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Fertility Doctor vs. Urologist: Who Should You See and When?

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August 29, 2016

When it comes to your infertility, it can be very difficult to decide which type of doctor you should see. Is a fertility doctor, or reproductive endocrinologist appropriate for treating both female factor infertility and male factor infertility? What about a urologist? The truth is, each doctor shares the goal of helping a couple have a baby and should refer you when a diagnosis is beyond their expertise.

For instances of female infertility like Endometriosis, Polycystic Ovarian Syndrome (PCOS), or high FSH, it is best to see a fertility doctor. Male factor infertility issues like low count or morphology may be suited for a fertility doctor as well, while varicocele, blockage, or vasectomy reversals are appropriate for a urologist.

Fertility doctor, David Walmer, M.D., of Atlantic Reproductive Medicine Specialists in North Carolina, believes that the majority of male factor infertility can be addressed by increasing egg production in the woman. “Eggs are the rate limiting step in reproduction. The goal is getting more eggs as targets for sperm”, he says. Most fertility treatment focuses on the woman because reproductive events are centered in the woman and advances in fertility treatment like intracytoplasmic sperm injection (ICSI) can offer high success rates when addressing male factor infertility.

When a referral to a urologist is needed, the fertility doctor fosters open communication with the urologist to ensure a collaborative effort in care for the patient. “If you think a patient needs an examination due to history, as in childhood injury or testicular torsion, or if impotence is a problem it is appropriate to see a urologist.” Similarly, if sperm is needed for a procedure like in vitro fertilization (IVF) with ICSI after a vasectomy or behind an obstruction, Dr. Walmer refers patients to a urologist without hesitation and ensures his laboratory team is present at a surgery to properly collect and freeze sperm for use in a future cycle.

Male factor infertility issues like sperm count can be treated with Clomid, which increases gamete production in women and men, though there are typically underlying factors- environmental or biological- affecting sperm production. Patients are encouraged to stay active and healthy, and to take a multivitamin to help boost nutrient intake.

In instances of extremely unhealthy states when sperm counts are low, it might be our body’s way of telling us there is another problem to be treated. “When sperm counts are low, the body says now is not a good time to reproduce and we have to put our energies into something else,” Walmer says.

“Ultimately, at the end of the day, IVF has become so successful it fixes every problem we know how to fix.” A recent study presented at the 2012 ASRM meeting shows advancements with single embryo transfer and PGD can yield higher success rates than a traditional double embryo transfer. ICSI, another astounding discovery, is effective for male factor infertility.

Knowing which doctor is appropriate for your diagnosis can be a challenge, but rest assured that a fertility doctor is an appropriate option for addressing the overall picture of infertility. They are specially trained to address many male factor issues, and will recommend a urologist for more complex male infertility cases.


Comments (3)

I've gone to a reproductive endocrinologist for 1.5 years. 5 miscarriages later, never making it past 6.5 wks, I wonder if I'm in the right place. I read up on IID and wonder if the I'd something in my itinerary tract killing the embryo? Thoughts?

Hi I'm 30 year old woman with PCOS and my husband is 32 with poor sperm morphology any help please..husband also on medication for type 2 diabetic and high blood pressure but al of that is under control and normal for years. I had 2 miscarridges.

I'm so sorry for your losses. You really should see a fertility doctor (reproductive endocrinologist) for a consultation. Our Patient Care Advocates can help you find someone in your area that's the right fit for your situation. Please contact us at 855-955-2229 or Best, Claire

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