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

Multiple Pregnancy and Birth: Considering Fertility Treatments (PDF, 235KB)
American Fertility Association
American Society for Reproductive Medicine
Centers for Disease Control and Prevention (CDC)
CDC Show Your Love Campaign
Protect Your Fertility
RESOLVE: The National Infertility Association
Society for Assisted Reproductive Technology

These organizations provide referrals to doctors and clinics.

September 2008 (7-09)

Most common questions

Genetic counseling

How do you know you're pregnant?

Knowing the signs of pregnancy can help you tell if you’re pregnant. Here are some signs that you might be pregnant:

If you have any of these pregnancy signs and think you may be pregnant, go to your health care provider. The sooner you know you're pregnant, the sooner you can begin prenatal checkups and start taking good care of yourself and your growing baby.

How soon can I take a pregnancy test?

Home pregnancy tests are usually more accurate when your period is late - about 2 weeks after conception (getting pregnant). If they're done too early, they may say that you're not pregnant when you really are. This is called a false negative. That's why it’s best to take a home pregnancy test when your period is late. Carefully follow the test's instructions. Tests done at a lab or at your health care provider's office are more accurate.

I’m late for my period but my pregnancy test is negative. Why?

If you've taken a home pregnancy test and it's negative (shows that you're not pregnant), you may want to take a blood pregnancy test at your health care provider's office. A blood pregnancy test is more sensitive than a home pregnancy test that checks your urine. The blood pregnancy test can tell a pregnancy very early on. 

Pregnancy tests work by looking for the hormone called human chorionic gonadotropin (hCG), a hormone that a woman's body makes during pregnancy. If both a blood and urine test come back negative and you still have a missed period, talk with your health care provider. Things like stress, eating habits, illness or infection can cause changes in your menstrual cycle.

I’ve been trying to get pregnant for 3 months. What’s wrong?

Pregnancy may not occur right away, so there is no need to worry. For most couples, it may take up to 1 year to conceive. If you’ve been trying to get pregnant for more than a year, or 6 months if you're over 35, it may be time to talk with your health care provider. You and your partner can get tests to find out why you are not getting pregnant

Is it possible to ovulate without having a period?

Ovulation is when a woman's ovary releases an egg. This egg travels down into the fallopian tube. If you had sex without using birth control, sperm will swim up to meet your egg so that your egg can be fertilized. If no fertilization occurs, and after about two weeks, your body sheds the unfertilized egg, the uterine lining and blood and tissue that would have nurtured a fertilized egg. This is known as menstruation (your period).

You ovulate before you menstruate. But if you don't get your period, it doesn't necessarily mean that you haven't ovulated. For example, some women have irregular cycles. Even if you're very regular, once in a while your cycle may change. Therefore, it's hard to pinpoint exactly when you ovulate. If you don't get your period, you may want to take a pregnancy test.

What is the best time to get pregnant?

The best time to get pregnant is a few days before ovulation or the day of ovulation. This is because a man's sperm can live up to 72 hours after intercourse and a woman's egg is fertile for 12 to 24 hours after its release. If your periods are regular, use an ovulation calculator. If your periods are irregular, use one of the following. Talk to your health care provider to learn more about the most effective way to use these.

  • Purchase a basal body thermometer. Use it to take your temperature before you get out of bed every day. Your temperature goes up by 1 degree when you ovulate.
  • Check the mucus in your vagina. It may become thinner, more slippery, clearer and more plentiful just before ovulation.
  • Purchase an ovulation prediction kit. Use it to test your urine for a substance called luteinizing hormone (LH). LH increases each month during ovulation.

Have intercourse as close as possible to ovulation to improve your chance of getting pregnant.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).