The American Society for Reproductive Medicine defines infertility as the inability to conceive after one year of unprotected intercourse. In women aged 35 and older, this time is often shortened to six months.
Infertility specialists undergo years of advanced training specifically dealing with the cause of, and treatments for, infertility. Fertility specialists must first complete a four year residency in Obstetrics and Gynecology and most attain their board certification in Ob/Gyn.
After completing the Ob/Gyn residency and board certification testing, the fertility specialist must complete a three year fellowship program in Reproductive Endocrinology and Infertility (REI) at a teaching/medical center. During this training, he/she learns the many facets of infertility causes and treatments and must demonstrate proficiency in delicate microsurgical and laparoscopic surgical techniques. The Fellow in REI works under the tutelage of respected leaders in reproductive medicine.
Infertility is a very complex condition with a myriad of causes. Like any sub specialist, fertility specialists focus their clinical work, additional advanced training, and literature reviews on infertility. Just as it is unlikely for a general practitioner to “keep up” with the advances in neurosurgery, it is difficult for a generalist to stay abreast of all the important and exciting advances in reproductive medicine.
The “one year benchmark” for referral is a useful general rule but there are many cases when a fertility specialist should be consulted sooner. For example, if a woman has a “known cause” of her infertility, such as PCOS, she should see a specialist immediately. In many cases, the initial diagnostic tests ordered by the Ob/Gyn will point to conditions that usually are managed by an infertility specialist, such as damaged or blocked fallopian tubes.
Another reason to consult a fertility specialist quickly is the presence of moderate to severe male factor infertility. Advanced reproductive technologies such as IVF with ICSI, may be the “first line” treatment for severe male infertility.
A patient’s failed response to Clomid is a reason to refer to a fertility specialist. Numerous clinical studies demonstrate that Clomid treatment is most likely to succeed in the first three or four ovulatory cycles and treatment beyond six cycles is not recommended. Extensive use of Clomid is generally a waste of time and money. If a woman has not conceived after three to six months of Clomid treatment, she should see a fertility specialist