Fighting for a family

If you are otherwise healthy and younger than 30, you should call your doctor if you haven't been able to conceive after trying for at least 1 year.

If you and your partner have been trying to have a baby, but you've not been able to get pregnant, don't despair. You might want to consider the fertility treatments available to you.

Infertility is a heartbreaking reality for millions of U.S. couples. If you are struggling to conceive, it's normal to feel depressed, angry and helpless. But thanks to medical advances, there are many fertility treatments available to help you start your family.

What is infertility?

Doctors define infertility as the inability to get pregnant after trying to conceive for at least one year. Nearly one in seven couples struggle with infertility issues. Approximately 30-40% of infertility cases are caused by the woman, another 30-40% are caused by the man, and the rest are unexplained or are caused by factors involving both partners.

What are the most common causes of female infertility?

Ovulation problems
An ovulation problem prevents the release of an egg from your ovaries. Excessive exercise, eating disorders, pituitary tumors, a hormone imbalance, thyroid disorders, stress and obesity can all lead to ovulation problems.

Problems with the fallopian tubes
If your fallopian tubes have been damaged or are blocked, it can keep sperm from reaching the egg, and it can also keep a fertilized egg from reaching the uterus. Your fallopian tubes can be damaged by pelvic inflammatory disease, scar tissue from surgery or previous tubal pregnancies–known as "ectopic pregnancies"–and inflammation of the fallopian tubes, which can be caused by sexually transmitted diseases such as chlamydia.

Problems with the uterus
Problems with your uterus can prevent a fertilized egg from implanting in the uterine lining. Uterine polyps and fibroids and an irregularly shaped uterus can affect your fertility.

Endometriosis
Endometriosis is a problem with the lining of your uterus. When you have your period, the lining (called endometrium) should come out in your menstrual flow. However, if you have endometriosis, tissue appears in other parts of the body. It can cause scar tissue, blocking your fallopian tubes or uterus.

Age
Fertility begins to decrease by your early 30s and, by your late 30s, infertility begins to accelerate. This is because there aren't as many eggs in your ovaries, and the quality of your eggs begins to decline. For instance, by the time you're 35, you have a 1 in 192 chance that your egg has a chromosomal abnormality, which could lead to serious birth defects.

Other causes of infertility include sperm allergy, poor egg quality, early menopause, polycystic ovary syndrome, medication use and illnesses such as cancer, HIV/AIDS or kidney disease. And don't forget: Female factors alone only account for 30-40% of infertility cases. If you haven't been able to get pregnant, your partner should also talk to his doctor about fertility testing.

What should I do if I haven t been able to get pregnant?

If you are otherwise healthy and younger than 30, you should call your doctor if you haven't been able to conceive after trying for at least 1 year. If you are over 30, or if you have any medical conditions, call your doctor if you've been trying without success to conceive for six months. Your doctor will ask you about your medical and sexual history and will perform a routine gynecologic exam. Your doctor will also talk to you about which infertility tests you may need. Some of the tests include:

Semen analysis
This test measures the amount of semen that a man produces and determines the number and quality of sperm in the sample of semen.

Ovulation test
This blood test checks the hormone levels your body needs for successful ovulation.

Laparoscopy
During laparoscopy, you are put to sleep under general anesthesia. A small incision is made beneath the belly button, and the doctor inserts a small amount of carbon dioxide gas into your abdomen. A laparoscope, a thin tube with a tiny light and camera on the tip, is inserted into the abdomen and the doctor looks at the ovaries, fallopian tubes and uterus. The doctor looks for scar tissue, adhesions or endometriosis.

Hysterosalpingography
This procedure is used to check for blockages in the uterus and fallopian tubes. A dye is injected through the vagina and an X-ray reveals whether the dye is able to move through the uterus and into the fallopian tubes.

Fertility testing can be a long process, often taking months to complete. Try not to get discouraged if the problem is not found immediately.

What treatments are available?

Now, more than ever, there are many different fertility treatments available to help you and your partner have a baby.

Fertility drugs
If you have a hormonal problem, fertility drugs can help you get pregnant. These drugs regulate your hormones and stimulate your ovaries to release one or more eggs during ovulation.

Artificial insemination
If sperm aren't getting to your egg, artificial insemination can help. A concentrated injection of sperm (either from your partner or a donor) is inserted into your uterus, making it easier to reach and fertilize the egg.

Surgery
Surgery can remove blockages or scar tissue from the ovaries, fallopian tubes or uterus. Blockages or scar tissue can be caused by endometriosis, polyps, fibroids or cysts.

Assisted reproductive technology (ART)
ART refers to several different fertility treatments. All treatments involve surgically removing eggs from the ovaries and mixing them with sperm in a laboratory. The fertilized eggs are then put back into the uterus or fallopian tube, depending on the type of ART.

Donor eggs, embryos and surrogate mothers If your eggs are of poor quality, you can consider using a donor egg. The donor's egg is mixed with your partner's sperm and is then implanted into your uterus.

A surrogate mother is used if you are unable to sustain a pregnancy. Your egg, or a donor's egg, is mixed with your partner's sperm. The fertilized egg is then implanted into the surrogate mother. When the baby is born, the surrogate mother signs away all parental rights.

If you are struggling with fertility issues, don't give up hope. There are many treatments available to help you realize your dream of starting a family. By working with your doctor, you can find the treatment that is best for you.