Gynecologists are primary health care physicians for women. This is why when a woman has infertility issues , the first doctor she will contact will usually be her gynecologist. Since gynecologists are specialists in dealing with women's health , they are very capable of handling basic infertility problems and will do so efficiently and effectively. Thus , most of them will do a basic workup in order to pinpoint what the problem is ; and will be able to offer basic therapy such as ovulation induction for patients with PCOD; or intrauterine insemination for patients with unexplained infertility.

It's appropriate that simple infertility problem should be treated by the gynecologist. Gynecologists are well equipped to handle these problems , and this is a much more cost-effective use of resources rather than using an IVF specialist. This is better for patients as well, because they already have a relationship with their present gynecologist , and would much rather be treated by them, rather than have to go look for a new specialist.

Most gynecologists understand their limitations ;and if they encounter infertile woman with complex problems ; or fail to get her pregnant in a few months with the first line basic treatment options which they can offer, they are quite happy to refer the patient to an infertility specialist for more advanced treatment. This kind of referral creates a win-win relationship for the gynecologist ( who can then expect the IVF specialist to refer her back for her antenatal care once she gets pregnant) ; the IVF specialist ( who can then focus his energies on women with complex infertility problems ) ; as well as the patient, who gets the best of all possible worlds.

However, sometimes there are gynecologists who refuse to accept their limitations and are reluctant to refer their patient to someone else. They will do their best to hang onto the patient because they do not want to "lose" their patient , as this would represent a financial loss to them ! Sometimes , it's an ego issue , because they feel they should be able to offer all the treatment themselves , rather than have to refer the patient to a specialist.

If this does happen, this is a disservice for the patient , who then gets trapped , and is forced to repeat ineffective treatments such as repeated cycles of clomid or IUI. These patients often get fed up and frustrated , and even though they want to move on, they don't know whom to go , which is why they remain stuck. They also naively believe that if they really required referral to an IVF specialist , the gynecologist would be happy to send them to one , and that if they gynecologist does not do so, this means they really don't need an IVF specialist at all.

However, you cannot afford to take such a passive approach to your treatment. You need to be much more proactive and have well-defined time limits , so you can maintain control of your course of action and formulate your own treatment plan, in partnership with your doctor.

What are some of the red flags which should cause concern ?
1. Your gynecologist keeps on repeating clomid treatment month after month
2. Your gynecologist does not seem to have a plan of action and does everything on an ad-hoc basis
3. Your gynecologist keeps on doing IUI treatment month after month
4. Your gynecologist advises you to do a laparoscopy
5. Your gynecologist refers you to an andrologist for treatment of a low sperm count

Sometimes patients are scared to ask their gynecologist to refer them to an IVF specialist because they're worried that the gynecologist may take offense at this , as he may feel that they're casting aspersions on his professional ability. Even worse , there are gynecologists who will bad mouth IVF specialists by labeling them as being greedy and money minded because they want to do IVF treatment all infertile couples .

While it is true that there are gynecologists who are very efficient at treating infertile couples cost effectively; and that there are some IVF specialists will overuse IVF treatment , the bottom line is that you need to take personal responsibility for educating yourself, so that you can use information therapy to make the decisions which are right for you.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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