Why choose Dr. Schmidt?

Dr. Schmidt's many years of experience as a physician specializing in this field will help you with emotional roller coaster and help you see the light at the end of the tunnel. Having experienced all IVF/IUI procedures herself, Dr. Schmidt, is very aware of what you are experiencing.

Dr. Schmidt is a highly respected authority in her field and is a frequent speaker on all infertility and gynecology issues at hospitals, clinics and on the news. See our In the News section.

What is a Reproductive Endocrinologist and how are they different from an OB/GYN?

An Ob/Gyn has completed a four year Ob/Gyn residency (after four years of college and four years of medical school). During their four year residency, they obtain broad based knowledge in the entire field of obstetrics and gynecology. Because of time restraints, learning the sub-specialty of Ob/Gyn known as REI (Reproductive Endocrinology) is limited to 2 - 4 weeks. REI encompasses three subspecialties of Ob/Gyn;

1. Infertility
2. Pre-Menstrual Syndrome (PMS)
3. Menopause

An REI has two to four years additional training after Ob/Gyn residency in what is called a Fellowship. During the Fellowship, education and experience is composed solely of in-depth study of the above listed three categories of reproductive endocrinology. Thus an REI is the sub-specialist of the Ob/Gyn specialist. The REI will do some basic infertility testing (or this may be performed by a general Ob/Gyn) and then proceed, if necessary with medical and or surgical procedures to assist you in your goal of pregnancy. Medical procedures may range from preparation of your partner's or donor sperm with subsequent intra-uterine insemination, to the highest technology currently available, IVF (In-Vitro Fertilization). The REI may suggest oral medication and possibly injections for a short period. Surgical procedures may be preformed by an REI to correct pelvic issues to enhance fertility. The REI may refer the male to a urologist who specializes in male infertility.

When do I need to make an appointment with an REI (Infertility Sub-Specialist)?

Many consult with an REI after one year of unprotected intercourse without achieving pregnancy or in the event of three miscarriages. However, several doctors recommend shortening the wait to 6 months if the woman is 35 years or older. It is encouraged by most to make the apt with an REI if you feel you can benefit, even if it is only to obtain reassurance that all is ok and you are proceeding correctly in your achieving parenthood.

What should I expect from my REI appointment?

An REI will take a very thorough medical history of both the woman and man. Also, any medical records will be reviewed. An ultrasound is usually performed. Planning of further basic testing, can be schedule if it has not previously done. Some of the testing is time sensitive, being performed at a specific time in the cycle. Depending on where the woman is in her cycle, some of the testing can begin right away.

Testing includes:

• Blood tests: done on day 3 and approximately day 21, 7 days after the woman surges. The surge = the message the brain sends to her ovary to release the egg mid-cycle. Surge precedes ovulation (release of the egg) by 1-2 days.

• Ultrasounds are done serially throughout the women's cycle to monitor two things: follicular development and uterine lining (thickness and configuration (triple vs. single layer).

• Hysterosalpingogram (HSG): a test done in the radiology department to assure the uterus has a smooth lining inside for the pregnancy to implant and to test if the fallopian tubes are patent and if not, possibly help them to unblock. Thus the HSG can be both diagnostic and therapeutic.

• Post coital test (PCT) is a test done mid-cycle after the woman surges and she has exposure to sperm, either by intercourse or intra-cervical insemination. A Q-tip is placed on the cervix where the sperm are and then touched to a microscope slide where the sperm are visualized for number (count) and movement (motility). Some women create antibodies that disrupt the sperm, keeping them from reaching the egg in the fallopian tube. If the PCT is abnormal, intra-uterine insemination of prepped sperm is recommended, along with a semen analysis.
  
  
• Semen Analysis is requested after a 3 day abstinence if the post coital is abnormal. A man ejaculates into a container provided to him, at the location of his choice, to be turned into the embryology lab within one hour of production after storing it next to his body for example in his pocket, or if the female brings it in, in a pocket or in the bra. Do not leave the sample out on the counter where it can be adversely affected from being too cold.

By the end of your first cycle (cycle= day 3 of the woman's period to day 28, which normally is the start of her next period), you should have an understanding of your diagnosis and the treatment plans available to you and if not pregnant, with what has been initially done, re-consult with your REI infertility doctor.