If you’re under 35 and have been trying to conceive for a year, or if you’re over 35 and have been trying for six months, it’s time to get help. Or, if you’ve had two or more miscarriages back-to-back, you should see a professional. The same goes if you’re having any worrisome symptoms or have risk factors for infertility, even if you haven’t been trying for six months to a year.
Make an Appointment With Your OB/GYN
Your first stop should be at your regular gynecologist—no need to go straight to a fertility clinic. You may want to bring your partner along, although that’s not necessarily required at this point. To prepare for your appointment, gather the following information:
The dates of your last six periods, even if your cycles are very regular. If you’ve been keeping a fertility calendar or body basal temperature chart, bring the last six months’ information. If you’ve done any at-home fertility testing, bring those results too. A list of medications you—and your partner—take on a regular basis. Some drugs can interfere with fertility, including certain antidepressants and even over-the-counter allergy treatments. A list of any infertility symptoms or risk factors you have. Any questions you have. If you write them down, you’re more likely to ask them.
When you discuss your symptoms, make sure to mention embarrassing ones, such as painful sex, unwanted hair growth, or low libido. These can all be symptoms of a fertility problem. Include any symptoms your male partner may be experiencing as well. Up to 40% of infertile couples face male infertility.
Begin Basic Fertility Testing
Basic fertility testing includes blood work and a semen analysis. Depending on your symptoms, your ob/gyn may also suggest a hysterosalpingogram (HSG), vaginal ultrasound, or diagnostic laparoscopy. Your healthcare provider will also likely perform a basic pelvic exam and Pap smear, and some test for certain sexually transmitted infections or diseases. It’s normal to feel anxious and worried as you go through fertility testing. Seek support from friends, family, or a therapist. An in-person support group or an online fertility forum also can provide emotional support.
(Maybe) Begin Basic Fertility Treatment
Based on the results of your fertility tests, your doctor may advise you to go ahead with some form of fertility treatment. You could have success, for example, by taking a medication such as Clomid (clomiphene); Femara (letrozole), a breast cancer drug that increases estrogen levels; or Metformin, an insulin-sensitizing drug that is used to treat infertility, sometimes along with Clomid. If testing reveals you have structural abnormalities (of your uterus, for example), or endometriosis, your doctor may suggest surgical treatment. They may refer you directly to a fertility specialist or reproductive surgeon.
Look For a Fertility Clinic
If basic fertility treatment isn’t successful, or if your test results suggest treatments that go beyond your gynecologist’s purview, they may refer you to a fertility specialist or fertility clinic. Because your fertility treatment likely won’t be covered by insurance, focus your search for a doctor or clinic on finding the best possible care that you can afford.
Quitting smoking Cutting back on drinking alcohol Losing weight if you’re overweight or obese (obesity also can be triggered by a hormonal imbalance) Reducing the amount of exercise you do if you tend to work out excessively or are underweight
When you begin researching fertility clinics, make certain you’re clear on how much the initial consultation will cost. Discuss fees ahead of time if you decide to move forward with treatment. Remember to factor in travel and lost work time if you’re considering a clinic that’s not close by. Many treatments require frequent visits.
Take More Fertility Tests
Often (but not always), your fertility clinic will want to do more testing or even rerun some tests you’ve already done. For example, wile your gynecologist may have checked your follicle-stimulating hormone (FSH) levels, the fertility clinic may decide to also do an antral follicle count or other ovarian reserve testing. If you’ve ever had a miscarriage, your gynecologist may have sent the tissue from the miscarriage for analysis. The fertility clinic may suggest karyotyping or a hysteroscopy.
Create a Plan of Action
After you get the results of any second-round or repeated tests, your fertility doctor will go over a recommended treatment plan. You also may sit down with the clinic’s financial advisor to discuss payment fees and options. Your doctor should give you and your partner time to consider the proposed treatments and figure out what you can afford.
Begin Fertility Treatment
Infertility treatments can be relatively simple, such as intrauterine insemination, or IUI. Or they can be complicated and involved, such as IVF—which sometimes is paired with additional technologies including intracytoplasmic sperm injection (ICSI) and pre-implantation genetic screening (PGS). Your treatment will depend on the cause of your infertility. For example, if you have endometriosis, your doctor may perform surgery to remove endometrial deposits first. Then, after you have time to recover, you may start in vitro fertilization treatments or even try on your own for a while.
Reevaluate Treatment Plans
Fertility treatment is less of a pinpoint solution and more of a try-this-then-that kind of process. You may conceive on your very first treatment cycle, but it’s more likely you’ll need a few cycles before you succeed. A good doctor will help you understand when to stick with the current treatment plan and when to make big or small changes. There are also suggested limits on treatments. For example, you shouldn’t take Clomid for more than six cycles. If you’re feeling overwhelmed, but not quite ready to give up, talk to your doctor about taking a break. You may be worried that delaying treatment will reduce your odds of success, but this isn’t always true. Plus, sometimes your mental health is more important.
Plan For a Healthy Pregnancy
If treatment is successful and you become pregnant, the fertility clinic will likely monitor you for the first several weeks of the pregnancy, and you may need to continue some hormonal treatments or injections. Depending on the cause of your infertility, and whether you conceive multiples, you may need closer monitoring during your pregnancy. Pregnancy after infertility is not the same as an “easily conceived” pregnancy. Even deciding when to tell people you’re expecting can be stressful. If you have infertile friends, you may experience survivor’s guilt or feel like you’re leaving them behind.
A Word From Verywell
Having fertility problems, whether you can’t get pregnant or experience recurrent miscarriage, can be heartbreaking. While there are treatments available, not all infertile people will conceive, and some must stop treatment for financial reasons. If your disappointment is overwhelming, see a counselor or join a self-help group to help you cope with your emotions.
