You should talk to your health care provider about the possibility of fertility problems:

• If you and your partner don't get pregnant after trying for 12 months.
• If you are a woman over the age of 35 who doesn't get pregnant after trying for 6-10 months. Older women are more likely to have fertility problems than younger women.

Causes
Infertility can be caused by many things, including:

• Problems with ovulation (a woman's ability to produce an egg)
• Problems with sperm in men (amount, quality or both)
• Aging (fertility declines as men and women age)
• Sexually transmitted infections
• Other reproductive infections
• Genetic conditions
• Certain chronic illnesses, such as diabetes or Hodgkin's disease
• Damage to the reproductive organs
• Smoking, drinking and drugs
• Exposure to radiation and certain chemicals, such as pesticides
• Cancer treatment

Often couples have more than one reason for infertility.

Finding a Doctor
Most couples begin by seeing an obstetrician-gynecologist or their family doctor. Because infertility is a highly technical field of medicine, talk with your doctor about whether you should see a specialist.

Advanced medical training is needed to be a specialist. Doctors often study the fields of reproductive endocrinology for women and urology for men. Specialists are more likely than other doctors to offer a variety of treatments, including information about their risks and benefits. They may be helpful with both nonsurgical and surgical fertility treatments (see below).

Diagnosis and Treatment
For both women and men, the doctor performs a physical examination, takes a medical history and, sometimes, orders specialized tests.

When a possible cause of infertility is found, the most common treatments are:

• Giving medications to the woman to help her body release eggs (ovulate).
• Performing surgery on the man or woman to repair part of the reproductive system. For instance, a woman may have scars in her fallopian tubes. These tubes carry the eggs to the uterus (womb). A man may have a problem that makes it hard for sperm to flow normally. Conditions such as these can often be corrected with surgery.

According to the American Society for Reproductive Medicine (ASRM), most infertility cases (85-90 percent) are treated with drugs or surgery.

More advanced types of infertility treatment include:

• Inserting sperm from the man or a donor into the woman's uterus. This is called artificial insemination or intrauterine insemination (IUI).
• Assisted reproductive technologies (ART). A woman's eggs are surgically removed, combined with sperm in the laboratory, and then returned to her body. In vitro fertilization (IVF) is the most common ART procedure.

Couples sometimes choose to ask another person to donate eggs, sperm or an embryo. (Embryo is the word for the human organism from conception until approximately the eighth week.)  Others make an agreement with a woman to bear a child for them. These choices involve serious ethical and legal issues and should be made with care.

Costs and Insurance
Insurance coverage for infertility treatments varies from company to company and state to state. Because treatment can be very costly, be sure to learn more about the costs and your insurance coverage while you are still thinking about treatment options.

Health Risks of Infertility Treatment
Infertility treatment has risks for both the woman and the baby. Sometimes fertility drugs can enlarge a woman's ovaries. The woman may feel pain, bloating, nausea or vomiting. If the condition becomes severe, the woman may have to be hospitalized.

Both reproductive surgery and ART may lead to bleeding, infection, or damage to organs or blood vessels.

Many experts are concerned that ART may be related to certain rare birth defects. More research is needed to learn about this possible risk.

Twins, Triplets and More
Fertility drugs and ART can both result in multiple gestation (twins, triplets or more). Fertility drugs increase the number of eggs a woman produces. This makes it more likely that the woman will have a multiple pregnancy. Having triplets or more is one of the most serious complications of fertility treatments.

With ART treatments, embryos are created in the laboratory and then transferred to the woman's body. Doctors may offer to transfer more than one embryo to increase the chances of a woman delivering a baby. But this practice also increases the likelihood of multiple pregnancy.

Women carrying more than one baby are at greater risk of anemia, bleeding, gestational diabetes, high blood pressure, and preterm labor and birth. Babies born too early are more likely than other babies to have health problems. Examples include breathing problems, infections, developmental problems and cerebral palsy. Women carrying more than one baby should be cared for by an obstetrician who specializes in high-risk pregnancy.

In 2006, ASRM and the Society for Assisted Reproductive Technology (SART) issued new guidelines to help ART providers and patients in choosing the appropriate number of embryos to transfer. These guidelines support the use of fewer transplanted embryos, whenever possible, based on various considerations. Here is a summary of the guidelines:

• Women under the age of 35: Transfer one or two embryos, depending upon the doctor's evaluation
• Women between 35 and 37 years of age: Transfer 2-3 embryos, depending upon the doctor's evaluation
• Women between 38 and 40 years of age: Transfer 3-4 embryos, depending upon the doctor's evaluation
• Women older than 40 years of age: Transfer no more than five embryos

In some circumstances, more embryos may be transferred. For instance, if a woman has had two or more failed IVF treatments, more may be used.

If a donor is contributing eggs, the age of the donor should be considered when deciding how many embryos to transfer.

The March of Dimes regards fertility treatments as options for couples desiring children and respects the guidelines established by SART and ASRM.  Prospective users of these treatments need to be well informed about their options, including possible benefits and risks, to help make the best decisions for themselves and their family.