General OB's treating infertility?

[JDoc9]

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Hi board,

Just had a quick question:

What is the scope of practice of General OB/GYN's in treating infertility without REI sub-specialization? I know/assume they probably should not be performing IVF, but just how much infertility work is done in the basic day-to-day of the general OB? Thank you in advance for your responses!

 

[THP]

Typically I will do a fairly in depth lab work up - which is really guided by the subset of infertility your evaluating, i.e. RPL versus not conceiving. In terms of imaging, will do US, SIS, hysteroscopy, HSG, diagnostic laparoscopy with chromopertubation, myomectomy - again depending on the situation. I do not do semen analysis and it is important to have a reliable lab you can refer to. In terms of treatment I will do clomid or letrazole +/- Ovidrel depending on the situation. I do not do IUI but I know there are general OB/GYNs who do. Obviously do not do ICSI or IVF. I have a great relationship with the local REI group.

 

[Geekchick921]

Typically I will do a fairly in depth lab work up - which is really guided by the subset of infertility your evaluating, i.e. RPL versus not conceiving. In terms of imaging, will do US, SIS, hysteroscopy, HSG, diagnostic laparoscopy with chromopertubation, myomectomy - again depending on the situation. I do not do semen analysis and it is important to have a reliable lab you can refer to. In terms of treatment I will do clomid or letrazole +/- Ovidrel depending on the situation. I do not do IUI but I know there are general OB/GYNs who do. Obviously do not do ICSI or IVF. I have a great relationship with the local REI group.

This is intriguing. I would really like to do this in my own practice one day. As it stands I love REI and think it's fascinating but don't want to give up obstetrics. Obviously, I might change in a few years but that's where I'm at now.

 

[THP]

This is intriguing. I would really like to do this in my own practice one day. As it stands I love REI and think it's fascinating but don't want to give up obstetrics. Obviously, I might change in a few years but that's where I'm at now.

I enjoy the REI evaluation and treatment, especially if I can help get her pregnant and then deliver the baby. It is very rewarding and you will have a patient for life.

Admittedly REI is not what I spend the majority of my time doing but I am doing a least a basic work up a few times per week. Pretty much always have a couple patients trying clomid or letrazole each month. One of the consequences of women waiting until their mid-30s to get married and then not trying for children right away.

 

[sia_simba]

I use to do infertility work up and simple ovulation induction. Checked for ovulation, semen analysis, ovarian reserve, HSG, etc. Anything else which requires FSH stimulation, hcg, etc. I leave it alone simply because of the higher risk of OHSS. I've never tried letrazole either, but its an alternative. I personally don't go more than 6 courses of clomid, even though some documents will say 10-12 courses increases your risk of ca. I also have an age cut-off of 35-38 depending on whether or not this is primary or secondary infertility.