What Happens Now? | FAQs for the Fertility Clinic to OB/GYN Transition

You're finally pregnant! Everything should be sunshine and rainbows now...right? Of course it's wonderful news. But being pregnant doesn't erase everything it took for you to get here.

In this article:

• I'm pregnant... now what?
• FAQs: Fertility Clinic to OB/GYN Transition
• How long will I stay with my fertility clinic after I get pregnant?
• When should I make my first appointment with my OB/GYN?
• FAQs: Pregnancy After Infertility
• Do I need a high-risk doctor?
• What is a 'geriatric' pregnancy?
• How often will I see my OB/GYN during pregnancy?
• Will I ever be a "normal" pregnant person?
• FAQs: Becoming a Parent After Infertility
• How do I transition from fertility patient to parent?
• What if I don't feel as happy as I thought I would?
• Will I ever be able to conceive on my own in the future?
• Advice from Former Fertility Patients
• Be Gentle with Yourself

I'm pregnant... now what?

As fertility patients, we put so much focus on the getting (and staying) pregnant piece of the puzzle, we don’t often let ourselves wonder about what comes next - for fear that it might never come.

So, what IS next? What can you expect when leaving your fertility clinic and transitioning to a new healthcare provider like an OB/GYN or midwife? It's only natural to have lots of questions popping up in your head right now. Let's talk through them together so you feel more confident as you enter the next phase of your journey to parenthood.

Here are the most frequently asked questions we hear from people in our support groups and in one-on-one conversations with patients about this exciting (yet emotional) transition from the fertility clinic to OB/GYN or midwifery care.

Note: The terms OB/GYN and midwife will both be used throughout this article, but the advice applies to both - regardless of the type of provider you choose for your pregnancy care.

FAQs: Fertility Clinic to OB/GYN Transition

Moving on from your fertility clinic can bring up a mix of emotions - gratitude (that you're finally pregnant), anxiety (not knowing what your new Care Team will be like), the list goes on.

Here are some common concerns and questions about this big transition period:

How long will I stay with my fertility clinic after I get pregnant?

Most fertility clinics “release” you to your obstetrician/gynecologist (OB/GYN) or midwife between 7-10 weeks of pregnancy. Typically, your fertility practice will have checked your blood HCG levels at least twice to confirm that they are rising normally.

What is HCG? Put simply, HCG (short for human chorionic gonadotropin) is the hormone that indicates pregnancy.

At least one ultrasound is also typically done at your fertility clinic, checking to see if there’s a gestational sac and/or a heartbeat. Keep in mind, all fertility clinics have different criteria and standards, so your experience may vary. 

When should I make my first appointment with my OB/GYN?

Obstetricians and midwives often book pretty far out, but they are also practices designed to frequently accommodate new patients (like you!) who are pregnant. Even though they are used to welcoming newly pregnant patients at different points during pregnancy, it's recommended that you call them and find out when they want to see you.

Some OB/GYNs or midwives want to see you earlier than is traditionally recommended, especially if you have undergone fertility treatment. Also, if you call earlier, you are more likely to get an appointment that suits you best.

Pro tip: Call and make your first appointment with an OB/GYN or midwife after you have had an ultrasound confirming the blood test results showing that you are pregnant.

Is it weird that I don’t want to leave my fertility clinic?

Nope. Even though you never wanted to need a fertility doctor to become pregnant, there is a high likelihood that you have grown attached to your reproductive endocrinologist and Care Team.

Fertility treatment cycles are so demanding of your time - you probably saw the fertility treatment team, including front desk staff, medical assistants, nurses, mental health professionals, and of course, the doctors...a lot. You may have even seen these team members several times a week at certain points during treatment.

You’ve grown attached to them (and believe us, we've grown attached to you too). You know their first names, they know yours. It’s hard to leave, even when getting pregnant and moving on was the goal of fertility treatment. So, know that you are in good company if you feel sad or strange about leaving your fertility clinic.

One question fertility doctors get asked a lot is “Can you also deliver my baby?” Well, technically, yes! A board certified reproductive endocrinologist (REI) is also board certified in Obstetrics/Gynecology. But unfortunately, the answer is no. Your fertility doctor sticks to helping people get pregnant, not delivering babies.

How do I say goodbye to my fertility clinic?

The answer to this varies from patient to patient. There is no perfect way to do it!

• Some patients leave their fertility clinic and never look back
• Some people bring or bake goodies as a thank you
• Some write a heartfelt card to their doctor
• Some send a birth announcement when their baby is born
• Some give gifts to special fertility treatment team members

We get a lot of holiday cards with updates, which we absolutely LOVE! And many patients just express their love and appreciation directly. However you choose to say goodbye during this transition, know that we get just as attached to you as you do to us.

Get free support:

Reach out for support and a compassionate listening ear. As a former fertility patient herself, Lisa Rosenthal is able to support those navigating this journey with a unique level of empathy. 

FAQs: Pregnancy After Infertility

Navigating the massive shift from trying to get pregnant to actually being pregnant can be quite challenging for some fertility patients. If you're feeling unexpectedly sad, anxious, or having a hard time connecting with your growing belly, you're not alone.

Here are some common questions we hear from newly pregnant parents-to-be:

Do I need a high-risk doctor?

The answer to this will depend on your personal medical history. To determine whether you need to transition to the care of a high-risk doctor, you and your OB/GYN and/or your fertility doctor will assess your needs and have a conversation.

If you’ve spent a long time trying to achieve a successful pregnancy and have had to undergo fertility treatment, you may assume that you need a high-risk doctor. You may be pleasantly surprised to find out that you likely don’t need one!

High-risk doctor: A physician who specializes in taking care of patients who are experiencing complications with their pregnancy (this often includes twin pregnancies). One type of high-risk doctor is called a maternal fetal medicine doctor (MFM).

While getting pregnant might have been difficult, try to keep in mind that that was due to fertility struggles. Being pregnant may be a very different experience for you in comparison to your fertility journey.

If you've experienced pregnancy losses or any bleeding (with this or other pregnancies), then you may be considered high risk. However, if you haven't, you'll likely be considered a typical pregnant patient after leaving your fertility clinic.

After trying so hard to conceive, it may be a bit of a strange adjustment, even if it’s a welcome one. Moving away from having something "wrong" (infertility) to having everything be "normal" can feel very strange - even anxiety-inducing. If you're feeling this way, know you're not alone!

What is a 'geriatric' pregnancy?

Only in the field of reproductive health could anyone be called "geriatric" if they’re age 35 or over! The term feels insulting, no doubt, especially when your ego has taken so many hits with infertility already. Many of us have had to manage feelings of being "damaged" or "less than" when we couldn’t get pregnant on our own (the old-fashioned way).

Hearing you're now a "geriatric" pregnant person feels like adding insult to injury.

One very important thing to remember is that this is mainly a label. Another term for this is "advanced maternal age." Less offensive? Not sure about that.

However, there are a few things that will need to be done differently in your pregnancy because of some increased risks due to your age. Yes, there may be more monitoring than if you were under 35. But after all you’ve been through to get pregnant, you may actually appreciate the extra care!

How much of my fertility journey should I share with my OB/GYN?

When it comes to details about your medical and physical history, share everything with your OB/GYN or midwife. It’s the best way for them to full understand and provide the care you need during this pregnancy.

By sharing your full history, you can even lower your risk of complications or surprise issues. 

Note: Mental health history is also different than emotional health history and should always be shared. Be sure to tell your OB/GYN or midwife about any medications or extra tools you need to help support your mental health.

What do you need to share about your emotional history with infertility? Well, it's up to you. Some patients become very close with their OB/GYN or midwife and end up sharing quite a lot about what they experienced during the ups and downs of fertility treatment.

Some patients do not. Some feel quite nervous going to see their OB/GYN or midwife and need to express their concerns and get reassurance that everything is normal and okay. Some patients go through their pregnancies completely confident, without bringing the emotions of their infertility experience with them.

Expect that you will be somewhere on that spectrum and that your experience with your new provider may slide around a little. Some appointments you will feel confident and relaxed. Some appointments you may not. 

Give yourself a break, and know that no matter how you're feeling - it's all okay. Share what you want to share with your OB/GYN or midwife, but don’t feel compelled to if you aren't comfortable.

How often will I see my OB/GYN during pregnancy?

If you have a typical, non-high-risk pregnancy, you’ll usually see your OB/GYN or midwife on a schedule that looks something like this:

• Prenatal visit every 4 weeks until 28 weeks gestation
• Prenatal visit every 2-3 weeks from 28-36 weeks gestation
• Prenatal visit every week until delivery after 36 weeks gestation

The frequency of your appointments during pregnancy will of course depend on your individual situation, but this may help give you a sense of what to expect!

Will I ever be a "normal" pregnant person?

You will discover the answer likely fluctuates between yes and no and everything in between.

The most important thing is to notice how you feel. Resist the urge to shame yourself for not experiencing pregnancy the way you think you should.

Another thing to avoid? Comparison. Just because your brother's wife went through IVF and had the "perfect" pregnancy and seemed to love it 24/7 doesn't mean you should too. Each person and each pregnancy are unique. 

Feelings are just feelings - not a reason to judge yourself. You’ll enjoy your pregnancy more fully if you simply avoid shaming yourself.

FAQs: Becoming a Parent After Infertility

Even though you've worked so hard to get to this point, you may find that shifting your identity from fertility warrior to new parent is surprisingly challenging. Here are some common concerns we hear from those who have battled infertility:

How do I transition from fertility patient to parent?

For some, the pain of infertility disappears the moment the baby arrives, not to be thought of again, or at least not frequently. But for most of us, it sticks around and rears its ugly head at moments that we think should feel less tender because we’ve now had our own baby:

• Pregnancy and baby shower announcements
• Questions about when we’re going to have another baby
• Feeling the pain of knowing that there may not be another child
• Considering when to start treatment again to have another child
• Bumping into a pregnant friend

Switching identities from fertility patient to parent is, of course, a relief. You finally get to be a parent instead of someone standing on the sidelines looking on at all the fun. That relief can also be delayed, as those nine months of pregnancy aren't always when we feel that role shift from patient to parent - that often doesn’t happen until baby arrives.

Note: Some of us feel almost shocked when there’s an actual baby in our arms after so much time spent trying and waiting. Be patient with yourself and know it will eventually feel real (and joyous). 

Will I be a good parent?

Having gone through infertility, you may think that you will have extra patience as a parent - and you might! You will also likely discover that your baby has no idea what you’ve gone through to have them and will be just as much work as any other newborn.

Like any other parent, you will want to do things perfectly and then come to realize that there’s a whole range of what that looks like for each family. Some babies have a harder time adjusting to the outside world and will cry a lot, even when you are doing everything right. 

It's okay to feel frustrated and overwhelmed.

Remember: You are the best parent for your baby, and the tough moments will pass.

A good rule of thumb to follow throughout parenthood? Keep forgiving yourself. Perfect isn't necessary (or even possible), so don’t be hard on yourself. You will do this right enough.

What if I don't feel as happy as I thought I would?

You will likely be navigating complex emotions as someone who has been through infertility and desperately wanted to be pregnant for so long. When it isn’t exactly what you thought it would be and you don’t feel the way you thought you would, it can feel jarring.

Here's the honest truth: Not everyone looks at their newborn baby and immediately falls in love. If it doesn't happen for you right away, rest assured that you are not alone. Infertility, pregnancy, labor and delivery each take their own toll on your emotional and physical self.

Be gentle with yourself. Most of us do fall in love with our babies soon enough. But you’ve been through a lot and now are faced with intense hormonal fluctuations that can leave you crying at a moment’s notice.

All those stories about how exhausting it is to be a new parent? They’re true! It is exhausting. It is sometimes lonely. It can be confusing and stressful to try to interpret your baby’s needs.

Note: If you're struggling to connect with your baby, feel extremely anxious, or depressed, never hesitate to reach out to a therapist or your doctor for some extra mental health support. Postpartum depression affects around 15% of new moms.

Will I ever be able to conceive on my own in the future?

Depending on your circumstances (i.e. your diagnosis and other factors), you may be able to conceive on your own after having a child with the help of fertility treatment. If you have blocked fallopian tubes, low ovarian reserve or other functional challenges, you’re unlikely to conceive the next time on your own without fertility treatment.

Although around 17% of those who don’t succeed with IVF will conceive on their own within five years, the chances of that happening will depend on each individual situation. Also, keep in mind that five years is a long time in the world of fertility, so playing the "wait and see" game can diminish your chances should you need fertility treatment again.

Our advice? Go back to your fertility clinic for an evaluation if you think you want another child to be sure there aren't any major roadblocks in your way.

Advice from Former Fertility Patients

You know who really "gets" how hard all of this can be? Former fertility patients. Here’s some solid advice from those who have made the big transition from fertility patient to finally pregnant.

“All my energy changed. I wouldn’t say that all my nervousness disappeared, but having new doctors made me feel like I had a new start. I saw myself as they saw me, an average pregnant woman!” - JW

“Best advice I could give? Pick an obstetrician that you really like, even if they are part of a large practice. You need to start this new experience with really liking and trusting someone.” - KV

“I wish I'd realized that my new healthcare provider already knew my history with infertility. My fertility practice sent them my history ahead of time. I spent more time than necessary telling them things they already knew because I was so nervous!” - BK

“Make use of the Pregnancy After Infertility [Facebook] group, even if you didn’t use the Ladies Night In group. Hold yourself gently and (try to) remember each moment is what you wanted and worked so freaking hard to get to experience.” - SL

“Advocate for yourself.” - GS

“If you need less medical intervention because you are tired of that and ready for your capable body to take over, just talk to your doctor about what things can be left out safely.” - AH

“The relationships that I made at my fertility practice—I still have them! I send them pictures and updates regularly. I’m excited to go back for Baby #2.” - PG

Be Gentle with Yourself

If you're feeling differently about being pregnant than you expected, give yourself a break. There was a lot of focus on getting pregnant. Now the focus has shifted to being pregnant.

I promise you’ll get there eventually and begin to embrace it. Even the people who have a hard time enjoying or accepting their pregnancy because of previous disappointments need to know that those feelings won’t create a bad outcome.

It can also be helpful to find a creative outlet! Here are some ideas:

• Writing
• Painting
• Dancing
• Walking
• Meditating 
• Picking up an old hobby

And if you choose to meditate: while you’re doing it, talk to your baby (you can do this out loud or in your head). You can also use a mantra. This can be very comforting and help connect you to the pregnancy that you’ve been dreaming about for so long. 

Lastly, be present with yourself, without judgment. Throughout this fertility clinic to OB/GYN transition and your pregnancy journey, you’ll likely have moments of intense joy as well as moments of worry. Just remember: you've worked so hard to get here, and however you're feeling right now is okay.

You've got this. And we're so excited for you!