A couple decides early on who will be chosen to help them with
their infertility. This selection dramatically effects the treatment
plan that is developed. Therefore, careful consideration of the
alternatives is advisable.
Not everyone turns to medicine for help. Some couples choose a
relative, like a mother or a grandmother. This is generally someone
who has a large family with clear success in terms of their own
reproduction. Others may turn to religious figures and entrust
their fertility to a higher being or guidelines set by an organized
religion. I beleive that physicians also have an important role in
the care of these couples. Infertility usually involves medical
conditions that are now treatable and professional advice is
generally available.
Differences in training among the available physicians will be
the focus of this section. All physicians treating infertile couples
should share certain basic characteristics, including:
* (1) Compassion and the willingness to listen.
These are important qualities in an infertility doctor. As you
discuss your situation with your doctor, you should be able to
identify a willingness to listen to your concerns.
Recent dramatic changes in health care have essentially limited
the time that is spent with patients by rewarding the number or
"volume" of patients seen rather than giving "the
personal touch." Infertility patients may come to resent
their doctor if (s)he doesn't address their unique needs or they
may change doctors frequently in an attempt to find one who will
"hear their concerns." This can be frustrating for both
the doctors and the couples.
* (2) Expertise in the rapidly changing field of infertility.
Book knowledge coupled with insights gained from extensive clinical
experience is a powerful combination.
All doctors are persons skilled in the healing arts who
have completed a defined rigorous course of study (typically 4
years). Doctors have been duly licensed by the State's Board of
Medical Examiners to practice within the profession. Therefore,
many couples believe that "any doctor" will be expert
in the treatment of their fertility issues. This may not be so.
Most graduates of medical school will have delivered (or helped
deliver) a baby and helped to perform (or watched) a hysterectomy.
However, many doctors have had no exposure to infertile couples
undergoing evaluation. Nevertheless, in many areas of the USA
the family doctor (either a family practitioner or internist)
is the initial contact for the infertile couple. This physician
will then consider whether (s)he is comfortable with ordering
the basic infertility evaluation and when to refer the couple
for care with an infertility specialist.
The obstetrician gynecologist is a doctor who has completed
medical school as well as an additional defined training program
(typically 4 years) in Obstetrics and Gynecology (Ob-Gyn). To
become board certified in Ob-Gyn, the "American Board of
Obstetricians and Gynecologists" requires candidates to pass
a written exam as well as an oral exam. The oral exam is given
by recognized authorities in the field and covers all areas of
Ob-Gyn including infertility. Therefore, Ob-Gyns are well trained
in the theory of infertility and many will have significant clinical
training and experience as well. When the obstetrician gynecologist
is the initial contact for an infertile couple there is usually
an organized approach that has been established. At some point
in the infertility care, the Ob-Gyn may suggest referral to an
infertility specialist.
Infertility specialists are doctors who should have completed
medical school, a residency training program in Obstetrics and
Gynecology, and an additional training fellowship (typically 2-3
years) in Reproductive Endocrinology (male and female hormones)
and Infertility. This subspecialty fellowship can provide an intense
clinical exposure to infertility care that dramatically redefines
the physician's approach to the infertile couple. The infertility
specialist's approach typically complements the Ob-Gyn's care.
To become board certified in Reproductive Endocrinology and Infertility
by the "American Board of Obstetricians and Gynecologists"
the candidate must have completed an approved training fellowship
in Reproductive Endocrinology and Infertility and be board certified
in Obstetrics and Gynecology. Candidates must pass a written exam
in Reproductive Endocrinology and Infertility as well as an oral
exam. The oral exam is given once a year by recognized authorities
in this subspecialty field and covers in detail the theory and
clinical principles within the field of Reproductive Endocrinology
and Infertility. The American Board's definition of a Reproductive
Endocrinologist is "a specialist in obstetrics and gynecology
who is capable of managing complex problems relating to reproductive
endocrinology and infertility, and whose current professional
activity involves the practice of reproductive endocrinology in
a setting wherein essential diagnostic and therapeutic resources
are available and being used appropriately."
Board certified Reproductive Endocrinology and Infertility
subspecialists are uncommon. There are less than 700 such
subspecialists in the USA in 1997. These persons have demonstrated
a high level of expertise in handling complex infertility related
situations.
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