This post was reviewed for medical accuracy by Rosalie Gunson, a Certified Registered Nurse Practitioner specializing in fertility care.
This picture is a bit of an exaggeration — you won’t literally graduate when you move on from a fertility clinic to a regular ob/gyn for prenatal care. But lots of people in the fertility world refer to it as “graduating,” because that’s what it feels like.
You’ll “graduate” to an OB when you’re about 8-10 weeks pregnant and your RE is confident that the pregnancy is stable. After that, your prenatal care probably won’t look much different from the care that non-infertile couples receive.
You may be referred to another type of specialist, a perinatologist, if you have a complex health history or complications arise during the pregnancy.
What does a reproductive endocrinologist (RE) do?
REs are a special type of ob/gyn, and they typically work at fertility clinics. They handle or oversee all aspects of fertility treatment, including retrievals and transfers for IVF.
They can also help women who’ve had recurrent pregnancy loss get to the bottom of the issue so they can hopefully have a healthy pregnancy with their rainbow baby.
You might wonder how REs are different from “regular” endocrinologists. Endocrinologists typically treat conditions like diabetes and thyroid disorders. They don’t have any special training in gynecology.
What does an ob/gyn do?
Most ob/gyns see a variety of patients, from teenagers dealing with heavy periods to women struggling with menopause symptoms. They do screenings, prescribe birth control, and treat gynecological conditions like endometriosis.
Some ob/gyns also do a certain amount of infertility testing and treatment. For example, I never saw an RE. My ob/gyn practice had a doctor and a nurse devoted to infertility patients, and they oversaw my medicated cycles and did my IUIs. Had I needed IVF, though, I would have been referred to an RE at a fertility clinic.
When it comes to pregnancy, ob/gyns handle prenatal care and deliver babies at the hospital, sometimes as part of a team that includes midwives.
They also do gynecological surgeries such as c-sections and tubal ligations (“getting your tubes tied”). REs don’t usually deliver babies themselves, but they have the training needed to do so.
For more info on the different providers involved in women’s health and fertility care, see Can Your PCP Prescribe Clomid?
How far into pregnancy will you transition from an RE to an OB?
If everything is going well, you will probably be discharged to an OB at 8-10 weeks, or about 3-5 weeks after you found out you were pregnant.
Remember that pregnancy dating is weird! It usually starts with your last menstrual period, which was before you even ovulated.
If you did IVF, though, your due date may not be based on the LMP. See my post Are Due Dates More Accurate With IVF? for more info.
By this point, your RE will have confirmed that your pregnancy looks viable — for example, the fetus has a heartbeat, is in the right place (not ectopic), and is growing “appropriately” for its gestational age. Since you did fertility treatment, the gestational age and your estimated due date should be pretty obvious.
If you’ve been going to a fertility clinic until now, you will likely be doing your prenatal care at a different practice. Many people have to travel a good distance to get to a fertility clinic, so being able to see a local ob/gyn is far more convenient.
What can you expect from the first appointment with your OB?
Typically, the first prenatal appointment will include the usual measurements (your blood pressure, weight, etc.), and a thorough review of your medical history. They’ll probably take some blood and have you pee in a cup. If you’re due for a Pap, they might do that too.
Many newly-pregnant women are afraid to get their hopes up in case something goes wrong. Anxiety after successful fertility treatment is very, very common! Don’t hesitate to share your concerns, even if they seem silly to you. This is a great opportunity to ask questions and get a feel for the practice.
If your new OB team doesn’t treat you with respect and compassion, dump them. I’m totally serious. Life is too short, and your health and the health of your baby are too important.
Will your prenatal care be any different because you did fertility treatment?
It depends on why you needed fertility treatment and whether you have a history of pregnancy complications.
Typically, women who did fertility treatment find out they are pregnant very soon — as early as 5 weeks. So by the time you’re discharged from your fertility clinic, you’ll have had more ultrasounds and blood work than the average woman gets in early pregnancy.
It’s not unusual for “regular” pregnant women to have no idea what their beta test result was, or what a beta even is!
Not all OBs are super knowledgeable about fertility treatment, especially IVF. Your new doctor may be confused about how your due date was calculated, for example. The info they need should be in the discharge paperwork from the fertility clinic.
Once you’ve moved on to an OB, your prenatal care will probably be about the same as anyone else’s. You may be surprised how few visits are actually involved! For uncomplicated pregnancies, a typical prenatal care schedule looks like this:
- Weeks 4-28: Once a month (with a thorough ultrasound around 20 weeks)
- Weeks 28-36: Twice a month
- Weeks 36 until delivery: Once a week
(That was before the pandemic. COVID-19 precautions have led many providers to scale back on routine visits.)
The transition can be jarring for women who are used to much more frequent appointments. When you’ve had as many as 4 ultrasounds in a single week, it’s very unsettling to hear you don’t need to come back for a month.
I was actually such a basket case in one of my prenatal appointments, the midwife ordered an extra scan just to reassure me that all was well.
If you did fertility treatment and are pregnant with multiples, you’ll be followed more closely and have more ultrasounds than women with singleton pregnancies. But that’s because multiples pregnancies are considered higher risk, not because of the fertility treatment per se.
For more info on the connection between fertility drugs and multiples, see my post Will Clomid Make You Have Twins?
Similarly, many women who conceived with fertility treatment have a history of pregnancy complications or miscarriage. Their doctors may recommend additional measures, such as hormone supplements or a cerclage, to help ensure a successful birth. But again, that extra support is because the pregnancy is considered high-risk.
Women who are pregnant with multiples or have a history of pregnancy complications may also be referred to a perinatologist for specialized prenatal care.
When might you need to consult with a perinatologist (also called a MFM)?
Most pregnant women will never need to see a perinatologist (also called a maternal fetal medicine specialist, or MFM). Like REs, perinatologists are a special kind of ob/gyn. They specialize in high-risk pregnancies.
I mentioned that women with a multiples pregnancy may see a MFM. I actually never saw one, mainly because I had the least-risky type of twins. My twins were di/di, which means each one had their own sac and placenta.
I probably would have seen a MFM if my twins shared a placenta, because that’s when many of the most serious twin-pregnancy complications can happen (such as twin-to-twin transfusion).
Here are some other reasons people may see a MFM as part of their prenatal care:
- The mother has a chronic disease (such as diabetes, heart disease, lupus, seizure disorders, etc.)
- Complications (such as problems with the placenta, preeclampsia, preterm labor, etc.) arose during this pregnancy or a previous pregnancy
- There are concerns about abnormal fetal growth or development
- There is a family history of genetic disease
Depending on the reason for the consult, you may only have to see the MFM once or twice during your pregnancy.
If the situation affects plans for childbirth, the MFM may be part of the team delivering your baby. That may involve planning to deliver at a specialty hospital further from your home if your local hospital doesn’t have the appropriate specialists on-site (or a well-equipped NICU, if needed).
Final thoughts
Being able to graduate from an RE to a regular OB is a step that many infertile couples dream about. It’s definitely a cause for celebration, although don’t be surprised if it feels a little bittersweet:
You probably developed a bond with your fertility team, especially the nurses and sonographers you saw regularly.
You might also feel anxious about what comes next, and even survivor’s guilt when you think about all those still trying for their BFP.
On top of all that, you might be dealing with nausea, exhaustion, or other side effects of the pregnancy you wished so long for.
All of those emotions are totally normal and understandable! Let yourself feel whatever you feel, and try to take each day as it comes. I know that sounds like lame advice, but it’s trite because it’s true!
As always, I wish you the best of luck with your pregnancy and beyond.
This post was last updated in June 2020.
I’m Jenn! Here I am with my beautiful twin boys. My pregnancy was possible thanks to fertility treatment for PCOS.
