We Can't Get Pregnant. Now What?

From Testing to Diagnosis to Treatment to (Hopefully) Success

Pregnant woman standing in the bedroom
When you've been trying to conceive for a long time, pregnancy can feel like a far off dream. But with help, your chances for success are good. Michael Poehlman / Getty Images

So, you can't get pregnant. What do you do now? If you've been trying to get pregnant for a year without success—or for six months if you're over 35—it's time to get help. If you've had two or more consecutive miscarriages, it's also time to seek help.

You should also seek help if you're having any worrisome symptoms or have risk factors for infertility, even if you haven't tried to get pregnant yet for a full year.

But how can you get that help? What does "help" look like? What can you expect? While not every couple's journey will look the same, here's a general guide of your next possible steps.

Step 1: Make an Appointment with Your OB/GYN

Your first stop should be at your regular gynecologist. While not necessarily required at this moment, your partner may also want to see a urologist.

You don't need to go straight to a fertility clinic. In fact, most clinics prefer you have a referral from your primary gynecologist or physician.

You could discuss your concerns when you get your next pap smear, or you can make a separate appointment to discuss your fertility concerns. Be sure to mention to the secretary that you need time to discuss an important issue with the doctor. This way, he can schedule enough time for the appointment.

While you're waiting, gather important health information together with your partner.

Write down your questions. This will help your doctor help you.

Information you should collect or write down includes:

  • A list of all the regular medications you and your partner take: Some drugs can interfere with your fertility. Some antidepressants and even over-the-counter allergy drugs lead to trouble conceiving.
  • 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 the "embarrassing" ones as well. Don't hide things from your doctor. Symptoms you may feel hesitant to share—but can indicate a fertility problem—include things like painful sex, unwanted hair growth, or low libido.

Don't forget symptoms your male partner is experiencing as well. Infertility isn't a female problem—it's a people problem. Up to 40 percent of infertile couples face male infertility.

Step 2: Begin Basic Fertility Testing

The next step is some basic fertility testing. This includes blood work for the woman and a semen analysis for the man. (Make sure your partner has the semen analysis before you start treatment! Clomid can't help you if there are male factors involved.)

Depending on your symptoms, testing may also include an HSG, vaginal ultrasound, or diagnostic laparoscopy. Your doctor will also likely preform a basic pelvic exam, pap smear, and some STD testing.

How much testing your doctor orders will depend on your symptoms and possibly also on your insurance coverage. (You can pay for fertility tests out of pocket, but many gynecologists prefer to refer you to a fertility clinic in those cases.)

These tests may or may not lead to a fertility diagnosis. Sometimes, finding out what's wrong exactly takes time. Up to 30 percent of couples never find out why they can't conceive and are diagnosed with unexplained infertility.

Fertility testing can bring up feelings of anxiety or worry. This is normal. Seek support from friends, family, or a therapist. A in-person support group or an online fertility forum can also provide emotional support.

Step 3: (Maybe) Begin Basic Fertility Treatment

Depending on the results of your fertility tests, your gynecologist may recommend treatment.

Treatment may involve treating an underlying medical disease that is causing infertility, or it may include very basic fertility treatment.

Examples of basic infertility treatment include:

If there are structural abnormalities or endometriosis, your doctor may suggest surgical treatment. It's also possible that your doctor will refer you directly to a fertility specialist or reproductive surgeon.

You may choose not to try basic treatments with your gynecologist and instead proceed straight to a specialist. If male infertility is a factor, your partner may be referred to an andrologist, or a male fertility doctor.

Another possibility is your doctor my suggest lifestyle changes to improve your fertility.

For example, smoking and excessive drinking can harm fertility. Obesity is another cause of preventable infertility. (It's important, however, to point out that obesity can also be triggered by a hormonal imbalance.) Excessive exercise or being underweight can also cause infertility.

If your gynecologist can't find a cause for the infertility—also known as unexplained infertility—she may suggest trying on your own for a little longer.

One study looked at 7,000 women with unexplained infertility, ages 28 to 36. Of those who did not pursue treatment, just over 40 percent eventually went on to conceive spontaneously.

Step 4: Graduate to a Fertility Clinic

If basic fertility treatment isn't successful, or if your test results suggest treatments that go beyond your gynecologist's purview, you may be referred to a fertility specialist. This usually means finding and choosing a fertility clinic.

In most of the United States, and in some countries, fertility treatment is not covered by insurance. Finding the best fertility clinic for you will require not only finding a good practice, but also finding something affordable.

Be sure when calling fertility clinics to be clear on how much the initial consultation costs and discuss the fees ahead of time for any recommended tests or treatments. Consider travel and lost work time if you're looking at clinics far away.

Step 5: 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, your gynecologist may have checked your FSH levels, while the fertility clinic will decide to also do an antral follicle count or other ovarian reserve testing. If you experienced a miscarriage, your gynecologist may have sent the tissue from the miscarriage for analysis, while the fertility clinic may suggest karyotyping or a hysteroscopy.

Be sure to discuss with your fertility clinic the costs for all recommended tests, as they may not be covered by your insurance.

Step 6: Create a Plan of Action with Your Partner and Your Doctor

After you receive the results of your fertility tests, you will likely meet with your doctor to discuss her recommended treatment plan. Be sure to ask about your chances for success with any given treatment. Also, ask what your doctor's experience is with this treatment, and the potential risks.

Your doctor may also recommend lifestyle and diet changes, which may improve your chances for treatment success.

After speaking to the doctor, you'll likely speak 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. (You don't need to decide on the spot if you want to go ahead with the proposed plan). You will also likely need time to figure out what you can afford. If you need to save up money to afford the treatment, be sure to discuss this with your doctor.

You may also decide to forgo treatment for a number of reasons. In this case, you may decide to pursue other family building options (like adoption), decide to continue to try without treatment, or decide to remain child-free.

Step 7: Begin Fertility Treatment Plans

Once you, your partner, and your doctor decide on a treatment plan, you'll begin. The process for starting treatment may be relatively simple, or it may be complicated and involved.

Your treatment plan may involve separate stages.

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 IVF or even try on your own for awhile.

Fertility treatment can be overwhelming. Be sure to ask your doctor and nurses questions as needed, and to get emotional support from friends, a support group, or a therapist.

Step 8: Reevaluate Treatment Plans When Unsuccessful

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. (Of course, every treatment has different per-cycle success rates, which you should speak to your doctor about.)

Keep in mind that one failed cycle isn't a sign that treatments will never work. Even couples without fertility problems need three to six months to conceive.

A good doctor will help you understand when to stick with the current treatment plan for a little longer, and when it's time 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 completely give up on treatment, talk to your doctor about taking a break from treatment. 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.

Sometimes, getting the treatment you need is more difficult than expected. You may face unexpected financial costs, lack local resources, or experience discrimination. Make sure you explore all your options for treatment access. If one doctor can't (or won't) help, consider seeing someone else.

If your treatment plans are unsuccessful for an extended amount of time, or you are very unhappy with the treatment you're receiving, you may want to consider switching doctors.

Step 9-A: When Successful, Plan for a Healthy Pregnancy

If treatments are successful, congratulations! Your 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.

Also, like any couple who gets pregnant, you should try your best to have a healthy pregnancy by making healthier lifestyle choices.

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.

You need just as much emotional support now as you did when you were trying to get pregnant. Reach out, don't try to do this alone.

Step 9-B: Deciding to Move On From Fertility Treatment

Sadly, not all infertile couples will conceive.

You may decide to move on after many failed treatments, or you may find yourself at this step early on if you can't afford the treatments or decide not to pursue them.

This can be a heartbreaking experience, but one that you can heal from with time and support. Be sure to seek counseling.

Once you have regained your emotional bearings, you may want to consider alternative family building options, like adoption or foster care, or you may decide to live child-free.

Source:

Danielle L. Herbert, Jayne C. Lucke, Annette J. Dobson. "Birth outcomes after spontaneous or assisted conception among infertile Australian women aged 28 to 36 years: a prospective, population-based study." Fertility and Sterility. March 2012 (Vol. 97, Issue 3, Pages 630-638, DOI: 10.1016/j.fertnstert.2011.12.033)

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