Closing fertility care gaps: A Q&A with Esther H. Chung, MD, FACOG

Fertility care is increasingly recognized as a critical component of preventive reproductive health, yet gaps in early education, emotional support, and timely intervention remain common for patients navigating infertility, according to Esther H. Chung, MD, FACOG, a board-certified ob-gyn and reproductive endocrinology and infertility specialist at HRC Fertility.

Delayed awareness of age-related fertility decline and limited integration of mental health resources can leave patients feeling unprepared and unsupported as challenges arise. As a result, there is a growing opportunity for the role of obstetrician-gynecologists in initiating proactive, routine conversations around fertility goals, reproductive timelines, and potential risks well before patients begin trying to conceive.

In this Q&A interview, Chung discusses key gaps in infertility care, practical strategies for earlier intervention, and how providers can better support patients both clinically and emotionally throughout their reproductive journey.

Q&A with Esther H. Chung, MD, FACOG

Contemporary OB/GYN:

What are the most common gaps in support you see among patients navigating infertility, and how can ob-gyns address these earlier in care?

Chung:

One of the most significant gaps is the lack of early, proactive fertility education. Many patients overestimate their reproductive timeline and are not aware of how quickly fertility declines with age or other contributing factors. This often leads to delayed evaluation and fewer available options. They often feel caught off guard when challenges arise.

A second major gap is insufficient emotional and psychological support. Infertility can be deeply distressing, yet mental health screening and counseling are not consistently integrated into care. Patients may feel isolated, overwhelmed, or unsupported, which can affect both their experience and treatment continuation. Ob-gyns can help address these gaps by incorporating anticipatory counseling into routine visits, normalizing discussions about fertility goals, timelines, and potential challenges early on.

In parallel, acknowledging the emotional impact of infertility and offering referrals earlier in the process can significantly improve patient support.
Contemporary OB/GYN:

What practical steps can practices take to identify patients who may be struggling emotionally during the fertility journey?
Chung:

The most effective approach is to offer diagnostic testing early (for both males and females), so that patients feel like they have taken steps forward in understanding their fertility. In addition, standardized screening for emotional distress with short, validated tools such as the PHQ-9 or GAD-7 can be incorporated into initial consultations or follow-up visits.

Lastly, practices can further support patients by establishing quick, clear referral pathways to local REIs (fertility physicians) and to mental health professionals with expertise in reproductive health, as well as offering information on support groups or counseling services.
Contemporary OB/GYN:

At what point in care should ob-gyns begin discussing fertility preservation and reproductive planning with patients?
Chung:

Fertility discussions should begin well before a patient is actively trying to conceive and be part of routine care for individuals of reproductive age. In many ways, discussions around fertility preservation should feel as routine as conversations about Pap smears or contraception. Even brief, proactive counseling can help patients understand how fertility changes over time, align reproductive goals with life plans, and consider options such as preservation when appropriate, especially for those with medical or family risk factors. Starting these conversations early allows ob-gyns to help patients make more informed, empowered decisions about their reproductive future.
Contemporary OB/GYN:

How can practices incorporate fertility education into routine annual visits in a time-efficient way?
Chung:

Fertility education can be integrated into annual visits through brief, structured counseling. Even a short conversation outlining key concepts, such as age-related fertility decline and basic reproductive health, can be impactful. It is the same science and biology that underlie our menstrual cycle, and so could be sprinkled in during our standard review of a female’s menstrual history.

Using pre-visit questionnaires can help identify patients who want to discuss fertility preservation or future family-building, allowing clinicians to tailor the conversation efficiently. Incorporating fertility into standard preventive care checklists also ensures it is addressed consistently. Providing take-home resources, digital materials, or links to reputable educational digital content allows patients to continue learning outside of the visit without requiring extended in-office time.

Contemporary OB/GYN:

What actionable tools or resources can providers offer patients to support informed fertility decision-making early on?

Chung:

Providers can support patients by offering a combination of education, clinical insight, and structured decision-making tools.

• Evidence-based educational materials help patients understand fertility, timing, and influencing factors
• Fertility awareness tools (cycle tracking, ovulation education) can empower patients to better understand their reproductive health
• Shared decision-making frameworks improve patient engagement and clarity around options
• Ovarian reserve testing (eg, AMH testing) may be appropriate in patients who are interested in learning about their ovarian reserve, but should always be interpreted within the broader clinical context
• Clear referral pathways to reproductive specialists ensure timely access to more advanced evaluation when needed

Equipping patients with these tools early allows them to take a more active role in their care and make informed, individualized decisions about family-building.