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Who should evaluate the infertile couple?

Posted Sep 25 2009 3:34pm

Patients end up seeing a Reproductive Endocrinologist as a result of a multitude of factors. Some are referred by friends and co-workers. Some are sent by their primary care provider or by their Ob/Gyn. Many are self-referred and end up seeing us because of advertising, the internet or because they read this fantastic book titled “100 Questions and Answers about Infertility.” Actually, I have yet to see a patient who came running to see me because of the book, but you never know what will happen once Oprah makes it a selection for her Book Club. Since many Ob Gyns refer patients to specialists we like to maintain a good working relationship with them, but sometimes this becomes an issue when it comes to the fertility evaluation.

Although many non-REs are perfectly capable of ordering the tests appropriate to the evaluation of the infertile couple, some may not know how to interpret the findings. Hence, we will sometimes see patients who have been managed in a sub-optimal fashion. For example, many Ob Gyns will treat patients with empiric clomiphene without any monitoring or even without completing a basic assessment of the fallopian tubes or sperm quality. This approach is not appropriate.

Many studies suggest either limited or no benefit to the use of empiric clomiphene without the synergistic addition of intrauterine insemination (IUI) in these cases. However, I assume that these physicians do occasionally see patients who conceive with this approach whereas I have a biased view since I see all the patients who have failed this therapy. Remember that a Reproductive Endocrinologist deals almost exclusively with fertility issues. No pregnancy management. No sudden calls to Labor and Delivery. No Gyn cancer issues (unless it pertains to fertility preservation). No urinary incontinence. Just fertility, fertility, fertility….24/7. Why limit ourselves to this clinical problem? Well that is a topic for another day…So that leaves us with today’s Question of the Day.

5. Who should evaluate the infertile couple?

In many cases, the routine fertility evaluation can be conducted by an obstetrician/gynecologist, a family practitioner, or a reproductive endocrinologist (RE). Certain tests can easily be obtained by physicians in the first two specialties, but a reproductive endocrinologist may be required to interpret advanced testing and provide the most accurate counseling. Women who are more than 34 years old may elect to immediately consult with a reproductive endocrinologist.

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