Difficulty conceiving for more than six months if you’re age 35 or older, or for more than a year if you’re younger Having had two or more miscarriages Starting to try to conceive with known risk factors or symptoms of infertility, such as irregular cycles, genetic conditions, or prior sexually transmitted infections (even if already treated) Interest in permanent birth control options, like tubal ligation or vasectomy People with a cancer diagnosis who need guidance on how to preserve fertility before treatments, or those ready to conceive after treatments
While your primary care physician or gynecologist may be able to begin the process of evaluation, and even prescribe basic treatments like Clomid, you may need to see a fertility specialist for beyond-the-basics testing and treatment.
Doctors Who Specialize in Fertility
There are a variety of doctors who specialize in fertility. The best one for you will depend on your particular medical history and needs.
Reproductive Endocrinologists
Reproductive endocrinologists (sometimes referred to as REs) are what most people think of as fertility specialists. A reproductive endocrinologist is a gynecologist who has additional training in infertility and fertility treatment; they treat both male and female fertility issues. Reproductive endocrinologists manage, carry out, and prescribe a variety of fertility tests and treatments, including IUI and IVF. When outside specialists are needed in a particular case, the reproductive endocrinologist is usually the primary consultant. They can also help cancer patients with fertility preservation, working with an oncologist to coordinate fertility preservation prior to the start of fertility-threatening cancer treatments.
Andrologists
Andrologists are urologists who have completed additional training in male fertility. Andrologists may evaluate and treat male fertility issues alone, or along with a reproductive endocrinologist. They may look further to find the cause for low or absent sperm counts and—if possible—treat the problem, so the couple can conceive without IVF. An andrologist can also perform a testicular biopsy for use in testicular sperm extraction (TESE). They also treat reproductive infections, erectile dysfunction, testicular torsion, and undescended testes.
Reproductive Surgeons
Another kind of fertility specialist is a reproductive surgeon. While reproductive endocrinologists also perform surgery, reproductive surgeons have even more training in surgical procedures and may treat patients for issues beyond trying to have a baby. Their primary training may be in gynecology or urology. For example, reproductive surgeons may remove fibroids or surgically treat endometriosis. A reproductive surgeon may also perform or reverse vasectomies and tubal ligations.
Reproductive Immunologists
Reproductive immunologists combine the knowledge of immunology and reproductive medicine. A reproductive immunologist may be consulted in cases of recurrent miscarriage, unexplained infertility, or unexplained repeated IVF failure. You might also consult a reproductive immunologist if you have endometriosis or an autoimmune disease, like lupus or rheumatoid arthritis. Reproductive immunologists may be physicians or scientists and usually work with a reproductive endocrinologist to treat infertile couples.
Fertility Clinic Staff
Most fertility clinics are directed by a reproductive endocrinologist or a team of reproductive endocrinologists. Some, but not all, have an on-staff andrologist. Reproductive immunologists are less likely to be on staff, but that doesn’t mean the clinic won’t collaborate with one in special cases. (However, some aspects of reproductive immunology are new, and not every fertility specialist is on board with the latest immunology-based treatments.) In addition to fertility doctors, a fertility clinic may also have nurses trained and experienced in reproductive medicine, embryologists, sonographers, and other lab technicians on staff. Some clinics may also have acupuncturists, nutritionists, and counselors. Besides medical specialists, clinics usually have financial advisers who will help you understand payment options and deal with your insurance (if applicable). Some clinics refuse to work with women over 40 unless they agree to use donor eggs from the start, while other clinics specialize in helping women over 40. If you know you’re dealing with male infertility, a clinic with an andrologist on staff would be ideal.
Working With Your OB/GYN
Switching to a fertility specialist can be emotionally (and sometimes practically) overwhelming. Fertility clinics may not take insurance (which means you’d need to apply for out-of-network coverage yourself), or your insurance may not cover fertility services at all. Also, you may not live near a fertility clinic. Depending on your location and the size of your city or town, getting to a fertility specialist may mean taking a day off of work. (Or, sometimes, even require overnight travel.) Given these drawbacks, you might feel tempted to stay with your regular gynecologist for as long as possible. Is that a good idea? It depends. If you are young and basic fertility tests (for both you and your partner) come back normal, staying with your regular OB/GYN for six more months probably is fine. Also, if basic fertility testing shows “mild” fertility challenges, and going to a clinic would be very difficult, staying with your regular doctor for six months more is also probably okay. However, if you are over age 35, or your fertility testing finds a more serious problem (like blocked fallopian tubes, primary ovarian insufficiency, or very low sperm count), then it’s better to switch to a specialist as soon as possible. Delaying treatment could reduce the odds of fertility treatment success.
A Word From Verywell
A fertility clinic is only as good as their doctors. Before you choose a fertility clinic, be sure to meet the staff. Take time to interview your potential doctor. Find out if the doctors are experienced with your fertility problems, and how they plan to work with you. If you decide to pursue testing and treatments, you may be working closely with the clinic for a long time—so you want a staff that not only cares but also knows how to best help you.
