When to see a reproductive endocrinologist at a glance
- Reproductive endocrinologists (fertility specialists) are doctors specially trained to diagnose and treat male and female infertility, as well as other fertility needs such as LGBTQIA or single parent family building.
- Male/female couples should see a reproductive endocrinologist if the woman is under the age of 35 and the couple hasn’t conceived after a year of unprotected sex (this qualifies as infertility).
- Because a woman’s fertility declines as she ages, if the woman is between 35 and 39 years old, the couple should see a fertility specialist after only six months of unprotected intercourse without pregnancy, and after just three months of unprotected intercourse without pregnancy if the woman is age 40 years or older.
- People with a history of illness or lifestyle factors that could affect their fertility may seek help from a fertility specialist sooner.
- Individuals undergoing cancer treatments or those who want to postpone having children through fertility preservation services should also see a reproductive endocrinologist to discuss options.
- LGBTQIA individuals and those seeking to become single parents may also see a fertility specialist to learn about and undergo third-party reproductive services, such as using an egg donor, sperm donor or gestational carrier.
What is a reproductive endocrinologist?
A reproductive endocrinologist, also called a fertility specialist, is a doctor who has undergone extensive training to diagnose and treat conditions that can affect male and female fertility, and provide reproductive services to those needing fertility assistance.
Fertility specialists undergo four years of medical school, as well as another four years of residency training in obstetrics and gynecology (OB/GYN).
After their residencies, fertility specialists complete a three-year fellowship in reproductive endocrinology and infertility (REI). The fellowship allows the physician to gain specific training in assisted reproductive technologies, reproductive surgery and how genetics can affect fertility, among other areas of study.
After their fellowships, physicians can then take an exam to become board certified as an REI. Our three FSMG physicians are board-certified reproductive endocrinologists as well as board-certified obstetrician/gynecologists.
Common reasons to see a reproductive endocrinologist
It’s estimated that 15% of Americans will have trouble with their fertility at some point in their lives.
But for many, it can be hard to determine when to see a fertility specialist. For those trying to conceive, there are a few clear indicators that it’s time to see a specialist. Those who fit into the following categories could benefit from a fertility evaluation.
- A woman is under 35 years of age and the couple is unable to get pregnant after 12 months of unprotected sex
- When the woman is between the ages of 35 and 39 and the couple hasn’t gotten pregnant after six months of unprotected intercourse
- When the woman is 40 years of age or older and the couple has tried to conceive for three months unsuccessfully
- Women who have experienced two or more miscarriages
- Individuals with a family history or personal history of conditions that can affect their ability to reproduce
Fertility preservation or third-party reproductive assistance
While many people go to see a fertility specialist because they’ve been struggling to get pregnant, reproductive endocrinologists can also help with other fertility concerns.
For example, fertility specialists can treat those who would like to preserve their fertility, or those who need third-party reproductive assistance to get pregnant or carry a baby.
Examples of others who can benefit from seeing a reproductive endocrinologist include the following:
- LGBTQIA individuals or couples who would like to start a family
- Single individuals who would like to have a child through donor eggs, sperm or embryos (and possibly also using a gestational carrier)
- Individuals undergoing treatment for illnesses that may affect fertility, such as cancer treatment, and wish to preserve fertility prior to treatment
- Individuals wishing to preserve fertility for future pregnancy by freezing eggs or sperm, or creating and freezing embryos.
Signs of infertility in women
Age is the primary factor that contributes to infertility in women and one of the earliest indicators that a woman may need to see a reproductive endocrinologist.
This is because a woman’s eggs naturally decline in quantity and quality as she gets older. After a woman turns 35, she is more likely to find it harder to become pregnant and more likely to experience miscarriages if she does.
Risk factors for infertility in women
Women who have been diagnosed with or experienced any of the following are also more likely to have infertility:
- Ectopic pregnancy
- Polycystic ovary syndrome (PCOS)
- Uterine fibroids or polyps
- Irregular periods or no periods
- Diminished ovarian reserve (DOR)
- A history of sexually transmitted infectious diseases (such as chlamydia or gonorrhea)
- History of abdominal or pelvic surgery
- Recurrent miscarriage (two or more)
- Cancer treatment.
Lifestyle factors that can cause infertility in women
Certain lifestyle and environmental factors can also affect a woman’s fertility. Notably, women who are underweight or obese may have problems getting pregnant. The American Society for Reproductive Medicine reports that 12% of all primary infertility cases are due to women being either overweight or underweight. A woman can evaluate if she belongs in either category by calculating her body mass index (BMI).
BMI is a measurement of body fat based on a simple height to weight ratio. A BMI of 18.5-24.9 is considered a healthy weight. Those far outside the healthy weight range may need to either gain or lose weight in order to improve their fertility. A fertility specialist can help a woman identify what lifestyle changes can help her improve her fertility.
Signs of infertility in men
Men are less likely to have obvious symptoms of infertility than women, but infertility affects men nonetheless.
A man should consider seeing a reproductive endocrinologist for a fertility evaluation if he has a history of any of the following:
- Erectile dysfunction
- Varicoceles (enlarged veins in the testicles)
- An undescended testicle, with or without repair
- Poor sperm quality (evaluated through a semen analysis)
- Spinal cord injuries
- Use of testosterone supplements
- Breast growth (called gynecomastia)
- Surgery on or injury of the penis, testes or groin
- Cancer treatment.
Lifestyle factors that can cause infertility in men
Lifestyle factors can also play a role in the development of infertility in men. Like women, men who are overweight or obese may have problems with their fertility, as this can lead to reduced sperm count and sperm quality. Being underweight can also contribute to problems conceiving but not to the same degree as it does with women.
A fertility specialist can also work with a man to identify any other possible lifestyle choices that could be affecting his ability to conceive, such as smoking, drinking alcohol and other factors.
When to consider fertility preservation
Fertility preservation is a unique service offered by fertility specialists that allows individuals to preserve their sperm, eggs or embryos through a process called cryopreservation (freezing).
People who are considering fertility preservation may not currently have problems with their fertility but are concerned about their future ability to have children.
Women can opt to preserve their fertility for what are sometimes called social reasons. For example, a woman who wishes to focus on her career may wish to freeze her eggs when she is young and her eggs are more plentiful and of better quality. Then, later in life, if struggling with fertility, she can use her frozen eggs and her partner’s or donor sperm to create embryos and hopefully achieve pregnancy.
Other people who could benefit from fertility preservation include the following:
- Transgender individuals who would like to freeze sperm or eggs before transitioning
- Individuals about to undergo cancer treatments that may impact fertility, such as chemotherapy or radiation
- Individuals with an autoimmune disease, such as lupus
- Those with genetic conditions that could affect their long-term fertility
- People who have been exposed to toxic chemicals in their workplace or while in the military.
Those in the above categories can consult with a reproductive endocrinologist to learn more about their fertility preservation options.
Fertility preservation allows individuals to freeze eggs or embryos in order to preserve fertility at a time in reproductive life when eggs are most likely to be chromosomally and metabolically normal. Patients can then use these cryopreserved eggs or embryos at a later time when they are ready to build a family.
Oncofertility is the field of reproductive medicine that works with oncologists (cancer doctors) to provide options for cancer patients who wish to preserve their fertility prior to undergoing treatments that may impact future fertility.
When to consider third-party reproduction services
Some individuals may also elect to see a fertility specialist to review third-party reproduction options, such as using an egg donor, sperm donor or gestational carrier.
People who may use these services include the following:
- LGBTQIA individuals or couples who want to use donor sperm, donor eggs, a gestational carrier or a combination of these options to start a family
- Single women who would like to get pregnant using donor sperm
- Women who have had problems carrying children to term in the past or have had high-risk pregnancies
- Individuals who are worried about passing on a genetic condition to their offspring.
A fertility specialist can review a person’s medical history to help determine which third party reproductive services are needed and what other treatments might be required. IVF or intrauterine insemination are commonly used in conjunction with these treatments to help an individual or couple get pregnant.
What to expect at a fertility consultation
A new patient consultation with Fertility Specialists Medical Group (FSMG) will typically take between 1 1/2 and 2 hours, depending on an individual or couple’s needs. We recommend that both partners, if applicable, be present for the first appointment.
During the consultation, we will review the patients’ histories, medical records, tests results, any surgical reports, and have a detailed discussion with them about their situation and desires. We ask that patients bring or forward in advance any medical records that may be relevant to their condition.
The consultation will also include a physical examination and some basic diagnostic testing, and may include a vaginal ultrasound, if applicable. From there, we will develop a treatment plan.
Fertility evaluation and treatment plan
The goal of the evaluation plan is to help identify any issues contributing to infertility or that could impact the outcome of treatments, with the goal of e a healthy baby.
Our team will work with patients to schedule follow-up testing as needed and answer any questions. In most cases, a follow-up visit will be arranged to finalize a treatment plan. Our clinical and financial teams work hard to make the best use of patients’ time, as well as financial and emotional resources.
Financial review and counseling
Our financial experts can also provide additional information on financing and insurance options for various fertility treatments.