When should I see a doctor? — See your doctor if you do not get pregnant after having unprotected sex for 1 year. But if you get worried before then, see your doctor sooner. And if you are older than 35 or not getting your period every month, see your doctor if you can't get pregnant after 6 months of trying.

Your doctor will talk with you and do an exam. He or she will often do tests to try to figure out the cause of the problem. Plus, your partner might need to be tested, too. But don't be surprised if your doctor cannot tell you what is wrong. It's not always possible to find out why a woman cannot get pregnant.

Is there anything I can do on my own? — If you are overweight, losing weight might help you become pregnant. Losing weight can also help you have a healthier pregnancy when you become pregnant.

What treatments are available? — Women who have trouble getting pregnant might choose to have one or more of the following treatments. You and your doctor should discuss which treatment to try first. Treatments can include:

• A medicine called clomiphene – This medicine improves the chances that ovulation will occur. Many times, doctors prescribe this treatment first. Your doctor will tell you how and when to take this medicine. He or she will also tell you when to have sex so the treatment has the best chance of working. If this medicine does not work after a few months, your doctor might recommend trying other medicines to help with ovulation.
• Hormone shots – Hormone shots are often recommended if a woman does not get pregnant with clomiphene. Hormones improve the chances that ovulation will occur. Your doctor will tell you how and when to do this treatment.
• Intrauterine insemination – For this treatment, a doctor uses a tube to place sperm directly inside a woman's uterus. This is done right before ovulation. For some women, this treatment is combined with clomiphene or hormone shots to increase the chance of pregnancy.
• In vitro fertilization, also called "IVF" – IVF is a procedure that is usually done if other treatments have not worked. It involves the following:

          •A woman gives herself hormone shots for a few weeks. These hormones get the ovary ready to ovulate.
          •Just before ovulation, the doctor uses a thin needle to remove some eggs from the ovaries.
           He or she does this through the vagina.
          •The eggs are put into a test tube with sperm so that the sperm can fertilize one or more eggs.
          •After 2 to 5 days, the fertilized egg or eggs are put in the woman's uterus. Hopefully, one of the eggs will
           attach to the uterus and grow into a pregnancy.
          •IVF is usually done in women:
           -Whose fallopian tubes are missing or blocked
           -With male partners who have too few sperm
           -Who have not been able to get pregnant using other treatments

How will I know if a treatment is working? — Your doctor will do tests at different times during treatment to check if it is working. These tests can include blood tests and ultrasounds. Ultrasound is an imaging test that creates pictures of the inside of the body.

Do treatments always work? — No. Treatments do not always help a woman get pregnant. The same treatment can work for one woman, but not another.

How do I decide which treatment to have? — Talk with your doctor about the benefits and downsides of the different treatments. To choose the treatment that is right for you, you might want to think about:

• How well your doctor thinks the treatment will work.
• Cost of the treatment – Some treatments cost a lot of money. Health insurance does not pay for all types of treatments.
• How long the treatment will take – Treatments might need to be done more than once to work. Getting pregnant can take months to years.
• Side effects and downsides of the treatment.

You should also talk with your doctor about other options for having children, such as adoption.

A woman can have a tough time making these decisions. You might find it helpful to talk to a counselor or go to a support group for people who are having trouble getting pregnant.

Male Infertility

What is male infertility? — Male infertility is the term doctors use when a man has trouble getting a woman pregnant. In order to get a woman pregnant, a man needs to have a normal number of healthy sperm. Doctors call this a "normal sperm count." Men with infertility can have one of the following problems with their sperm:

• They have no sperm at all.
• They do not have enough sperm – this is called having a "low sperm count"
• They have unhealthy sperm – the sperm might move too slowly or have abnormal shapes.

There are many reasons that men can have an abnormal sperm count. These include:

• Problems in the testicles, such as a block in the vas deferens – The vas deferens is the tube the sperm travels through to reach the penis. A block can be caused by a past infection or by a vasectomy. A vasectomy is a surgery a man can choose to have so that he can't get a woman pregnant. In a vasectomy, a doctor cuts or blocks the vas deferens.
• Having low levels of the hormone testosterone.
• Genetic problems that men might be born with.

But most of the time, doctors cannot explain why a man has an abnormal sperm count.

When should I see a doctor? — In most cases, doctors recommend that a man be tested if a couple cannot get pregnant after having unprotected sex for 1 year. At that time, both the man and the woman are often tested. But if you are worried, talk with your doctor. He or she might recommend that you have tests done sooner. If your partner is over age 35 and has not gotten pregnant after 6 months of trying, your doctor will start tests at that time.

What tests will I have? — Your doctor will order a test called a "sperm count" to check your sperm. This test counts your sperm and checks to see how healthy they are. For this test, a man needs to provide a sample of his sperm.

If your sperm count is low, your doctor will repeat the test 1 or more times. If repeat sperm counts are still abnormal, your doctor might do other tests. For example, he or she might do:

• Blood tests
• An exam to measure the size of your testicles
• Tests to see if there is a block in your testicles

What treatments can help men with infertility? — Different treatments can help men with infertility. These can include:

• Hormone treatment to increase sperm counts – Some men have low hormone levels in the brain and can be treated with hormone shots.
• Surgery to open up a block in the testicle – For example, a man who had a vasectomy in the past can have surgery to reopen the tube the sperm travels through.
• In vitro fertilization, also called "IVF" – During IVF, a doctor takes an egg or eggs from a woman and sperm from a man. He or she puts them together in a test tube so that the sperm can fertilize an egg. Then the fertilized egg is put into the woman's uterus to grow . Many times, a doctor will do a treatment called "intracytoplasmic sperm injection," or "ICSI," along with IVF. During ICSI, a doctor takes only 1 sperm and puts it right next to an egg. IVF with ICSI is often used for men who have low sperm counts or abnormal sperm. But this treatment can also be used for men who seem to make no sperm. This is because these men might still have sperm in their testicles that a doctor can take out and use for the procedure.

Do treatments always work? — No. Treatments do not always help a couple get pregnant. The same treatment can help 1 couple get pregnant, but not another couple.

How do I decide which treatment to have? — Talk with your doctor about the benefits and downsides of the different treatments. To choose the treatment that is right for you and your partner, you might want to think about:

• How well your doctor thinks the treatment will work.
• Cost of the treatment – Health insurance pays for treatment in some states, but not all.
• How long your doctor thinks the treatment will take
• Downsides of the treatment

What choices do I have if I choose to stop or not have treatment? — Couples who choose to stop or not have treatment have other options. They can:

• Try to have a baby using another man's sperm, such as sperm from a sperm bank (called "donor" sperm).
• Adopt a child
• Not have children of their own.

Couples can have a tough time making these decisions. You might find it helpful to talk to a counselor or go to a support group for people who are facing the same issues.