Trying to get pregnant

There are many steps you can take to help you get pregnant.
Most couples who try to get pregnant do so within 1 year.
Talk to your provider about any questions you may have.

Thinking about fertility treatment

Have you been trying to get pregnant for a long time? Are you beginning to wonder if you can get pregnant? You are not alone. Many women need fertility treatment to get pregnant.

When should I start thinking about fertility treatment?
If you’ve been trying to get pregnant for three or four months, keep trying. It may just take more time, even longer than you think it could. You may want to think about fertility treatment if:

You are younger than 35 and have been trying to get pregnant for at least a year.
You are 35 or older and have been trying to get pregnant for at least six months.

What should I do before I get fertility treatment?
Here are some things you and your partner can do to find out if you need treatment:

Talk to your health care provider about whether or not you need treatment.
Learn about how things like smoking and weight affect fertility. You may be able to make changes in your life that will help you get pregnant without fertility treatment. Talk to your health care provider about what you can do on your own, without fertility treatment.
Tell your health care provider about diseases and other health problems in your family.
Keep a monthly diary of your periods. Write down the date you start and end your period each month. This will help you figure out when you ovulate (make an egg).
Have your partner get his sperm tested to make sure it’s healthy.
Have a test to make sure your fallopian tubes are open and your uterus (womb) is a normal shape. (When your ovary releases an egg, it travels down the fallopian tube to your uterus.)

When and how do I choose a fertility specialist and center?
Most couples begin by seeing an obstetrician-gynecologist or their family doctor. Because infertility is a highly technical field of medicine, talk with your health care provider 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 (see below). Here are things to think about when choosing a specialist:

What is the fertility center’s success rate? The Centers for Disease Control and Prevention has a report that provides information on some fertility centers.
How many women treated at the center get pregnant with multiples? Multiples mean twins, triplets or more. Compared to pregnancies that have only one baby, multiple pregnancies are more likely to have complications for the mother and the baby. The March of Dimes recommends that you consider using a clinic with lower rates of multiples.
Is the center near where you live?
Does your insurance pay for the specialist and treatment?

What do I need to know about diagnosis and treatment?
The doctor begins by performing a physical examination, taking your medical history and, sometimes, ordering 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). Examples of these medications are Clomid, Serophene and clomiphene. Some of these medications increase the number of eggs the woman produces during a cycle. This can lead to a multiple pregnancy (twins, triplets or more). Hormone shots may also be given.
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.

Are there any problems with fertility treatment for the baby or the woman?
Fertility treatment does help many women get pregnant. But it can cause certain problems.

One serious problem is that treatment can cause you to get pregnant with multiples (twins, triplets or more). Multiples are more likely to be premature (before 37 completed weeks of pregnancy). Premature babies are at risk of breathing, vision and hearing problems. Being pregnant with multiples also can cause problems for the mother. Examples are high blood pressure, preterm labor, bleeding and problems with the placenta, and diabetes.

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.

Even one baby born after ART is more likely to have problems that a baby born without fertility treatment. These problems include being born too early or too small. Many experts are concerned that ART may be related to certain rare birth defects. More research is needed to learn about this possible risk.

Does health insurance pay for fertility treatment?
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.

For women having ART, how many embryos are usually transferred to the woman’s body at one time?
The number of embryos depends upon the woman’s age and her individual circumstances. March of Dimes and many fertility experts agree that it’s important to lower the chances of getting pregnant with multiples, especially three or more babies.

Medical guidelines help specialists decide how many embryos to transfer. The aim of the guidelines is to give women the best chance of getting pregnant while lowering the chances of multiples. The following recommendations are from the American Society of Reproductive Medicine:

Women under the age of 35: Transfer 1 or 2 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 5 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.

For more information

These organizations provide referrals to doctors and clinics.

September 2008 (7-09)