Many times patients are not sure when
they should consult a fertility specialist, reproductive endocrinologist.
The American Society for Reproductive Medicine defines
infertility as the inability,
of women less than thirty-five years of age, to become
pregnant after 
one
year of unprotected intercourse.
Fertility specialists agree that advancing
female age is a major cause of infertility; therefore
the definition is often shortened to six months in women thirty-five
or older.
Board Certified Reproductive Endocrinologists, Infertility Specialists (REIs), like Dr. Deaton, have undergone advanced training in the diagnosis and treatment of infertility. Fertility specialists must first successfully complete an accredited residency program in obstetrics and gynecology followed by a three-year fellowship in reproductive endocrinology and infertility.
During their fellowships, infertility specialists work directly
with infertility experts and leaders in the field to learn advanced
diagnostic and treatment techniques including extensive
work in microsurgical laparoscopic
surgery. Infertility specialist training also focuses on assisted reproductive
technologies, such as in
vitro fertilization (IVF), which require the administration of fertility
drugs. Fertility drugs, such as FSH (Gonal-F, Follistim, Repronex, Bravelle, Menopur) must be carefully administered
and fertility specialists gain extensive experience in their safe use.
The reproductive endocrinology infertility subspecialty can be compared to others, such
as cardiology, orthopedics, and pediatric surgery.
If someone breaks a bone, he/she will most likely see
an orthopedist or if they have a heart attack they will
see a cardiologist. Infertility
is similar and patients should see the physician with
the broadest training and experience such as a reproductive
endocrinologist, infertility specialist.
“When to see an infertility specialist”
also depends upon numerous patient specific variables.
In general, women aged thirty-five or older should seek
specialty care sooner as their fertility can decline
rapidly. However, younger women can also experience
premature menopause, termed “declining ovarian
reserve”. Conditions such as polycystic
ovarian syndrome (PCOS), severe endometriosis,
male factor infertility,
fallopian tube
disease, and others warrant immediate fertility specialist care.
A woman’s Obstetrician/Gynecologist
(OB/GYN) will often do an initial workup to diagnose
the cause of infertility and then prescribe the ovulation-induction
drug Clomid
as a first line therapy, which is continued for three
to six months. If a woman does not become pregnant
using Clomid, she should seek care from an infertility
specialist. Also, if severe endometriosis
or significant pelvic disease is present in women trying
to become pregnant, a fertility specialist should be consulted.
Male factor
infertility is another condition that warrants infertility specialist
care. The OB/GYN will order a semen
analysis at the beginning of the fertility evaluation to document the number and “quality” of
sperm. In the past, the only treatment for severe male
factor was to use donor sperm. It is now possible for
men with severe sperm deficiencies to father children
using advanced reproductive technologies, such as IVF
with intracytoplasmic
sperm injection (ICSI).
Sometimes patients delay fertility specialist care because of cost
concerns. Numerous managed care studies demonstrate
that care from an REI is actually less expensive.
This is because the appropriate diagnostic tests are
ordered early in the evaluation leading to more effective
treatments. Time and money are not wasted on ineffective
treatments such as continued use of Clomid.
Fertility care can be expensive especially
if procedures such as IVF, ICSI, PGD or other assisted
reproductive technologies are needed. However,
studies demonstrate that the majority of patients will
not need ART and 80% become pregnant using other treatments,
such as intrauterine
insemination (IUI). Some patients have insurance
coverage and you should obtain a copy of your policy
for our staff to review. We work with patients
to make sure they receive benefits they are entitled
to. Also, many policies cover some of the diagnostic
tests, such as the hysterosalpingogram
(HSG).
Please contact us if you need more information. You can also review Dr. Deaton’s educational background by reading his CV.
