Your first stop for infertility concerns is usually your OB-GYN, who can run initial tests and determine whether you need a specialist. From there, you may be referred to a reproductive endocrinologist for advanced treatment, or a reproductive urologist if male factor infertility is involved. The right doctor depends on where you are in the process and what’s causing the problem.
Start With Your OB-GYN
Your OB-GYN is typically the first doctor to assess infertility. They can order blood work to check hormone levels, urine tests to confirm whether and when you’re ovulating, and pelvic ultrasounds to examine your reproductive organs. For a male partner, they’ll often order a semen analysis to evaluate sperm count, shape, and movement, along with blood tests for male reproductive hormones.
Many OB-GYNs can also prescribe first-line fertility medications and perform basic procedures. But if initial treatments don’t work or testing reveals a more complex issue, your OB-GYN will refer you to a subspecialist.
When to Start the Process
The American Society for Reproductive Medicine recommends seeking evaluation after 12 months of trying to conceive if you’re under 35, and after 6 months if you’re 35 or older. If you’re over 40, more immediate evaluation is warranted. These aren’t arbitrary cutoffs. Egg quality and quantity decline meaningfully in the late 30s, and earlier intervention improves outcomes.
You don’t need to wait out the full timeline if you already know something is off. Irregular or absent periods, a history of endometriosis or pelvic surgery, or a known male factor issue are all good reasons to skip the waiting period and get evaluated sooner.
Reproductive Endocrinologist: The Fertility Specialist
A reproductive endocrinologist (often called an RE or REI) is the specialist most people think of when they hear “fertility doctor.” These physicians complete medical school, a four-year OB-GYN residency, and then an additional fellowship specifically in reproductive endocrinology and infertility. They’re board-certified through the American Board of Obstetrics and Gynecology.
REIs handle everything from ovulation-inducing medications to IUI (intrauterine insemination) and IVF (in vitro fertilization). They’re the only specialty with dedicated hands-on training in procedures like embryo transfers and difficult intrauterine inseminations. If you need IVF, an REI will manage your entire cycle, including egg retrieval, embryo development, and transfer.
They also manage complex reproductive surgeries. Severe endometriosis, large fibroids that distort the uterine cavity, structural abnormalities of the uterus, and scar tissue inside the uterus all fall within their scope. If your OB-GYN suspects any of these conditions are contributing to infertility, an REI is the appropriate next step.
Reproductive Urologist: For Male Factor Issues
Male factors contribute to roughly half of all infertility cases, yet they’re frequently underinvestigated. A reproductive urologist specializes in diagnosing and treating male infertility, going well beyond the basic semen analysis your OB-GYN orders.
Referral to a reproductive urologist is appropriate when a semen analysis shows abnormalities, particularly absent sperm (azoospermia) or very low sperm counts. Other triggers for referral include repeated IUI or IVF failure, recurrent pregnancy loss without an identified female cause, or a physical finding like a varicocele (enlarged veins in the scrotum that can impair sperm production). A reproductive urologist can diagnose and grade varicoceles on physical exam and counsel you on whether surgical repair could improve your chances.
These specialists also perform advanced sperm testing, including DNA fragmentation analysis and chromosomal screening, that can reveal hidden problems a standard semen analysis misses. This information can change the treatment approach, sometimes shifting a couple from IUI to IVF or to a more targeted form of IVF.
Specialists for PCOS and Endometriosis
Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility, and the core problem is usually absent or irregular ovulation. Treatment typically starts with lifestyle changes, which can sometimes restore ovulation on their own. When that’s not enough, medications that stimulate ovulation are the next step. Letrozole has been shown to be more effective than the older standard medication (clomiphene) at triggering ovulation and improving live-birth rates for women with PCOS. If oral medications fail, injectable hormones that directly stimulate the ovaries are an option, though they carry a higher risk of multiple pregnancies. Your OB-GYN may manage early PCOS treatment, but an REI takes over if you need more aggressive approaches.
Endometriosis-related infertility often requires both surgical and medical management. An REI can perform or co-manage surgeries to remove endometrial tissue, repair damaged fallopian tubes, or address ovarian cysts caused by endometriosis. When surgery alone isn’t sufficient, IVF is often the recommended path forward.
Reproductive Immunologist: For Recurrent Loss
If you’ve experienced multiple miscarriages, a reproductive immunologist may be part of your care team. Recurrent pregnancy loss can sometimes stem from immune system dysfunction, where the body’s inflammatory response interferes with a developing pregnancy. Specific issues include antiphospholipid antibodies that promote blood clotting in the placenta, an imbalance in immune cells that tips toward inflammation rather than tolerance, and elevated levels of inflammatory signaling molecules.
This is a newer and still-evolving field. Testing can identify specific immune profiles, and treatments range from established therapies to newer approaches that target particular immune pathways. Not every patient with recurrent loss needs immune testing, but it becomes relevant when standard causes (chromosomal abnormalities, uterine problems, hormonal issues) have been ruled out.
Key Tests You’ll Encounter
Two imaging tests come up frequently in fertility workups, and it helps to know the difference. A hysterosalpingogram (HSG) uses X-ray and a contrast dye to check whether your fallopian tubes are open. It’s about 83% accurate for determining tubal patency and requires a radiology facility. A saline infusion sonography (SIS) uses ultrasound and sterile saline to evaluate both the uterine cavity and tubal openness. It can be done in a clinic setting and is less invasive, but it can’t show detailed tubal anatomy or confirm which specific tube is open if only one is. Your doctor will choose based on what they’re looking for.
Choosing and Evaluating a Fertility Clinic
All U.S. fertility clinics are required to report their assisted reproductive technology outcomes annually. The CDC publishes these results in a searchable database that lets you compare clinics by success rates for your age group, using your own eggs or donor eggs. You can see what percentage of egg retrievals or embryo transfers resulted in live births, along with details about each clinic’s patient population and services. This data is freely available on the CDC’s ART Success Rates page.
When you visit a clinic for the first time, ask about success rates specifically for patients in your age group, not just the clinic’s overall numbers. Clinics that take on more complex cases may have lower headline rates but could be a better fit for your situation. Ask what your evaluation will include (blood work, ultrasounds, semen analysis, genetic screening), what the estimated cost of your recommended treatment will be, whether your insurance covers any fertility services, and what the plan would be if the first treatment cycle doesn’t work.
Insurance Coverage Varies Widely
Whether your insurance covers fertility care depends heavily on where you live. A growing number of states now mandate coverage for both infertility diagnosis and treatment, including IVF. Colorado, Connecticut, Delaware, Massachusetts, Maine, and the District of Columbia all require coverage of diagnostic testing, medications, and procedures like IVF and IUI. California and Illinois have mandates taking effect in 2026 for large group plans. Massachusetts has no lifetime cap or cycle limit, while other states cap coverage at a set number of egg retrievals (commonly three to six) with unlimited embryo transfers.
Even in states without mandates, many insurers cover diagnostic testing while excluding treatment. That means your blood work, ultrasounds, and HSG might be covered, but IVF or IUI may not be. Call your insurance company before your first appointment and ask specifically what fertility services are covered, whether you need a referral or prior authorization, and whether the clinic you’re considering is in-network. Many fertility clinics have financial counselors who can help you navigate this and discuss payment plans if you’re paying out of pocket.