By Jessica Joseph, RN, BSN, MHA
If you’re trying to get pregnant and it’s taking longer than expected, you’re not alone. In fact, about 1 in 5 married couples experience infertility, which is defined as the inability to conceive after one year of regular, unprotected sex.
Many individuals and couples go months—or even years—without clear answers, feeling stuck in a cycle of waiting and wondering. It’s common to begin your journey with your obstetrician/gynecologist (OB-GYN), who often provides the first round of testing and basic treatment. But OB-GYNs are generalists, and their tools and training may not be enough to uncover more complex causes of infertility or guide you through advanced treatment options.
That’s where a reproductive endocrinologist (RE), also known as a fertility specialist, comes in. These specialists focus solely on reproductive health and are trained to diagnose and treat a wide range of fertility challenges. Understanding when it’s time to make the transition from an OB-GYN to an RE can be a key turning point on your fertility journey. Taking that step not only opens the door to more personalized care and targeted treatment, but also helps you move forward with confidence and clarity.
What’s the Difference Between an OB-GYN and an RE?
Your OB-GYN handles a wide range of women’s health concerns. This includes menstrual health concerns (irregular cycles, painful periods), birth control, pregnancy care, and common reproductive issues like uterine fibroids or endometriosis.
But an OB-GYN may not have the same tools or specialized training as a reproductive endocrinologist (RE). REs are OB-GYNs who complete an additional three years of fellowship training in reproductive endocrinology and infertility. They are board-certified experts in diagnosing and treating complex causes of infertility, including hormonal disorders, structural abnormalities, and challenges related to ovulation or sperm quality.
REs also offer advanced fertility treatments such as intrauterine insemination (IUI), in vitro fertilization (IVF), third-party reproduction (donor egg, sperm, or embryos), and fertility preservation through egg or embryo freezing.
When Is It Time to See a Fertility Specialist?
Here are some signs that it might be time to move from your OB-GYN to an RE:
1. You’ve Been Trying for a While
- If you’re under 35 and have been trying to conceive for 12 months with no success, it’s time to see a fertility specialist.
- If you’re 35 or older, seek help after just 6 months of trying
This timeline exists because age affects fertility, especially for women. Egg quality and quantity both decline as you get older, and early testing can make a big difference.
2. You Have Irregular Menstrual Cycles
If your menstrual cycle is unpredictable, too long, too short, or skipped altogether, you may not be ovulating regularly. This can point to a problem like polycystic ovary syndrome (PCOS) or thyroid issues—both of which can affect fertility.
Your OB-GYN may do initial blood work or prescribe medication, but an RE can dig deeper into hormone levels, ovarian function, and personalized treatment.
3. You’ve Had Multiple Pregnancy Losses
Experiencing more than one pregnancy loss (miscarriage) is heartbreaking—and also a reason to seek a fertility doctor. An RE can run detailed tests to find causes, such as chromosomal abnormalities, uterine abnormalities, or immune issues.
What an OB-GYN Can Do
Most OB-GYNs will start with a basic fertility workup, which may include:
- A review of your medical history
- Blood tests to check hormone levels
- A check of your menstrual periods and ovulation
- A physical exam and pelvic ultrasound
- Guidance on timing intercourse with ovulation
They might also order a semen analysis to check your partner’s sperm count and motility.
In some cases, OB-GYNs can prescribe medications to encourage ovulation. However, if this doesn’t lead to pregnancy after a few cycles, it may be time to consult a fertility specialist.
What a Reproductive Endocrinologist Can Offer
REs can look deeper into both female and male infertility and offer more advanced testing and treatment options, including:
- Hysterosalpingogram (HSG) to check fallopian tubes for blockages or scar tissue
- Genetic testing for chromosomal abnormalities
- Assessment of uterine fibroids, growths, or other abnormalities
- Monitoring ovarian reserve and response to medication
- Advanced blood work and imaging
- Procedures like IUI or IVF
REs are especially helpful if you have a known medical condition like PCOS or endometriosis, which may make conception more difficult.
Fertility Treatment Options with an RE
REs offer a range of treatment options to support individuals and couples facing infertility. Ovulation induction uses medications to stimulate the ovaries and promote the release of one or more eggs. Intrauterine insemination (IUI) involves placing sperm directly into the uterus around the time of ovulation to increase the chances of fertilization. In vitro fertilization (IVF) includes retrieving eggs, fertilizing them in a lab, and transferring the resulting embryo into the uterus. Egg freezing allows individuals to preserve their eggs for future use by retrieving and cryopreserving (freezing) them.
Surgical treatments may be recommended to remove fibroids, scar tissue, or correct structural abnormalities that interfere with conception. In addition to these treatments, REs also support individuals and couples using donor sperm, egg donation, gestational carriers, and other forms of third-party reproduction.
Special Situations That Call for an RE
Sometimes, the cause of infertility isn’t obvious. If you fall into any of these categories, consider a consult with an RE:
- You have PCOS, endometriosis, or irregular cycles
- Your OB-GYN can’t find a cause of infertility
- You’re over 40 and trying to conceive
- You’ve had past pelvic infections like chlamydia, which can affect the fallopian tubes
- You have a history of pregnancy loss
- You’ve had surgery on reproductive organs
- You or your partner have a low sperm count or past hormone issues
What to Expect at a Fertility Clinic
Your first visit may include a full review of your medical history, lifestyle factors like obesity or past use of birth control, and your fertility journey so far.
You may be asked to:
- Track your menstrual cycle
- Get a blood test
- Complete a semen analysis
- Have a transvaginal ultrasound
From there, your healthcare provider will recommend a step-by-step plan. This may be as simple as timed intercourse or as complex as IVF—depending on your needs.
You Don’t Have to Wait for a Referral
Many people think they need a referral from their OB-GYN to see a fertility specialist, but in most cases, you can schedule a consultation on your own. This can save time, especially if you’ve already had basic testing. Check with your insurance plan—some may require prior authorization or have preferred clinics in-network.
Advocate for Your Path
Fertility is personal, and no two journeys are alike. If you’ve been trying without success and feel stuck, it’s okay to ask for more help. Moving from your OB-GYN to a reproductive endocrinologist isn’t “giving up”—it’s a smart, proactive next step.
Remember, infertility is a medical condition, and getting care from a trained specialist can make all the difference. Whether it’s looking into treatment options, reviewing your hormone levels, or identifying hidden risk factors, a fertility doctor can guide you with clarity, compassion, and expertise.
You deserve answers. You deserve support. And you deserve to feel hopeful again.
