Which Type of Fertility Doctor Should We See?

Fertility Doctor

OB/GYN? Reproductive endocrinologist? Urologist? Ask your friends and family, and you’re going to get a whole lot of names thrown at you.

They all mean well. But just because Dr. Jones and Dr. Smith helped your best friend from high school doesn’t mean they’re the one for you.

So let’s break this one down, shall we? Take a look at the doctors who tend to have a hand in fertility treatment, and the roles they play in the process.

Can’t I just see my OB/GYN?

You probably know one of these docs already. Do you really need to find another? Maybe. Then again, maybe not.

OB/GYN is short for obstetrician and gynecologist. These are the medical doctors who tend to start seeing girls in their teens and follow us through adulthood, pulling out their speculums and palpating our breasts every year or two (depending on how well you keep up with your “annual” exam). So what can they do for you now?

How they’re trained

OB/GYNs graduate from medical school and complete an OB/GYN-specific residency, which prepares them to treat yeast infections, spot breast cancer, deliver babies, and plenty more. Along the way, most OB/GYNS are trained to do a basic and advanced infertility work up and some treatment, says Alyssa Dweck, M.D., an assistant clinical professor at the Mount Sinai School of Medicine in New York.

What they treat

Most general OB/GYNs can diagnose and treat conditions that are related to fertility concerns in heterosexual couples—from polycystic ovarian syndrome to inhospitable mucus in the cervix. Generalists can also provide Clomid and similar ovulation stimulating drugs, which might even be all you need for pregnancy to happen.

When drugs alone are not enough or if a woman is looking to conceive as a single mom or with a same sex partner, some OB/GYNs also provide intrauterine insemination (IUI) services as well, although not all. If IVF is in the cards, they may be able to help run tests that diagnose complication conditions (such as polyps), but OB/GYNs don’t provide IVF services.

When to see them

If you’re a straight woman who’s been timing your cycle, having regular sex, and can’t figure out what’s going on, a stop at the OB/GYN is in order to start the fertility treatment process. It’s also an optimal first stop if you’re planning to pursue IUI and know your OB/GYN offers the service.

If IVF ends up being your main treatment option, don’t worry. You’ll likely see your OB/GYN again, says Dr. Jaime Knopman, M.D., a reproductive endocrinologist with Colorado Center for Reproductive Medicine (CCRM) in NY. That will likely happen around the 9-week point of your pregnancy, when your fertility clinic discharges you to obstetrical care. After all, someone’s got to provide prenatal care and deliver that baby!

So, what about a urologist?

If you’ve got a male partner, they’re going to need to make calls and find one of these doctors.

How they’re trained

Urologists are board certified medical practitioners just like the OB/GYN, but their medical school focus is typically on the male and female urinary-tract system and the male reproductive organs. Some urologists go on for an extra year to two years of training in a special fellowship becoming reproductive urologists, the type that specializes in stepping in when a couple is encountering male factor fertility issues.

What they treat

These docs diagnose and treat the most common causes of male factor fertility issues, including low testosterone levels, sperm motility and health issues, testicular varicose veins, and sexually transmitted infections, says Marc Goldstein, M.D., director of the Center for Male Reproductive Medicine and Surgery at Weill Cornell Medicine/New York Presbyterian Hospital. A reproductive endocrinologist can also identify if a man is suffering from a congenital bilateral absence of vas, a condition that blocks sperm from exiting the urethra. “This was once considered the worst diagnosis for a man in terms of fertility,” Goldstein says. These days it’s easily treatable with a surgical procedure that enables sperm collection for IVF.

When to see them

If a couple is engaging in heterosexual sex but can’t get pregnant, Goldstein says the male partner should call a reproductive urologist right away. Male factor fertility issues are responsible for approximately half of all fertility issues in heterosexual couples, and testing is typically less invasive than that required to diagnose female fertility concerns. “For the woman, the ovaries are on the inside, but on the male, everything is hanging in the breeze!” Goldstein points out.

The female partner should still get a work-up from her OB/GYN—after all, both partners can have contributing factors in a third of couples—but testing for a man should be done simultaneously, not as an afterthought, Goldstein says.

What the heck is a reproductive endocrinologist?

Depending on how things shake out with the OB/GYN (and possibly the urologist), you may have to make friends with a new doctor too. But don’t get nervous! Reproductive endocrinologists do nothing all day but help people get pregnant. That’s what they’re here for.

How they’re trained

Technically a reproductive endocrinologist is an OB/GYN. But these doctors do double duty, says Paul Lin, M.D., a reproductive endocrinologist with Seattle Reproductive Medicine and president-elect of the Society for Reproductive Technologies (SART). Every reproductive endocrinologist has to have double board certification—once as an OB/GYN and once as a reproductive endocrinologist. So they know all about obstetrics and gynecology, but they also have in-depth training in not only diagnosis but treatment of fertility, from stimulating ovulation with medication all the way through to the needs of a gestational surrogate.

What they treat

There isn’t much in the fertility world that reproductive endocrinologists can’t treat, although there are some male factor infertility issues that may be sent to a urologist, Lin says. The IVF process is largely managed by a reproductive endocrinologist, although they get some major behind the scenes help from an embryologist. Also doctors, embryologists work largely in labs, where they help sperm and eggs cells become the teeny tiny embryos that a reproductive endocrinologist transfers into the uterus.

When to see them

This is typically a woman’s next step after an initial visit with your OB/GYN. If you know from the get-go that you are going to need IVF, however, this should be your first start. If you’re LGBT and/or already planning to use some sort of third party reproduction, such as a gestational surrogate or an egg donor, you might want to skip the OB/GYN straight ahead to a fertility clinic. After all, they’ve got the OB/GYN training under their belts too, and they cover the whole range of services for fertility.

Summing it all up

Fertility issues are different from person to person, but fortunately there’s a wide range of fertility specialists ready to help you.

Jeanne Sager

Jeanne Sager is a writer and photographer from upstate New York. She's strung words together for The New York Times, The Atlantic, The Washington Post, and more.

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