Do I Need to See a Doctor? What will happen if I do?

Are you wondering whether it might be time to talk to a doctor about your fertility?  Do you know who to talk to?  These are questions I get asked a lot.  The answers vary depending on your situation.  If you have been trying to conceive for more than a year without any success, it's time to see a doctor.  If you have been having unprotected intercourse for a year without a conception, even if you haven't been actively tracking menstrual cycles and ovulation dates, it's time to see a doctor.  If you are 35 or older and you have been trying to conceive for 6 months or more, it is also time to see a doctor.  This is because a woman's fertility declines as she gets older.  A woman over 35 does not have as much time left to conceive, therefore she needs to be seen sooner.  You should also see a doctor if your cycles are not regular, even if you haven't started trying yet.  A normal menstrual cycle (from the start of one period to the start of the next period) is usually 26-35 days.  It's OK for the length of your menstrual cycle to vary by a few days each month.  If your cycle lengths vary more than a few days, or you skip cycles altogether, you need to speak to a doctor.  You should also see a physician if your cycles are less than 26 days or more than 35 days in length.  Of course there are other reasons you may want to talk to your doctor too.  Severe pain with your periods, a known fertility problem like a fallopian tube that has been removed for an ectopic pregnancy, or a husband who had trouble conceiving with a previous partner are all good reasons to talk to a physician.

The next question, of course, is what type of physician should you see?  Here you have several options.  A General Practitioner or Family Practice doctor will have a little bit of training in infertility.  He or she may be able to answer your questions and do some preliminary testing.  Some even feel comfortable prescribing mild fertility medications like Clomid.  An OB/GYN will have had a little more training.  They should be able to do testing to help you figure out why you are not getting pregnant.  Depending on the results, they may be able to treat you or they may need to refer you to a specialist.  A Reproductive Endocrinologist is an OB/GYN that has done an extra 2 or 3 years of training in infertility after his or her OB/GYN training.  They can do the testing and all of the treatment too.  So, who you see depends on what you want.  If you want to keep it low key and you have a good relationship with a GP or OB/GYN, than that's a good place to start.  If you want one-stop shopping, where you are not going to get shuttled to another doctor, start with an Reproductive Endocrinologist.

Whomever you see, they are likely to start with some questions about your general health, menstrual cycles, family history and your husbands health too.  It is helpful if he can come along to the first meeting with the doctor.  He can provide information about his health and family history that you may not know.  It also great to have 2 sets of ears listening to what the doctor says!  Next the doctor will probably want to do some tests.  Usually, he or she will order some blood tests to look for hormonal problems like an underactive or overactive thyroid, high prolactin levels (the hormone that is involved in breast-feeding), to make sure that you are ovulating, and to see about the quantity and quality of your eggs.   He or she will also likely order a semen analysis on your husband.  Tell your husband not to worry, though.  He is unlikely to be handed a cup and asked for a sperm specimen on the spot.  This is usually a test that needs to be scheduled, and you can always asked to schedule it for the future if your doctor suggests doing it now.  The doctor may do an ultrasound to look at your uterus and ovaries too.  The final test that is often ordered is a hysterosalpingogram.  This is a test where dye or contrast is infused through the cervix and allowed to fill up the uterus and flow out the fallopian tubes under x-ray.  It will tell the doctor whether your tubes are open or not.  Recently, we have started using a device that allows us to combine the ultrasound and tube evaluation into one.  This has the advantage of being one procedure instead of two, more comfortable than a traditional hysterosalpingogram, and no radiation because it is done without x-rays.  This may be available at your doctor's office too.  If you are due for a PAP smear, your doctor may want to do that as well. 

Although the thought of going to see a doctor about fertility problems can be daunting, I think you will find that you feel better after you do it.  You will get answers as to what has been going on, and you will get a plan of action.  Most fertility issues can be solved with resorting to expensive treatments or risking having triplets or more.  A good physician should be able to answer your questions and explain things in a way that you understand.  He or she should be able to give you treatment options and let you decide what you want to do too.  If you doctor is not doing that, ask them about it or get a second opinion.  Asks friends, family members, and coworkers for suggestions.  You can ask you GP or OB/GYN for their recommendation for a good R.E. too.  If you don't have anyone to ask, see who is available in you area.  Board certification is always a good thing to look for in a doctor.  There is a separate board certification for Reproductive Endocrinology.  Beware of websites that rate doctors, they tend to attract frustrated patients who want to vent (and it often times is not the doctors fault that they are not getting pregnant), and it is easy for an unscrupulous doctor to write his or her own good reviews.  There a lots of terrific doctors out there, and we love helping couples have babies.  It's the most rewarding job!  If yours is not acting that way, then find one who does!