Most couples in India visit their gynecologist when they find out they have a problem conceiving. While most gynecologists are good at helping them sort out their problems, it’s also true that many gynecologists do not have the interest or the expertise to provide infertile couples with state of the art care. There are many reasons for this deplorable state of affairs.

1. Reproductive technology has advanced so rapidly in recent years that many gynecologists are not able to keep abreast of the latest advances. They have to depend on attending conferences to learn about recent trends, as a result of which many are woefully ignorant of what can be accomplished in modern IVF laboratories.
2. Because so many of these advances have occurred in the IVF laboratory, many gynecologists are completely clueless about what the “state of the art” treatment can offer to infertile couples today. Most have never stepped into an IVF laboratory, so they just don’t have an idea of what happens here. Most of their knowledge is “second-hand” or gleaned by listening to lectures at conferences – many of which are very confusing, leaving them more confused than ever !
3. Traditionally, doctors learn medicine during their residency by actually treating patients admitted in teaching hospitals. Sadly, no medical college in India offers IVF treatment to its patients. This means that all gynecologists in India who have graduated in the last 10 years and have received their training only in India, have never even seen an IVF procedure being performed, leave alone perform one ! While some of the more studious ones may learn the theory, they do not have any practical experience in treating infertile patients.  Many have to learn “ on the job”, by practicing on their patients; or by attending 4-day “workshops” so that they can get diplomas which proclaim that they are now “experts”.
4. Many continue to practice the “old-fashioned” infertility medicine which was taught many years ago, and have failed to keep up with the times. They continue to do perform outdated procedures such as unnecessary laparoscopies, instead of offering their patients the right treatment. A lot of these unnecessary surgical procedures ( removal of small fibroids or ovarian cysts) can result in iatrogenic infertility, by causing scarring or infection.
5. Many general gynecologists offer a wide variety of services and see a broad range of patients. They are often so busy delivering babies ( most gynecologists have a busy obstetric practice, which they refuse to give up) or performing laparoscopies, hysterectomies or abortions, that they do not have the time, energy or patience to devote to their infertile patients.
6. Because infertility is a small part of the general gynecologist’s practice, they often refuse to invest the money needed to upgrade their equipment. They either depend on old-fashioned ultrasound scanners ( with poor resolution); or refer their patients to radiologists for the ultrasound scans, as a result of which the patient’s care gets fragmented and disorganized. Many patients end up half the day just running around from the doctor to the sonography clinic to the laboratory, even for simple procedures like IUI ( intrauterine insemination).
7. Because they do not see a sufficiently large volume of infertile patients, they never acquire the experience , the expertise , or the skills, to treat patients with complex problems. Unfortunately, instead of referring their patients to infertility specialists, many prefer trying to do it all themselves, because they do not want to “lose their patient”. This is in sharp contrast to current practice in the US or UK, where gynecologists quickly refer infertile couples to specialists, when they realize they are not doing a competent job.
8. Because they are gynecologists, they do not have  clue about examining or treating an infertile man. This often means that the men are referred to a urologist, so that the care becomes unsystematic and confused, because the right hand does not know what the left hand is doing. The couple consequently suffers unnecessarily in the process.
9. Their clinics are not organized or stream-lined to treat infertile couples. This means that  infertile couples are often forced to wait along with pregnant women in the same waiting room – a fact which can be very demoralizing and disheartening, contributing to the sense of isolation and helplessness infertile couples feel.
10. They often lack the sensitivity and counseling skills to handle infertile couples, as a result of which their infertile patients often feel helpless and trapped. This is especially a problem with older women. Many gynecologists are not aware of how quickly fertility drops as a woman gets older; and often will waste a lot of time in the group of 35-plus women, by pursuing ineffective treatment options.

While I am not suggesting that all infertile patients need to be treated by specialists, if you are not happy with your present gynecologist, remember the fault may not be his – it’s just that he may not have the training needed to help you, as a result of which he may not be the best person to handle your problem. It’s always a good idea to get a second opinion from an infertility specialist, to ensure you are on the right track !