Not pregnant yet? When to see a specialist
Simply put: If you are a female who is over the age of 35 and have been having unprotected intercourse for over 6 months or if you are less than 35 years old and have been trying for one year and are still not pregnant, you should seek the help of a board certified reproductive endocrinologist (RE) - an ob/gyn physician who has had additional specialized training in reproductive medicine and infertility.
In most cases, to see a fertility specialist, insurance generally requires that you first see your primary care doctor or your gynecologist to get a referral. (It's best to call your insurance company to find out their specific requirements). Once you receive your referral you can schedule your appointment with the fertility doctor. Make sure to try and schedule your appointment at a time when both you and your partner are available since your partner will also need to be evaluated.
At your first appointment, your RE will get a detailed medical history from both you and your partner. Be prepared to answer LOTS of personal questions about your sex life. They will also perform a physical exam, which will likely include a pelvic exam and an ultrasound to look at your ovaries and uterus. Once that has been completed, they will order some blood work. Your partner will have to provide a semen sample for analysis and your physician may order blood work for him as well. The bloodwork that your RE will order depends largely on your medical history.
After your RE receives the results of the blood work, you will schedule another appointment to discuss the results. They may be able to determine if there is a reason for your infertility or you may also require more testing and those procedures will need to be scheduled. It is important to note, that in 30% of couples, a diagnosis cannot be made - this is known as "unexplained infertility" but you can still undergo treatments to get pregnant. Once you have completed initial testing, based on your history and diagnosis, the RE will present you with a few options on how to best proceed and what your chances of success will be with each of those options.
Additionally, if you decide to undergo further treatment, some insurance companies will provide coverage, while other may only provide partial coverage, or none at all. Most fertility clinics have someone who can help you navigate this process and understand what financing options are available if needed.
Feel free to email me at firstname.lastname@example.org if you have any questions about this initial visit.