Perhaps you’ve been trying to conceive for some time now, with no luck. Maybe your OB/GYN has done some tests and recommended some treatments, but you’re still not pregnant. It could be time for you to consider seeing an infertility specialist.

What Is an Infertility Specialist?
According to Dr. Lisa Erickson, every board-certified obstetrician/gynecologist (OB/GYN) completes a four-year residency, focusing on one of three subspecialties: high-risk maternal/fetal medicine, oncology or reproduction and infertility. Thus, some OB/GYNS call themselves "infertility specialists." But how skilled are they in this area? What exactly is an infertility specialist?

A true infertility specialist is a reproductive endocrinologist (RE), an OB/GYN who has completed three additional years of training in the area of reproduction and infertility and has become certified through passing a series of exams. Dr. Erickson, who practices with the Center for Reproductive Medicine in Minneapolis, is an RE. There is nothing to prevent any doctor from calling herself or himself an "infertility specialist," so it may be in your best interest to make sure that the doctor is an RE.

"I think that most patients should be able to turn to their OB/GYN or primary care physician to initiate the standard work-up for the diagnosis of infertility," says Dr. Erickson. "Some of these doctors are very comfortable with initiating initial treatment options. If those have been exhausted and the patient is ready for the next step, the OB [should] refer the patient to a reproductive endocrinologist."

How to Know When to Make the Switch
It didn’t happen quite that way for Gail Simons. Simons, of East Hampton, New York, had been trying to conceive for 14 months before she went to see her OB/GYN. The doctor gave her contradictory advice and, even after unsuccessful treatment, did not want to refer her to an RE. "He specifically stated, “This is something we can handle here at this office.’” says Simons. “It was not until I found online support groups that I found out what an RE was, and I immediately began looking for one."

Without the assistance of her OB/GYN, Simons found an RE through the ASRM (American Society of Reproductive Medicine) Web site and set up her own appointment without a referral. Simons learned that the OB/GYN had performed some of the tests incorrectly and had given her incorrect advice. "My OB/GYN gave me two options: ‘Keep trying and hope for a miracle’ or ‘go straight to IVF,’" says Simons. “After seeing the RE, I found out that my options were much greater."

Andi McCurdy*, of Salem, Ore., had a similar experience. "We made our own referral," she says. "My OB/GYN had said that if he couldn’t get us pregnant with Clomid he would refer [to a RE], but he never seemed to do it. We did seven cycles of Clomid after an SA (semen analysis), and surgery to look at fibroids, ovaries and tubes for me. His interpretation of the SA and tests were wrong." McCurdy and her husband tried to conceive for two years before they switched to a RE. She is awaiting the results of her second IVF (the first was unsuccessful).

Brenda Price, of Ontario, Canada, has been seeing an RE for four months, after first seeing a family doctor and then an OB/GYN. "We tried for approximately 18 months before switching to an RE," says Price. "In retrospect, I really wish I had insisted that our family doctor refer us to a RE as soon as it became apparent that we had a problem. I feel like we wasted a year with the OB/GYN. It was useful in that we were able to get all the basic infertility testing done, but I found that he wasn’t treating us as an individual couple. He seemed to have a standard treatment that he used for every couple, regardless of their diagnosis."

Brenda learned that a friend who was seeing the same doctor and had a very different diagnosis was following the same treatment protocol, and she became disenchanted with the doctor and his advice. "He kept telling us to ‘relax and enjoy each other’s bodies’ and that we would get pregnant,” says Price. “He also said that if the Clomid didn’t work, then I ‘probably’ had endometriosis, even though I had absolutely no indicators of endo." Price was frustrated because she felt the OB/GYN had no interest in finding the cause of their infertility.

The rule of thumb in seeing any doctor for help conceiving is that a couple without known fertility problems should first try to conceive on their own for a year if the woman is younger than 35 and six months if the woman is older than 35. Many women, especially those older than 35, believe that this common advice is too conservative. Claire Goodman is one of those women.

Goodman, of Oakland, Calif., started seeing an RE after trying to conceive for six months. Goodman, who was older than 35, had done some research and knew that time was running out for her, fertility-wise. She moved quickly; when the first RE made a serious error in her treatment, resulting in a failed IVF, Goodman switched to another RE for her second IVF. The happy result: an active and beautiful preschooler named Rebekah. Goodman advises women to take the lead when it comes to seeing an RE: "Do it when you are ready; don’t wait some arbitrary period of time or wait for a referral."

Dr. Erickson agrees with the advice that women who are older than 35 and have been trying to conceive for six months should see an RE. She also suggests that if a woman who has an obvious abnormality, especially one that requires surgery, it might be wise to make the switch sooner.

Price learned on her own, from charting her menstrual cycle, that she had a very short luteal phase (less than 14 days between ovulation and menstruation, commonly referred to as a luteal phase defect), which is a common infertility indicator. "Women should trust their instincts and switch to an RE at the earliest opportunity," says Price. "When dealing with infertility, time is definitely not on your side. I think women (and men) have to be active participants in their fertility treatments. Don’t be afraid to ask questions and demand answers. Inform yourself, and encourage your husband/partner to do the same."

Choosing the Right RE for You
If you decide, either on your own or with the aid of a doctor who has been treating you, that it’s in your best interest to see an RE, how do you find the right doctor for you? A good place to start is with REs who belong to SART (the Society for Assisted Reproductive Technologies). Go to their Web site for REs in your area who are SART members.

Networking with friends who are in infertility treatment can provide good anecdotal information about local REs, as can Internet e-mail lists and bulletin boards for infertility patients. It’s important to have choices so that you can find the best fit. If you want to be involved in your treatment and "Dr. X" prefers giving orders to collaborative decision making, his clinic may not be a comfortable place for you.

Many experienced infertility patients also caution against relying too heavily on the clinic’s success rates: They vary widely, depending on entry criteria into the individual clinic's program. Some programs with high success rates may take only patients who have a good chance of becoming pregnant quickly; those with a lower success rate may either be less competent or, just as likely, be willing to work with patients whose chances of success are lower.

Dr. Erickson thinks that it’s important for an RE’s clinic to be service-oriented. "At our clinic, we want people to look back and say that we helped them through a hard time and took good care of them," she says.

Dr. Erickson has some good advice about your relationship with your RE: "Chemistry is important. A relationship with your physician is like any relationship: Sometimes it has to be worked on. You want a clinic that has the philosophy that it’s an honor and a privilege to be part of your journey to parenthood."

*Name changed to protect privacy. Want to See More?

• The Infertility Marketplace: How Success Rates Are Advertised
• Choosing Assisted Reproduction: Social Emotional and Ethical Considerations
• Luteal Phase Defect: How It Affects Fertility
• Talk about it!