Lesson 3: Your Doctor, Your Options
When You Should Switch from an OB to an RE

Unless there is a history of previous infertility, it is almost always best to see an OB/GYN first. An OB/GYN can provide diagnostic care and low-tech infertility treatments at a cost that is usually much lower than that of an RE. However, cost is not the only reason to see an OB/GYN first. Most women see an OB/GYN on a fairly regular basis for pap smears, pelvic exams, and contraceptive prescriptions. Because of this, your current OB/GYN is going to have much of your reproductive history on file.

A woman or a couple may feel so comfortable with her OB/GYN that they do not want to switch to an RE until all possibilities have been fully exhausted. This is not always the best road to follow, and the couple should discuss with the OB/GYN at what point, if pregnancy has not been achieved, a referral to an RE will happen. If the OB/GYN says that this is unlikely to happen, or not to worry about it until it is necessary, you may want to start thinking about switching sooner rather than later. 

Most OB/GYNs will tell a couple that if the low-tech treatments such as clomid and IUI have not been successful after six months, a referral to an RE is the next step to take. If the doctor diagnoses severe endometriosis, PCOS, blocked fallopian tubes, or other infertility issues that will need specialized treatment or advanced ART for a pregnancy to occur, a referral to an RE should be immediate.

Age is another reason to switch quickly from an OB/GYN to an RE. As a woman gets older, her fertility drops, sometimes quite dramatically, as trying low-tech approaches cannot only be frustrating, but time consuming. After age 35, the time spent with an OB/GYN should be only six months max. This allows for clomid for four months, the last two possibly combined with IUI.

Of course, age is not the only factor to consider when deciding how long to stay with an OB/GYN before moving on to an RE. Finances also have to be considered. Finances include what you have saved, or spendable cash, and insurance coverage. If you live in one of the following states, your insurance policy may cover some of your infertility treatments, including IVF.

For complete information on the state laws concerning coverage of infertility, visit the American Society of Reproductive Medicine's page on State Infertility Insurance Laws.

Probably the most important reason to switch from an OB/GYN to an RE is if you feel that your treatment is not progressing. It is good to evaluate your doctor, whether an OB/GYN or an RE, from time to time, and to discuss your goals with the doctor. If you and your doctor do not feel that you are 'on the same page', it may be time to find a new doctor.