7 Signs You Should See an REI Fertility Specialist Now

Most often, a person or couple will visit a reproductive specialist, such as a reproductive endocrinologist, if they're hoping to become pregnant but having trouble doing so. However, this isn't the only reason to be evaluated by a doctor who specializes in fertility.

Other reasons to see a fertility specialist include treating absent or irregular menstrual cycles, polycystic ovarian syndrome (PCOS), endometriosis, uterine fibroids or sexual dysfunction.

Whether someone with these health issues wants to become pregnant or not, it's a good idea to receive help from a specialist who can help address underlying causes, treat unwanted symptoms, and prevent complications from developing in the future.

Which Conditions Can Reproductive Specialists Treat?

When you visit a reproductive endocrinologist (REI) or another type of fertility specialist, you can receive help for some of the following conditions:

• Irregular menstrual cycles
• Ovulation issues, such as irregular or absent ovulation (anovulation)
• PCOS
• Sperm-related issues, such as low sperm count or motility
• Diminished ovarian reserve/low egg count
• Damaged or absent fallopian tubes
• Fibroids
• Genetic abnormalities of embryos
• Recurring miscarriages

What's the difference between an REI and a fertility specialist, and which one should you visit?

An REI is a board-certified doctor who has completed seven years of advanced medical training to become a specialist in reproductive health.

While an REI has to complete a very specific training program and written and oral exams, a "fertility specialist" is a non-specific term that can be used by many types of practitioners who treat fertility issues, such as OB/GYNs, urologists (specialists in the male reproductive system), or naturopaths.

There's also a difference between OB/GYNS and REIs; OB/GYNs focus on female reproductive health and obstetrics, while REIs have the same training plus three years of fellowship to allow them to treat anyone dealing with a wide range of fertility factors, including female and male fertility issues.

7 Signs You Should Visit A Reproductive Endocrinologist and Infertility Specialist

REIs use medications, procedures, and sometimes surgeries to help treat infertility and other reproductive problems. Below are situations that warrant visiting an REI:

1. You've been trying to get pregnant without success for about one year

If you're under 35, a general recommendation is to try conceiving for about one year before seeking help. If you're over 35, you should spend about six months trying before you see a reproductive endocrinologist. If you rarely or never get your period or have a known issue stopping conception (e.g., partner’s vasectomy), you do not need to wait for 6-12 months before scheduling an appointment with an REI.

And if you're over 40, you may want to visit a specialist even sooner, after about a few months of trying on your own.

REIs perform extensive exams and tests to uncover the full picture of a patient's reproductive health, including a pelvic ultrasound (which can identify issues such as endometriosis or ovarian cysts), tubal evaluation, ovarian reserve testing, hormonal panel tests, and semen analysis for a male partner.

Based on test results, your REI or another specialist can help you decide which treatment options are most likely to be successful in helping you to achieve your goals, such as intrauterine insemination (IUI) (most often for women under 35), in vitro fertilization (IVF), or use of donor eggs, donor sperm, or possibly a gestational carrier.

2. You've had more than two miscarriages

Miscarriages are more common than many people realize. About 1 in every 5 to 10 pregnancies (between 10% and 20%) ends in miscarriage. Often, especially as women get older, the cause of a miscarriage is a chromosomal abnormality that prevents the fertilized egg from implanting in the uterus or developing normally in the uterus.

Your REI can help determine what's contributing to your pregnancy losses and use treatments such as genetic testing or IVF to help you conceive and have a healthy pregnancy.

3. You're over 40 and want to conceive

Once someone reaches their late-30s, both the quantity and quality of their eggs continue to decrease.

The average 40-year-old woman without any pre-existing conditions that affect fertility (such as a history of cancer) has about a 5% chance of conceiving each month.

By the age of 45, the average person’s ability to get pregnant on their own has substantially decreased, to the extent that they’re very unlikely to get pregnant without any intervention.

Remaining eggs in older women are also more likely to have abnormal chromosomes compared to eggs in those that are younger, which is one reason why working with a specialist can be beneficial.

Assisted reproductive technologies, including in vitro fertilization (IVF), can help with a variety of infertility causes that come into play in your 40s. This is a good option if your doctor uncovers damaged or absent fallopian tubes, genetic abnormalities of embryos, low ovarian follicle (egg) count, or a partner with low sperm quantity or quality.

4. You have a pre-existing medical condition that affects your reproductive health

Certain medical conditions can affect both the ability to get pregnant and the chances of delivering a healthy baby. It's recommended that people with a history of the health conditions below be evaluated by a fertility specialist before getting pregnant:

• Cancer (or previous chemotherapy treatment)
• Diabetes
• Genetic disorders
• Hypertension (high blood pressure)
• Heart disease
• Kidney disease
• Thyroid condition
• Endometriosis
• Family history of early menopause or other known fertility issues

Each of these issues is handled differently by fertility specialists. For instance, surgery, hormone replacement therapy, or the use of other medications might be needed to help someone become pregnant and remain pregnant.

5. Your periods are irregular or absent

In order to get pregnant without medical assistance, someone needs to ovulate (release an egg from the ovaries) so that the egg can be fertilized by sperm.

Not ovulating regularly — meaning less than once every 28 to 35 days — will make it harder to conceive. And for those who don't ovulate at all, getting pregnant won't be possible without help.

If you currently don't have a monthly period, visit a specialist for an evaluation in order to determine what could be the cause. The cause may be a condition such as PCOS, a thyroid disorder, or imbalanced hormones due to issues like low body weight, excessive exercise, or high amounts of stress. All of these can interfere with normal ovulation.

If your periods are irregular, meaning they're spaced out more than 35 days, you may have a condition affecting ovulation, such as PCOS. It's still possible to get pregnant, but it might take longer and/or require help from medications.

Also, signs such as bleeding between periods, very heavy and uncomfortable periods, and periods that last more than seven days are concerning. These can potentially indicate issues such as uterine fibroids, a cervical lesion, endometriosis, or an endocrine abnormality. These symptoms are usually something to first mention to your primary care provider or OB/GYN, and then potentially to a fertility specialist.

6. You have a pelvic inflammatory disease or another untreated sexually transmitted infection

Certain sexually transmitted infections (STIs) that go untreated or unmanaged can cause damage to the reproductive system, such as by contributing to pelvic inflammatory disease that causes scarring in the fallopian tubes. Sometimes, these can even be present without symptoms.

If an STI has led you to develop complications, such as pain, inflammation, and changes in your menstrual cycles, you should visit a specialist in order to determine how to best treat any existing damage.

Some STIs can also affect sperm mobility, function, and sperm count if they aren't treated properly, including chlamydia, gonorrhea, and hepatitis. Antibiotics soon after being infected are the best way to treat many STIs, but sometimes scarring needs to be removed in order to restore fertility.

7. You or your partner are dealing with sexual dysfunction

"Sexual dysfunction" comes in many forms, such as experiencing pain or bleeding during sex, trouble achieving or maintaining an erection, low cervical mucus, which leads to vaginal dryness, or general lack of libido and sexual interest.

To help you enjoy sex more and to decrease any discomfort you're facing, make an appointment with a fertility specialist who can help treat underlying causes, such as low hormone levels or scarring affecting the reproductive system. Hormone replacement therapy is sometimes recommended depending on the level of certain hormones, such as estrogen or testosterone, which contribute to a person's sex drive.

Your mental health might also come into play here, for example, if anxiety or depression or affecting your sex drive. In this case, your provider might recommend that you visit a therapist who can help.

If you can relate to any of the signs listed above, schedule a consultation with a fertility specialist today.