If you're hoping to get pregnant yet have been trying to conceive without success, you'll hear lots of advice. "Be patient," friends, family, even your ob-gyn might advise you. "It'll happen when it's meant to happen."
But the fact is, if you’re a woman under age 35 and have been having unprotected sex for 12 months (or a woman over 35 and been trying for 6 months), it's probably time to look into infertility treatments.
According to Resolve/National Infertility Association, 1 in 8 couples has trouble getting or staying pregnant. The good news? Of those who seek treatment, about 65% go on to have a baby. Here’s what you and your partner can expect as you go through the process.
The first step for both you and your partner is to get an exam and major workup from a fertility doctor.
“It’s not uncommon to have more than one cause of infertility,” says Brooke Hodes-Wertz MD, MPH, a reproductive endocrinology and infertility specialist at NYU Langone. “Anywhere from 10% to 30% of cases are due to a mix of both male and female infertility.”
For women, blood tests can reveal a lot:
Ovulation: The tests can tell you if you’re actually releasing an egg each month.
Ovarian reserve: How many eggs you have left in your ovaries and their quality
Hormone levels: It’s important to see if you have enough hormones like estradiol, progesterone, and follicle-stimulating hormone (FSH), all three of which are crucial to pregnancy.
Imaging tests and biopsies can also be done to look for abnormalities in your uterus, fallopian tubes, and ovaries that may be preventing a healthy pregnancy.
For men, testing often starts with a semen analysis. “This allows us to look at sperm count, motility, velocity, and the shape of the sperm,” says David Diaz, MD, a reproductive endocrinologist and fertility expert at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
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From there, doctors can also check on levels of testosterone and other hormones. They'll investigate a man's genes to see if a genetic abnormality is the cause of infertility, which can be the case. Doctors will also check out any physical problems, such as damage or blockage in the male reproductive tract.
The infertility treatment your doctor advises will depend on “what your workup reveals and the causes of your infertility,” says Dr. Hodes-Wertz. Some common infertility treatments include:
Lifestyle changes. Habits that you and/or your partner have can impact fertility, so your doctor may start by suggesting some easy changes. “There’s some evidence that avoiding smoking, marijuana, excessive alcohol, and obesity might help,” says Dr. Hodes-Wertz.
Medication. “Fertility drugs are often used for patients who are having a hard time ovulating or to increase the chances of conception,” he adds. In men, testicular function drugs can help increase sperm count or quality. Hormone treatments can adjust male hormones to the levels they need to be.
Surgery. Sometimes the source of infertility is a uterine fibroid, endometrial polyp, or another benign growth. If that's the case, your doctor will advise that you have surgery to remove the growth and then start trying to get pregnant. Surgical treatment can also help men if damage or a blockage is believed to be causing infertility.
Assisted reproductive technology (ART). This broad term refers to any procedure that manipulates both your egg and your partner’s sperm. “These can range from intra-uterine insemination, egg freezing, embryo freezing, fresh embryo transfer, ovarian freezing, egg donation, surrogacy, frozen embryo transfer, ovarian stimulation with injectable medicines, and of course, in vitro fertilization (IVF) with or without embryo screening for genetic diseases,” says Dr. Diaz.
IVF is one of the most common types of ART. During IVF, mature eggs are collected from your ovaries, then fertilized by sperm in a lab. Once one or more embryos have developed, they’re implanted back inside your uterus. Egg, sperm, and embryo donors can be used, and another woman can be a gestational carrier and carry the baby to term if you’re not able to.
“IVF forms the foundation for many of the most successful methods of treating infertility in both men and women,” explains Dr. Diaz. “It provides the most expedient method of achieving fertilization of human eggs and documenting the characteristics of the resulting embryos.”
Future treatments. If your head’s spinning already at the available options, just wait. “A multitude of evolving ideas and experimental procedures are being developed at all times,” says Dr. Diaz. “Fertility specialists are always searching ways to improve the outcome for our patients.” Among them: freezing ovarian tissue, maturing eggs outside your body, and uterine transplants.
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The cost of infertility treatment
Infertility treatment isn’t cheap. Unsurprisingly, many health insurance policies don’t cover all or even some of it. The average cost of IVF is approximately $13,000.
Still, “don’t wait too long,” advises Dr. Diaz. “The greatest regret I hear from patients is that they wish they started sooner. Timing is critical and time passes.”
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