Why OB/GYNs Need to Talk to Patients About Fertility

Most women have an OB/GYN they see regularly for birth control, Pap smears, STI testing, and any gynecologic issues.  For many women, the gynecologist is the only physician they visit on a regular basis.  Gynecologists can be on the front line of detection for health issues like high blood pressure, obesity, and diabetes.  They can also play an important role in how you manage your fertility, and discussion of fertility should be part of your care.

Protecting Your Fertility

Your OB/GYN can detect and treat infections that can directly impact your ability to have children down the road.  Even if you don’t want to get pregnant now, it is SO important to get tested regularly for sexually transmitted infections (STIs) and get treated when you need it.  Chlamydia and gonorrhea are causes of pelvic inflammatory disease, which can cause scarring and blockage of the fallopian tubes, a major source of infertility. Your gynecologist should ask you about your and your partner’s sexual activity and advise you when you need testing.  Chlamydia doesn’t always cause symptoms in women, and gonorrhea almost never does. The Centers for Disease Control and Prevention (CDC) recommends that sexually active women under age 25 and older women who have risk factors, like a new sex partner, having sex without using a condom, or a partner who has an STI, should be tested every year.  If you do have symptoms be sure and see your doctor right away.

Managing Conditions That Affect Fertility

If you have painful or heavy periods, bleeding outside your period, irregular periods or pain during sex, you may have endometriosis.  Studies have shown that between 25 percent and 50 percent of infertile women have endometriosis, and between 30 and 40 percent of women with endometriosis have fertility problems, according to the National Institute of Child Health and Human Development.  This condition sometimes does not cause symptoms, and may only be detected when you have trouble getting pregnant.  Tell your GYN if you do have symptoms.  An early diagnosis can help manage the pain and give you a heads-up on potential fertility problems. Polycystic ovary syndrome (PCOS) is another very common condition that is a primary cause of fertility problems.  In this condition a woman’s ovaries or adrenal glands produce too much androgen, which interferes with the development of follicles and release of mature eggs. PCOS is associated with overweight and obesity, but it’s a chicken-and-egg problem—it’s not clear if obesity causes PCOS or PCOS causes obesity.  As well as causing infertility, PCOS is associated with diabetes and high blood pressure.  Your gynecologist may refer you to an endocrinologist to diagnose and treat PCOS.

Referring You to a Fertility Specialist

Your gynecologist should talk to you about whether you want to have children and when you want to have them, and help you manage your fertility on your own terms.  If you’ve just started trying to get pregnant, make sure your OB/GYN knows you are trying.  They need to be aware that your clock is ticking, especially if you are 35 or older, and that having a baby is something you really want. If you are under 35 and have been trying to get pregnant without success for 12 months, or 35 to 39 and have been trying for six months, or 40+ and have been trying for three months, your OB/GYN can refer you to a fertility specialist, also known as a reproductive endocrinologist.  Be aware that you can also find a fertility specialist on your own, doing research on the internet and asking friends and family what their experience has been.

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