More Complex Fertility Problems
In the woman, blocked tubes from old infections or endometriosis pose the greatest challenges to the OB-GYN. You can have normal cycles and all the right hormones, but if there is a mechanical blockage in the system, sperm may never meet egg. And if there is a partial blockage, fertilization may take place, but the fertilized egg may get hung up on its way to the uterus, creating an ectopic pregnancy.
Surgery, laparoscopic (with or without laser) or conventional, may be necessary to treat blocked or kinked tubes. This treatment has become less popular, however, because of the increased success of other assisted reproductive techniques, like in vitro fertilization and other forms of artificial insemination.
Some very unusual infertility conditions may involve antibodies to sperm or involve recurrent miscarriage for immunological reasons. Antibodies related to the disease lupus and others may point to a recurring reason for infertility and early miscarriage. Again, a woman's regular OB-GYN can tell her and her partner when it's time to seek further specialists in infertility—usually when the causes of the infertility are unusual or require specialized surgery or sophisticated laboratory protocols.
Although an OB-GYN is a specialist also, it would be foolish for one to hang on to a particularly difficult case beyond his or her capabilities. When a certain level of difficulty is reached, a patient is best served going to a gynecologist who specializes in infertility.