If you are being treated, or considering seeking infertility treatment, it is appropriate to start with either a good general gynecologist or with an infertility specialist - also referred to as a reproductive endocrinologist.

Some general gynecologists are very good at the initial fertility evaluation and very basic infertility treatment. However, you should know about your doctor's training and experience.

Many women think they are being treated by a fertility specialist when they are not. You should know whether your doctor is a fellowship trained fertility specialist. If you do not know, just ask whether he/she did a fellowship in Reproductive Endocrinology and Infertility. A fellowship involves 2 to 3 additional years of specialized infertility training after the doctor has completed his or her Obstetrics and Gynecology residency training.

If your physician is a general gynecologist, you should ask at what point he/she will refer you to an infertility specialist. In general, you should be referred to a fertility specialist either immediately - or after up to 6-12 months of treatment with the gynecologist. This will also depend on the female partner's age and the cause of the infertility. Some cases should be referred to a specialist immediately.
When to see a fertility specialist?

There are several criteria for immediate referral to a fertility specialist doctor, who are also referred to as Reproductive Endocrinology and Infertility specialists:

* Female age of about 38 or older
* Blocked fallopian tubes at any age (1 or both tubes blocked)
* Other tubal problems at any age - such as more than one tubal ectopic pregnancy
* Moderate or severe endometriosis at any age
* Significant male factor - sperm concentration less than 10 million per ml, or motility less than 40%
* Ovulation problems such as polycystic ovary syndrome, PCOS treated with 3 to 6 months of Clomid without conception at any age
* Abnormal ovarian reserve tests, such as elevated day 3 FSH level at any age
* It does not have to be expensive to be treated by an infertility specialist. The cost depends on the fertility treatment you need.

If you are already seeing a fertility specialist doctor and are considering in vitro fertilization (IVF), ask him or her for:

* IVF pregnancy success rates per egg retrieval and per embryo transfer
o Are they giving you initial pregnancy rates, ongoing pregnancy rates or live birth rates?
* Get IVF success rates in writing. You should ask for their most recent CDC and/or SART IVF success statistics - links to the most recent reports are on our IVF success rates page. Compare IVF clinic success rates with these reports.
* His or her individual success rate over the past year for all IVF procedures performed.
* His or her individual success rate for cases with fertility problems similar to yours.