results tell your doctor: If you decide to move forward with treatment, you’ll have your AFC checked regularly to see how your body is responding to medication. Low AFC can indicate a poor response to fertility medications

Additional tests

Depending on the outcomes of those tests, your doctor might recommend a few other tests: 

HSG (hysterosalpingography): Checks the fallopian tubes’ health and structure, including finding any blockages

Hysteroscopy: Checks the cervix and uterus’ structure, including looking for polyps or fibroids that could impact your ability to conceive

Genetic carrier screening: Checks blood samples from both partners for inheritable genetic conditions that could be passed down to your children

Tests specifically for men

Semen analysis

What it does: Gives a doctor an understanding of a man’s sperm health and can highlight any concerns about sperm’s quality or quantity

What it tests: pH, volume, density, morphology (shape), motility (speed), liquefaction (time it takes to go from sticky to fluid), vitality (percent of live sperm) and white blood cells (to test for any infections or inflammation) 

The process: Masturbate (either at home or at a fertility clinic) to provide a semen sample for a doctor to test

What the results tell your doctor: Whether a male partner’s sperm has any problems that could keep it from fertilizing an egg

Wrapping up

This sounds like a lot, but many people won’t need all of the tests. Most people will start with egg quantity tests, and your doctor will order more tests as needed. 

As you go through your initial testing, reach out to your care team (or if you’re a Gaia Member, your Gaia Advocate!) any time you have a question. We’re all here to help. 

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