fertility news

A recent survey conducted by the American Fertility Association on reproductive lifestyle and basic infertility given to more than 12,000 women demonstrated a significant lack of fertility awareness since only one respondent answered all 15 questions in the survey correctly. Most women rely on their OB-GYNs to give them this kind of basic information and the authors suggest that OB-GYNs should include frank and open discussions about fertility and fertility preservation as well as contraception with all women of childbearing age. For example, a young college graduate focused on her career might make healthier life style choices if she knew the long term implications of smoking and alcohol on her future fertility. Unfortunately, these kinds of discussions may not be routine.

Likewise the woman experiencing infertility might be in denial about the problem or relying on her physician to initiate a discussion on reproductive options and this might result in the loss of precious time before treatment is started. The biggest regret most fertility patients report is not starting treatment sooner either because they just weren’t aware of the time limitations on their fertility or because their physician did not tell them.

The first step in the process is to inform your OB-GYN that you are trying to have a baby. Fertility evaluations by any physician should start with a thorough medical history of the couple and a physical exam for both partners. Basic tests your OB-GYN might order would also include a semen analysis, hormone screening and an evaluation of the uterine cavity and fallopian tubes. Some OB-GYNs will prescribe ovulation inducing drugs and perform artificial inseminations. Before starting any treatment with your OB-GYN you should discuss how much experience the physician has treating infertility, what your treatment options are and how many cycles are recommended before moving on to alternative therapies.

If you do not conceive within the established time frame it is probably time to see a board certified reproductive endocrinologist (RE). A board certified RE is an OB-GYN with additional training. They complete a 2 or 3 year fellowship specializing in infertility, have to pass a written exam, must be in practice two years with a review of all the patients they have seen, passed an oral exam and written a thesis. Some patients are uncomfortable discussing the transition of care with their OB, a physician who they may have seen for many years. Your OB is a professional and should be prepared to recommend an RE if you have been unsuccessful with the treatment plan he/she has tried. Furthermore, one study suggests that “the sooner an OB-GYN refers a patient to an infertility specialist the sooner she comes back pregnant and happy.”

For all patients, but especially the infertility patient, you must proactively manage your care since there are time limits that significantly impact your treatment options. The American College of Obstetricians and Gynecologists (ACOG) recommends that a couple discuss fertility options with their physician after trying to conceive for 12 months and if the woman is 35 and older, after 6 months of trying. The American Society for Reproductive Medicine (ASRM) has more specific guidelines. They recommend patients see a reproductive endocrinologist (RE) if they have not conceived within 6 to 12 months of treatment with their OB-GYN. If the patient or her partner has a known serious problem such as diminished ovarian reserve, advanced age, pelvic adhesions, severe endometriosis, previous pelvic surgeries, male factor or other problems, they should go to an RE immediately or within six months.

In a Resolve interview given by David Adamson MD from by Advanced Reproductive Care, Inc. (ARC) there are risks if you wait too long to transition your care from your OB to an RE. These include: an inaccurate diagnosis; incomplete testing; wasting precious time as you get older; wasting resources on ineffective treatments; and finally the psychological stress and depression that ensue because you are not pregnant. Moreover, Dr. Adamson states there are some red flags that indicate the quality of care could be better. He suggests, “a patient should always know what the problem is (diagnosis--even if this is unexplained infertility, since this is not uncommon), understand their treatment plan, what they are doing, why and for how long, what the chances are for pregnancy with this treatment, what it costs, what the next step is, and what the overall management strategy is all the way to the exit strategy (e.g. donor egg, adoption, child-free living). The patient should be able to get questions answered directly and have good support in the doctor's office. If these conditions are not being met then it might be time to look for another physician.”

In summary, your OB-GYN is a good place to start your initial infertility evaluation. If you are not successful in a reasonable amount of time given your age and diagnosis or if you are unhappy with the care you are receiving, it is always a wise decision to see a physician who specializes in infertility sooner rather than later.

Good Luck!

References:
ACOG. Patient information pamphlet Planning Your Pregnancy.
Available at: http://www.acog.org/publications/patient_education/ab012.cfm

Adamson D. When to switch from OB/GYN to RE. Available at: http://www.resolve.org/site/PageServer?pagename=cop_ch_20050413

Birrittieri C. What every woman should know about her biological clock. Available at:
http://www.resolve.org/site/PageServer?pagename=cop_ch_20050713

Copperman K. Patients' return to referring physicians for obstetrical care is related to the duration of their infertility. Fertility Sterility 2004; 82: (Supplement 2), Pages S101-S102).

Madsen P. Just the facts ma’am: coming clean about fertility. Sexuality, Reproduction & Menopause 2003; 1: 27-29.