Don't delay infertility referrals.(Guest Editorial)

Many ob.gyns, do an excellent job caring for subfertile patients, and they're to be commended for that. They keep current, reading the latest reproductive medicine journals and attending meetings of specialty societies. They make fertility issues a priority in their practices and provide their patients with good emotional support.

Primary care ob.gyns. also conscientiously try to help all their patients who want to become parents achieve their goals. They counsel young women about how to preserve their fertility by following an appropriate diet and exercise routine, avoiding tobacco and drugs, and engaging in safe sexual practices. They tell women in their 20s that they should plan their reproductive lives, just as they have planned where to go to college, what type of a career to pursue, and where they'd like to live.

Knowledgeable ob.gyns. help dispel the myth that turning on fertility in a woman's 40s is just as easy as turning it off with the birth control pill or the patch at 22.

However, it is also possible for ob.gyns. to stop helping their patients and begin to inadvertently harm their chances of avoiding infertility. This happens when a woman in her 30s, maybe even her mid- to late 30s, brings up the issue and is reassured that she still has lots of time to start her family.

A survey by the American Infertility Association found that by the time a woman admits to her gynecologist that she is having trouble conceiving, she has been trying to become pregnant for 18-24 months.

Thinking she may just need more time, her physician may counsel her to try some more; they'll talk about it again at her next appointment. In a year. Or 18 months.

Perhaps the well-meaning doctor will start her out with higher and higher doses of clomiphene or artificial insemination for three or four cycles. Or five. Or six. Practicing infertility therapy using paradigms that were the best we could do 10 or 15 years ago does a tremendous disservice to patients in their mid-30s or older. The clock is ticking for such patients, depleting their chance of success--as well as ...