Five things to know before starting infertility treatment

I had the opportunity to interview Harvey Kliman, MD, PhD, a physician scientist at the Yale University School of Medicine, who has an inside perspective to infertility.

What does he want you to know as you navigate infertility?


“Research and find a reproductive endocrinologist who does work in infertility.”

Kliman provides further logic behind this, “What you really want if you have had multiple pregnancy losses is to have somebody who understands the actual biology of pregnancy and the placenta is the most important aspect.”


What is the single most important factor in having a healthy baby? 

A healthy placenta. 

“Placental examination could help determine the cause of more than 90% of previously unexplained pregnancy losses.”* Studies have shown that a number of “stillbirths could have been detected in utero – flagging those pregnancies as high risk prior to the loss,” based on measuring the placenta.

Since some pregnancy losses are due to anatomic reasons, there are a few basic tests that need to be done.

“This can include an ultrasound of the uterus to determine it is structurally normal and to make sure there are no polyps inside of the cavity, for example,” Kliman said.

First things first, “Let’s make sure that all the structural things are functional,” he said.

In addition to “anatomic reasons, there are also esoteric reasons for pregnancy loss,” Kliman added.

You can expect tests to check your thyroid levels as well as a complete blood count for your doctor to gain better understanding of your general health.

But beyond that – is more testing really necessary? 

Is it true that once you walk into an infertility clinic the tests never seem to end?

I think this is a hot topic because I am certainly aware of the extensive testing individuals undergo at fertility clinics (think 19 vials of blood can be taken in one day).

Kliman witnesses firsthand the reality of this.


I think infertility is unfortunately an area that is ripe for exploitation of these patients,” he said.

Keen awareness and being your own advocate are my two suggestions, no matter what health condition you are being treated for. We all want a positive outcome for our medical situations.

“Many people (physicians or otherwise) do lots of other testing for these patients because, of course, 1) it’s very upsetting, 2) these families become very desperate to try and solve the problem and if they go to somebody who promises to solve the problem then they go down the rabbit hole.

It’s simple – “Patients want to trust doctors.”

However, you find a doctor – whether it be social media, who you find to be reasonable after meeting, or who your medical group assigns you – it should be a doctor you can trust and work together with to improve your health.

Kliman explained that “so many doctors, when they find a patient with pregnancy loss, will automatically start treating and doing testing for clotting disorders, for immunologic causes, for theoretical pregnancy loss.”

What have the studies shown?  “Less than 2% of all those losses” are linked to those.

“Our studies have found that those two reasons either: 1) clotting disorders or 2) immunologic reasons for pregnancy loss are rare.”

What is Kliman’s expert advice?

I really do not advise patients to have those tests and be treated that way unless there is an actual diagnosis.


What is the best way to diagnose the reason for a pregnancy loss?

“To have the loss tissue examined under a microscope by a pathologist,” Kliman explains.

He “really thinks any loss should be looked at,” especially if the patient experiences recurrent pregnancy losses.

There are two ways to collect and have the tissue examined.

  • If you have a dilation & curettage (D&C)

Discuss with your doctor that you would like the tissue sent to the pathology department.

  • If you pass the loss naturally at home

Talk to your healthcare provider if it’s likely you will pass the tissue at home. They may recommend a “sitz insert” for a toilet bowl seat. Easy to locate on Amazon. The woman collects the tissue and places in a clean, sealed container in the refrigerator until it can be taken to the doctor to be sent to the pathology department.

Dr. Kliman’s team, including research assistant Kristin Milano, at Yale University has an opportunity for you to have your pregnancy loss tissue reviewed by their team.  Please find out more and if interested, sign the release forms, located here:

Don’t worry if your pregnancy loss tissue is not recent.  As long as the pathology department has the tissue, Kliman reassures “even if the tissue is from years ago, the paraffin blocks are still in the drawer from the pathology department – we can actually cut those blocks and still look at the pregnancy loss tissue.”

“I have looked at cases 22 years after the delivery,” Kliman emphasized.
It’s not a problem.


What is Kliman’s approach to infertility and helping women sustain a pregnancy?

“There are many ways to get to the answer but I have a very simpleminded approach.  One should not use treatments until you actually make a diagnosis.”


Patient resources from Yale, including if you would like pregnancy tissue examined by their team, can be found here:

Media articles on Kliman can be found here:


It was an honor to interview Dr. Harvey Kliman. Kliman is a research scientist in the department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine as well as the Director of the Reproductive and Placental Research Unit. He has received many awards and recognition, including the Star Award Stillbirth Research in 2019. 

Watch for more from Dr. Harvey Kliman in the coming weeks. 


This website does not provide medical advice. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. It is for informational purposes only.  Always seek the advice of a medical professional or other qualified health care provider on any health matter or question.


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