Finding a Specialist
Most gynecologists are able to work with their patients to assist them on the pathway to conceiving a child. When you first decide you would like to have a baby, you need to go in for a preconception checkup. At this visit, you should discuss your age and health conditions with your doctor and specifically ask if you should see a specialist. The standard of care for women over age 35 is to try unassisted for six months and then begin fertility testing and treatment.
If your insurance will cover it, you have the right to seek out a specialist before this point. Should you decide to do so, or should your gynecologist recommend it, you will want to see a reproductive endocrinologist (RE) who is board certified. Reproductive endocrinologists are physicians who specialize in female fertility. Many reproductive endocrinologists practice in a group with urologists, labs, and facilities all in one place. It is important to realize that many gynecologists who are board certified in general obstetrics and gynecology will advertise themselves as “infertility specialists.” These individuals should not be confused with reproductive endocrinologists (REs).
Many insurance plans do not cover fertility treatments. Only twelve states mandate some coverage for fertility treatments. Be sure to learn what your plan will cover before you undergo any treatments; an IVF cycle can cost over $10,000 alone. Some fertility clinics are able to arrange payment plans, so ask about them.
To find an RE, first ask for a referral from your gynecologist and check it against the list of participating physicians in your insurance plan. You should feel free to shop around until you find an RE you like. You may be able to get another referral from your family doctor. You can also use the find-a-physician feature of the American Society of Reproductive Medicine (at
Once you have the names of a few physicians that accept your insurance, make appointments with those you are considering. Use this appointment to ask questions and get a feel for the doctor's style. Questions to ask include these:
How long have you been practicing this specialty?
Are you board certified?
Do you have a urologist on staff to evaluate male fertility?
What is your office or clinic's rate of take-home babies?
What kind of testing and treatment would you suggest for me?
What kind of rate of success is involved?
Based on my age, what do you think my odds might be?
At what hospitals do you have privileges?
What kind of financial arrangements can you make for treatments not covered by insurance?
If I need advanced treatment, such as in-vitro fertilization, do you have the capabilities to perform these procedures, or will I have to be referred?
When you first see a specialist, she will meet with you and your partner and take a detailed medical history. You will be asked questions about not only your medical conditions but also about the frequency of intercourse and how many children you each have. Then the specialist will most likely order what is called a fertility workup, a series of tests (described later in this chapter) to assess the best course of treatment for you. An RE follows your care until you are pregnant and until a heartbeat is confirmed. At that point, you are turned back over to your OB/GYN or your maternal-fetal medicine specialist. (See Chapter 6 for more information.)