Infertility specialists undergo years of advanced training specifically dealing with the causes of, and treatments for, infertility. Our Charlottesville, VA fertility specialists, Dr. Williams and Dr. Bateman, are both Board Certified in Reproductive Endocrinology and Infertility.
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.
Fertility specialists must first complete a four year residency in obstetrics and gynecology and most attain their board certified 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's 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. Our fertility specialists are recognized experts in performing the tubal reversal procedure.
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 polycystic ovarian syndrome 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 a 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.
One of the initial fertility treatments may be intrauterine insemination with FSH drug stimulation. Stimulated IUI cycles must be administered and monitored by a fertility specialist. In fact, the physician information sheet for these products specifically states that they should only be administered by a fertility specialist (reproductive endocrinologist).
Women aged 35 and over should see a specialist much sooner than younger women. This is because fertility can decline precipitously and there may not be time for “first level” treatments.
Two other findings have been stated in many peer reviewed medical journal articles. First, treatment by a fertility specialist has been shown to be more likely to produce a healthy pregnancy in a shorter period of time and second, is usually less expensive.
Expense is controlled because oftentimes “treatment dollars” are not wasted on therapies that will not work, such as repeated Clomid or Letrozole cycles. It is a common misconception that women who see a specialist will become IVF patients. Actually, the percentage who will eventually require IVF is less than 20% dependent upon the practice profile (patient age, tertiary referral center, etc.). The vast majority of women become pregnant using less expensive treatment techniques.
Another important aspect of seeing a fertility specialist is that a dedicated program is open for treatment 7 days a week. If your doctor is only available 5 of 7 days a week, there is no way to offer appropriate care. For instance, if you are doing IUI then more than 20% of the time you will miss the opportunity to conceive.
The choice to see a fertility specialist should be based upon who is the best trained and therefore the most likely to help couples realize their dreams of children. If your internist told you that you needed brain surgery you would probably consult a neurosurgeon, not a general practitioner who has an interest in the subject. The choice a see a fertility specialist is no different.
Our fertility specialists are conveniently located in Charlottesville, VA.
