While some women see a separate ob/gyn on at least an annual basis, lots of women see their primary care physician for all their medical care, including their birth control prescriptions and annual gynecological exams.
If you don’t already have an ob/gyn, you may wonder if you can get fertility medications like Clomid through your regular primary care doctor.
Primary care doctors usually won’t feel comfortable prescribing Clomid or any other fertility drugs, because:
1) It’s not their area of expertise, and
2) A specialist would be better equipped to do the testing and monitoring involved.
The Role of Primary Care Physicians (PCPs)
Many medical insurance plans require people to designate a doctor as their primary care physician (PCP). This doctor handles all the run-of-the-mill medical stuff, from strep throat and flu shots to mystery rashes and annual physicals.
If you need to see a specialist, your PCP would refer you to that specialist. They would also oversee the big picture, including all the medications you are taking and your overall health.
If you have concerns about your fertility or your menstrual cycles, your PCP may order blood work to check for non-gynecological medical conditions. For example, you could have a thyroid problem that is messing with your cycles.
If those tests come back negative, your PCP would likely refer you to an ob/gyn.
The Role of Obstetrician/ Gynecologists (Ob/Gyns)
PCPs see people of all ages with all kinds of conditions, so there is some overlap with a lot of medical specialties. Some women have their PCP handle their annual exams, cancer screenings, and birth control prescriptions, while other women prefer to see a separate ob/gyn for these things.
For instance, if you have an IUD, you’ll need to have your primary care physician or an ob/gyn remove it for you so you can begin TTC. I have a whole post about that scenario here.
Usually, you’d see an ob/gyn (with or without the support of a midwife) for the following:
- Treatment of ovarian cysts, endometriosis, uterine fibroids, etc.
- Childbirth
- Surgery, such as c-sections and tubal ligations (“getting your tubes tied”)
- Prenatal and postpartum care
- Infertility evaluation
- Treatment of menopause symptoms
Ob/gyns see patients with these conditions every day, and they have up-to-date expertise. When I saw my PCP for an annual physical while I was doing fertility treatment, it was obvious that she wasn’t familiar with the injections I was taking, or why I was unable to tell her the specific dose (it varied by the day).
An ob/gyn or a fertility specialist would also do testing that the average PCP doesn’t have the equipment for. Most doctors will want to do some baseline testing before prescribing medications like Clomid, to make sure that you don’t have an underlying issue that needs to be addressed first.
For instance, there is not much point in going through repeated Clomid cycles if your fallopian tubes are blocked. You would find that out by doing a test called an HSG. See my post Does an HSG Hurt? What to Expect for more information about this test.
In addition, your ob/gyn will want to monitor your follicles to ensure that you are responding to Clomid appropriately. Follicle monitoring is done using transvaginal ultrasound.
Your doctor will also be able to measure the endometrial lining via ultrasound. I go into more detail about the importance of a good lining in the post Can You Get Pregnant With a 5 mm Endometrial Lining?
As I explained in another post called Will Clomid Make You Have Twins?, doing unmonitored cycles is not a good idea. You don’t know if you’re responding well (or too well!), and you could risk developing OHSS or getting pregnant with multiples.
Knowing you have several mature follicles and making the informed decision to move forward is one thing… Unwittingly conceiving quadruplets is another!
The Role of Reproductive Endocrinologists (REs)
Reproductive endocrinology is actually a sub-specialty of obstetrics and gynecology. REs can do more advanced fertility treatment than regular ob/gyns, including IVF and genetic testing.
Women with complex health histories, including those who are TTC a rainbow baby after recurrent pregnancy loss, may see an RE to maximize their chances of a successful full-term pregnancy.
I never actually saw an RE. I did all my fertility treatment at a women’s health practice that included a team of ob/gyns and midwives. One of the ob/gyns specialized in fertility, so all the fertility patients saw her until they were about 8 weeks pregnant.
After that, I was able to see any of the providers. See Graduating from an RE to an OB for Prenatal Care for more info on the transition to prenatal care.
For most things, it was a one-stop shop. I had my blood drawn there, my ultrasounds done there, my IUIs done there, and my HSG done there. If I had needed IVF, though, I would have had to go to a fertility center in Boston, the nearest major city.
The REs in Boston would have handled the actual IVF process, such as the egg retrieval, and my local OB office would have done the follow-up.
A Few Notes About the ACA (Obamacare)
While I am on the topic of PCPs and ob/gyns, I should mention the Affordable Care Act (Obamacare). Whether you love or hate Obamacare, it’s important to understand a few provisions of the law that apply to women’s health.
One common misconception is that the ACA applies only to plans that people buy on the individual market, but these rules also govern most group plans that people get through their employer.
Before the ACA, insurance companies could apply co-pays and deductibles to certain women’s health services, or refuse to cover them at all.
They could also require you to get a referral from your PCP to see a separate ob/gyn, even for routine care. And then when you got to your ob/gyn appointment, they could charge you a higher co-pay for seeing a specialist. Ugh!
The ACA requires insurance companies to cover the following with no co-pay or deductible:
- Contraception
- Annual well-woman visits
- Screening for gestational diabetes
- Breastfeeding support, counseling, and supplies (such as breast pumps)
- Mammograms
Also, thanks to the ACA, insurance companies can’t charge you more for your premiums just because:
- You’re female
- You’re pregnant
- You have a history of medical problems
You still need to choose a provider in your insurance plan’s network, though. The ACA does not require companies to cover ANY provider you may want to see.
Depending on what treatment you are receiving, your provider may need to fill out pre-authorization paperwork for your insurance company. Some insurance plans will require preliminary screening to be done before they will accept a referral to an RE. This could include bloodwork and an ultrasound on CD 3, an HSG, and a semen analysis.
Keep in mind that you may be charged a co-pay or a deductible if you end up talking about a health concern during your appointment. For example, if you go to your annual physical and you mention that you are not getting regular cycles, suddenly that could become a “problem visit.”
This can be frustrating, because it means the visit is “free” unless you actually have a health issue worth discussing! But it’s better than nothing.
Obamacare does not require insurance companies to cover IVF or other fertility treatment, but some states have set their own requirements. Resolve, the National Infertility Association, is a great resource for state rules regarding insurance coverage for infertility treatment.
Resolve worked here in my home state of New Hampshire to strengthen requirements for infertility coverage. I posted a letter I wrote to my state representative in support of this legislation here.
For more information about health insurance for fertility, check out my post Insurance Coverage for Fertility Treatment: 8 Things to Know. I also have a specific post about the cost of IUIs called How Much Does an IUI Cost Without Insurance?
Conclusion
If you think you need a fertility medication like Clomid or letrozole, you will most likely have to see an ob/gyn or a reproductive endocrinologist (RE) for that prescription.
You probably don’t need a referral to see an ob/gyn, assuming you have an Obamacare-compliant health insurance plan.
But seeing your PCP about any fertility-related concerns you have is still a good idea, because your PCP may want to order some preliminary blood work before sending you to a specialist.
In any case, fertility is part of your overall health. Some people are even campaigning for regular periods to be considered a vital sign (I go into more detail on that here).
This post was last updated in May 2020.
I’m Jenn! Here I am with my beautiful twin boys. My pregnancy was possible thanks to fertility treatment for PCOS.
