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Fertility treatment: Between cost and expertise

By Abayomi Ajayi

Infertility is much more common than once believed. In fact, approximately 20 percent of couples experience infertility at some time in their reproductive lives. The good news is that most couples, who are under the care of an infertility specialist, will become pregnant.

Pregnancy is usually achieved with ART therapies, such as in vitro fertilization (IVF) and Intrauterine insemination (IUI) is the solution for many couples. Common causes of infertility include ovulatory dysfunction, reduced ovarian reserve, fallopian tube damage or blockage, endometriosis, cervical mucus abnormalities, uterine disease, PCOS, male factor infertility, and more.

Oftentimes there is more than once cause for a couple’s infertility and women are concerned exactly who to consult. Is it their regular gynaecologist or another specialist altogether?

In my view, it is a fertility specialist that should be consulted. This is a specialist physician who spends the majority of his/her time treating couples with infertility. This specialist undergoes extensive advanced medical training which enables him or her to accurately diagnosis the many conditions that can lead to infertility.

A reproductive endocrinologist is a subspecialty-trained physician who has completed a Fellowship programme approved by a recognised Board of Obstetrics and Gynaecology.

A reproductive endocrinology Fellowship consists of an additional 2 or 3 years of training in the diagnosis and treatment of all types of male and female infertility problems. Fertility specialists, receive special training in the diagnosis and treatment of hormonal problems, disorders involving the pituitary, thyroid, and adrenal glands, and ovaries, and management of the full range of assisted reproductive technologies and pharmaceuticals.

An Ob/Gyn typically receives less than six months (and often less than three months) of training in infertility, with a greater emphasis on primary women’s health care, obstetrics, and routine gynaecology.

The next obvious question is who should see a fertility specialist?

Essentially, a fertility specialist should evaluate any couple having difficulty conceiving after one or more years, or having difficulty with pregnancy loss. Infertility is classically defined as the inability to conceive after one or more years. Although this one-year time period is arbitrary, most couples should probably try to conceive without intervention before seeking medical advice from a fertility specialist.

From experience we know that approximately 85 percent of couples aged 18-42 years will conceive within one-year of regular intercourse. Some couples, however, need to seek medical advice from a fertility specialist before this arbitrary one-year time period. Other factors warrant an earlier evaluation, particularly those couples with a female partner who is 35 years of age or older, or who has known tubal occlusion or problems ovulating, or couples with known male infertility.

The rule of the thumb is that the older the age of the female partner, the sooner the couple should seek the advice of a fertility specialist.

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