If you’ve been trying to conceive without success, it may be a sign of underlying fertility issues. The Centers for Disease Control and Prevention reports that among women ages 15 to 49 who have never given birth, nearly 20% will experience infertility, and 26% will have trouble getting pregnant or carrying a pregnancy to term. But infertility isn’t just a women’s issue—men contribute to infertility, too.
If you’re having trouble getting pregnant, you may be considering fertility treatment. But with so many options available, it can be overwhelming to know where (and when) to start. Whether you’re just beginning your fertility journey or have already explored other avenues, we’re here to help. Keep reading to discover how to find the right specialist to help you achieve your dreams of starting or growing your family.
When to See a Fertility Specialist
If you’re trying to conceive, you may be wondering whether it’s time to see a specialist. Women under 35 who have been actively trying to conceive for one year or more (and women over 35 who’ve been trying for over six months) should seek fertility care, says Mark Sauer, M.D., a dual board-certified OB-GYN and reproductive endocrinologist and chief of obstetrics and gynecology at RWJUH and Rutgers-Robert Wood Johnson Medical School.
For the best outcome, women over age 40 should seek care even sooner, adds Thomas Molinaro, M.D., a board-certified reproductive endocrinologist at Reproductive Medicine Associates of New Jersey and clinical assistant professor of obstetrics, gynecology, and reproductive science at Rutgers-Robert Wood Johnson Medical School.
“Women who have irregular menstrual cycles, prior pelvic surgery, recurrent pregnancy losses, and those with a history of endometriosis should see a fertility specialist,” says William Ziegler, D.O., a board-certified specialist in reproductive endocrinology and infertility and medical director of the Reproductive Science Center of New Jersey. He adds that male partners should have an evaluation if they have sexual dysfunction, a history of testicular trauma, or anabolic steroid use.
How to Choose a Fertility Specialist
“If you had a serious heart problem, you’d probably want to see a cardiologist. And if you had a serious kidney problem, you’d go to a nephrologist,” says Dr. Sauer. He says the same goes for individuals with fertility issues—they should see a reproductive endocrinologist.
While all OB/GYNs can conduct a basic infertility workup, look for one certified in reproductive endocrinology and infertility (REI), as advised by Dr. Ziegler. “Their training focuses on the hormones and the mechanisms that regulate sexual development, sexual function, and reproduction,” he says. To achieve this designation, he explains that an individual must first complete four years of an OB/GYN residency followed by a three-year REI fellowship.
Dr. Molinaro recommends checking a fertility center’s website for services offered, location, provider information, and patient reviews. He says its success rates, which must be reported to the Centers for Disease Control and Prevention according to federal law, are available on the Society for Assisted Reproductive Technology’s website, SART.org.
Cost is another important consideration, says Dr. Molinaro. He urges checking your coverage with your insurance company and picking a center that participates with your plan. Recent legislation requires private health insurance companies in New Jersey with over 50 employees to provide coverage for any services related to infertility, including in vitro fertilization (IVF), intrauterine insemination (IUI), genetic testing, and embryo transfers. “Taking advantage of these funding opportunities can dramatically reduce the cost,” says Dr. Sauer.
Common Fertility Treatment Options
First, your provider will review your fertility, medical, and reproductive history and order a standard battery of tests, says Dr. Sauer. These may include pelvic ultrasounds and blood tests timed with a woman’s menstrual cycle to measure hormone levels. In men, semen analysis is critically important, he adds. “Often, people assume that infertility is a female problem, but actually, it’s almost as common for there to be issues with sperm,” Dr. Sauer says.
“On completion of an infertility evaluation, a treatment plan is discussed with the patient or couple,” says Dr. Ziegler. He says a reproductive endocrinologist may recommend the following treatment options:
- Intrauterine insemination (IUI): In this procedure, fresh or cryopreserved (frozen) sperm is placed in the uterus with a catheter to increase the chances of fertilization. Dr. Ziegler says that fertility medications are often used with IUI to improve ovulation.
- In vitro fertilization (IVF): IVF may be used if there is failure to conceive with IUI, endometriosis, male factor infertility, and unexplained infertility, says Dr. Ziegler. Fertility medications are used to stimulate egg production in the ovaries, hormones are injected to help the eggs mature, and the eggs are harvested under light sedation, he explains.
- Donor eggs or sperm: “Women who cannot use their own oocytes (eggs) due to primary ovarian insufficiency (POI) or age-related decline in oocyte number may use donor oocyte IVF,” he says. Similarly, if there is an issue with sperm quality, donor sperm may be used.
Lifestyle Factors to Consider
When it comes to fertility, important factors to address with your healthcare provider include body weight, activity level, and diet, says Dr. Ziegler. And while alternative treatments like yoga and acupuncture may have fertility-boosting benefits, they should be used as adjuvant therapy rather than a standalone treatment.
Mental health is also essential, Dr. Molinaro emphasizes. “The infertility journey is such an emotional roller coaster. It’s not only physically demanding, but it’s also emotionally and psychologically demanding,” he says, adding that fertility clinics typically offer psychological services to help with the challenging aspects of treatment.
Dr. Molinaro reminds those considering fertility treatment that it’s a marathon, not a sprint–-patience is essential. At the same time, he recognizes the emotional toll of enduring multiple treatment cycles without the desired outcome. Having the right support system in place can help you manage stress and navigate any grief you may encounter on your fertility journey, Dr. Molinaro says.
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