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    Time to See a Fertility Specialist?
    Joel Bernstien, MD posted:
    The general consensus is that, if you are under 35, you should attempt conception by having regular, unprotected intercourse for at least 12 months. After 12 months, if you have not achieved a pregnancy, then you should visit your ob-gyn. If you are 35 or over, the consensus is to try via regular intercourse for at least 6 months before visiting your ob-gyn.

    You should seek help sooner than 6 or 12 months if:
    - There is any reason to suspect an underlying problem for you or your partner that would impede conception
    - You suspect anovulation, or that you are not producing an egg each month
    - You are not having menstrual cycles every 24 to 35 days regularly, which typically means that a woman is not ovulating regularly
    Most ob-gyns should be able to perform the basic infertility workup. If they feel it is warranted, they may subsequently refer you to a reproductive endocrinologist, a sub-specialist who focuses on infertility.

    When scheduling these kinds of appointments, let your doctor know that you want to discuss fertility or conception. Practices often have special time slots to discuss these issues, so as not to rush through the conversation. Expect that a thorough medical history will be requested for both partners. Menstrual history and sexual frequency will need to be discussed. You may have to have an exam done, as well. Depending on your situation, your provider may order blood tests, radiographic studies (ultrasounds or x-rays), and may even have your partner's sperm checked for quality and quantity.

    These are not hard-fast rules. Remember that everyone's situation is unique.

    Have you been trying to conceive for more than a year? What has stopped you from seeing a fertility specialist?
    An_241766 responded:
    Why do some OBs not care about infertility? My wife's OB is nnot very helpful, responsive, or compassionate. We went for two weeks thinking that the HSG test results were normal and then were blindsided by the OB telling us my wife might have fibroids. I've also heard from other women that had to change dOB's during their infertility journey becuase of a lack of helpfulness, compassion, responsiveness, etc. It's unacceptable for couples to have to deal with OBs that treat their patients like this.
    spartyfanva replied to An_241766's response:
    If my wife and I could do it all over again, we would go to an fertility clinic. Unfortunately, we need a referral for that. The lack of quality care from her OB is unacceptable. We leave appointments feeling confused with more questions rather than answers. In summary, going to an OB for infertility care will not help a couple.
    Joel Bernstien, MD replied to An_241766's response:
    I'm sorry to hear you had a bad experience in your interactions with you current OBGYN doctor(s). Fortunately, you have to right to choose to go elsewhere. I would recommend finding someone who is able to spend the quality time with you that you and your wife deserve. Remember, when making this appointment at the new office, let the schedulers know you would like to discuss infertility and would like a consult visit. Many offices are set up to have consultations at the end of the morning or afternoon. This allows plenty of time to discuss all of your concerns and to work together with the doctor to initiate a plan of care that satisfies your needs.
    Joel Bernstien, MD replied to spartyfanva's response:
    There are many situations that warrant a referral to a fertility specialist. I believe that most women's healthcare providers can at least initiate an infertility evaluation. The benefit of having this information prior to a referral to the specialist is that the specialist can really focus on what he/she believes may be the cause(s) of the infertility and thus initiate a plan of care accordingly. There is nothing wrong with a referral prior to an evaluation; however, the initial consultation with the specialist will be that of telling you about the evaluation and likely not a plan of care, that is, until the results return.

    I am happy to say that almost all women whom my partners and I care for who are undergoing evaluation and/or treatment for infertility are satisfied with their care with us. There are many times that we (as OB doctors) are able to hone in on a cause of infertility that may not require the help or expense of a specialist. That being said, we are very fortunate to have several infertility groups around town to where we refer patients on a daily basis.

    I am sorry that your particular situation felt unsatisfying, and I agree with you that this would be extremely frustrating. I do not however think your situation is generalizable all OB doctors in relation to their efforts to diagnose and treat infertility.
    spartyfanva replied to Joel Bernstien, MD's response:
    Thanks for the response, Dr. Bernstein. It is very helpful and informative. My wife and I are going to try a new OB/GYN and that might help. I think her current OB/GYN is not a good fit for us. I appreciate your support.
    An_241766 replied to spartyfanva's response:
    How often do fibroids need to be removed for couples dealing with infertility?
    Joel Bernstien, MD replied to An_241766's response:
    Great question. And the answer is not so simple. It really depends on where the fibroid(s) are located. If the fibroid(s) are impinging on the lining of the uterus, and thus making a potentially suboptimal environment for implantation, then they may need removal. Otherwise (with many exceptions of course) most fibroids, especially those on the smaller side, will not interfere with fertility and do not need to be removed before conception.
    An_241766 replied to Joel Bernstien, MD's response:
    Thanks so much for the response. It is good to know that most fibroids don't need to be removed. My wife is getting a pelvic ultrasound done to check for fibroids. We are praying that the fibroids are not the "bad-type" that need to be removed. We've been trying for about 18 months and we've accepted that we probably won't be able to get pregnant on our own. We've already done the HSG, Semen Analysis, and Day 3 bloodwork testing and all the results were normal. Do you think we could get a referral to a fertility clinic since we've completed these tests? I really appreciate your support.
    juliepeck responded:
    I really need some advice on what to do...Im 28 years old & My husband & I have been TTCing for 6 months now. Im having normal Menses.,& Im Ovulating. I know im Ovulating because Im using Clear Blue Test (the Smiley Face ones).I can also most of the time tell when Im going to start Ov. from the cramping like feelings I have.there is only a few things Im unsure of ...1~ When I Ovulate one month I will Ov. for 2 & 3 days & sometimes 4days in that cycle & then the next month I will only Ov. for 1 day. I know you body goes from one ovariey to the other each maybe thats why.2~I found out I have an auto immune problem & I have to see a specialist for that in june,what I have makes the eyes ,mouth , & other areas dry. So,I got something called Pre-seed , Hoping this will help me if thats the problem.We just started using this in this cycle.3~My Husband is 33 & has had trouble with Testostirone & has been on meds. for that for some time now. But, we have had 2 children since this ,the only thing is that his levels have not only lowered ,but they have bottomed out now & he is on even more replacement Meds. than he was before & it is still not enough. I Guess what Im trying to ask you Doctor is from what I've told you ,do you think any of these things could be the problem?? Or,Do you think there could be something else wrong with me that we may not know about??? I have tried to get My Ob/Gyn to test my levels & she told me there was no reason. That if she tested & it was even a little off that she would'nt put me on any Meds. & that as long as Im having a monthly cycle then Im normal. But,I cant help to think that she may be wrong & she could at least test me for everything & just try to see if there is anything to Help us. I will be so greatful if you would Help me out with so answers. Thank you so very Much!!
    Joel Bernstien, MD replied to juliepeck's response:
    Thanks for reading my blogs juliepeck. At 28 years old with normal predictable menses and positive ovulation predictor kits AND having 2 successful pregnancies, I do not think you NEED an evaluation until 1 year of trying. That being said, if your husband has a known problem, he may want to speak to his endocrine doctor or urologist to see if his condition could affect sperm quality/quantity and if it could, maybe he could get a semen analysis.

    As for your evaluation, I would probably have to agree with your OBGYN, but I do not know but what you have described above, and thus I defer to your provider.

    Lastly, you are not ovulating 4 days a month. An ovulation is a single event. The test kits may turn positive for more than one day, but the act of ovulation does not occur 4 days a month. Since you know you are ovulating, I would stop the kits and just have regular frequent intercourse. Save a few bucks!
    An_241766 replied to Joel Bernstien, MD's response:
    When I see people on this board that are complaining and have already had 2 children, it makes me angry. Be thankful that you already have healthy children. My wife and I have been trying for our first for 17 months and we're not sure if we'll be able to have children. How would you feel if you were in our shoes?
    An_245254 replied to An_241766's response:
    I second you An_241766.
    juliepeck replied to An_241766's response:
    Im sorry that you & your wife have had probles but,I would like to let you know that I have had 2 children & I wasn't in any way complaining...I was just asking for advice. My second child that me & my husband had Died due to SIDS. he lived for 3 months & I fine what you said very hurt & unnessicary. You dont know me or what has happened with our lives ,but I guess now you know alittle more. You really should make asumtions .... Im turely sorry for your trouble with concieving & I pray things get better for you both.God Bless
    An_241766 replied to juliepeck's response:
    I'm very sorry for your loss. I apologize for making assumptions. I'm very frustrated and stressed that my wife and I haven't been able to get pregnant. Thanks for your support. I hope it gets better for you as well.

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