Thinking about fertility treatment

What is fertility treatment?

Many women need special medical treatment to help them get pregnant. This kind of treatment is called fertility treatment.

Infertility is when you’re not able to get pregnant (conceive) after one year (or longer) of having unprotected sex.

For pregnancy to happen, sperm from a male needs to be joined with an egg from a female.  For many couples without infertility, this may happen when:

• A woman’s body releases an egg from one of her ovaries (also called ovulation)
• A man’s sperm joins the egg along the way (also called fertilize)
• The fertilized egg travels through the fallopian tube toward the uterus (womb)
• The fertilized egg attaches to the inside of the uterus (implantation)

If you’ve been trying to get pregnant for 3 or 4 months, keep trying. It may just take more time, even longer than you think it should. You may want to think about fertility treatment if:

• You’re younger than 35 and have been trying to get pregnant for at least a year.
• You’re 35 or older and have been trying to get pregnant for at least 6 months.
• You’re trying to get pregnant and you have irregular, very painful or no periods.
• You’re trying to get pregnant and you have conditions like endometriosis, pelvic inflammatory disease or a past miscarriage.
• You and your partner think there may be a male factor (like a history of testicular trauma or past infertility with another partner).

Talk to your health care provider if you think you may need fertility treatment.

How can you find out if you need fertility treatment?

If you think you and your partner may need treatment to help you get pregnant, here’s what you can do:

• Talk to your health care provider. You can see a prenatal care provider, like an obstetrician or a midwife, who takes care of pregnant women. Or you can see a fertility specialist (also called a reproductive endocrinologist). This is a doctor who’s an expert in helping women get pregnant.
• Tell your provider about your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in your families have had. Be sure to tell your provider if you’ve been pregnant before and about any children you’ve had.
• Make changes in your life that may help you get pregnant without treatment. For example, things like smoking, being over- or underweight, drinking too much caffeine and taking certain medicines can affect you and your partner’s fertility and make it harder for you to get pregnant. Even using a hot tub can affect fertility in men because high temperatures affect sperm movement.   
• Keep track of your periods to find out when you ovulate. Ovulation is when your ovary releases an egg into your fallopian tubes. The time you ovulate usually happens in the middle of your menstrual cycle or halfway between the start of your periods. To find out when you ovulate, write down when your period starts each month and how long it lasts. Or use our online ovulation calendar. Knowing when you ovulate helps you know the best times of the month to have sex with your partner to try and get pregnant.

Your provider may give you and your partner medical tests to find out if you may need treatment. For example, your provider may:

• Want your partner to get his sperm tested to make sure it’s healthy. This is called a semen analysis. Your provider can tell him where to get this test.
• Give you some tests to make sure there are no problems with your fallopian tubes or uterus.  If your tubes are blocked or if there are problems with your uterus, you may have trouble getting pregnant. You may be able to get treatment to fix these problems.

After these tests, you, your partner and your provider can decide about fertility treatment.   

What problems can fertility treatment cause?

Fertility treatment does help many women get pregnant. But it can cause certain problems, too. The most serious problem is that treatment can cause you to get pregnant with multiples. Some fertility treatments may cause you to release many eggs at the same time. Each of these eggs can become fertilized by sperm, which can make you pregnant with more than one baby.

Even if you get pregnant with just one baby, some fertility treatments make your baby more likely to have problems than a baby born without fertility treatment. These include premature birth, low birthweight and birth defects. Talk to your provider about the risks of fertility treatment so you and your partner have all the information you need to decide if treatment is right for you.

Depending on what fertility treatments you use, there is also a risk for bleeding and infection.  You may also have Ovarian Hyperstimulation Syndrome (OHSS).  This is when the medications used in some fertility treatments cause pain in your ovaries.  OHSS can cause bloating and nausea. Although rare, some women may have rapid weight gain and shortness of breath that needs emergency treatment. 

What kinds of fertility treatment are there?

There are several kinds of fertility treatment. You, your partner and your provider can decide which treatment gives you the best chance of getting pregnant and having a healthy pregnancy. Common treatments include:

• Surgery to repair parts of your or your partner’s reproductive system. For example, you may need surgery on your Fallopian tubes to help your eggs travel from your ovaries to your uterus.
• Controlled ovarian hyperstimulation
• In vitro fertilization
• Intracytoplasmic sperm injection

You can find out about other kinds of fertility treatments at resolve.org.

What is controlled ovarian hyperstimulation?

Controlled ovarian hyperstimulation (also called COH) is a kind of fertility treatment that uses medicines to help your body ovulate (release an egg). If you’re having COH, your provider can adjust your treatment if she thinks you’re likely to release more than one egg. The medicines used for COH include:

• Clomiphine citrate (also called clomiphene, Clomid® or Serophene®). This medicine comes as a pill. It’s the most common medicine used to help women ovulate. You may have side effects from the medicine, like feeling sick to your stomach, feeling moody and having hot flashes and sore breasts.
• Gonadotropins. You get this medicine in shots. Side effects include feeling bloated or having pain in your lower belly.

If you’re getting COH, have sex a few days before and the day that you ovulate. The more often you have sex during this time, the more likely you are to get pregnant. Your provider may recommend that along with COH you also have a treatment called intrauterine insemination (also called IUI). In IUI, your provider places sperm inside your uterus when you ovulate.      

What is in vitro fertilization?

In vitro fertilization (also called IVF) is a kind of fertility treatment called assisted reproductive technology (also called ART). ART is any kind of fertility treatment where both the egg and sperm are handled in a lab. ART treatments remove mature female eggs from the ovaries using a needle and join it with the sperm in a lab. 

IVF is the most common kind of ART. In IVF, an egg and sperm are combined in a lab to create an embryo (fertilized egg) which is then put into your uterus.  The steps to IVF include:

• Ovarian stimulation. Like COH, you take medication by shots or injections in your lower belly to help make your eggs mature.
• Egg Retrieval. Mature eggs are removed from your ovaries with the help of ultrasound and a needle. Ultrasound uses sound waves and a computer screen to take pictures of your ovaries.
• Fertilization. The sperm and egg are joined together in a lab.
• Embryo transfer.  A long thin tube is inserted in the vagina to place the embryo in the uterus. 

What is Intracytoplasmic sperm injection?

Intracytoplasmic sperm injection (also called ICSI) is another form of ART similar to IVF where a single sperm is injected into a mature egg. ICSI may be done if there are male factors that affect fertility and if IVF hasn’t been successful. Male factors can include the number of sperm and how it moves. After the sperm is injected into the egg to create an embryo, the embryo is placed into your uterus. 

For more information

• American Society for Reproductive Medicine's ReproductiveFacts.org
• Centers for Disease Control and Prevention (CDC)
•  CDC Show Your Love Campaign
•  RESOLVE: The National Infertility Association
•  Society for Assisted Reproductive Technology

Last reviewed: April 2020