What to Do When You Can't Get Pregnant

9 Steps Every Couple Should Take

The inability to get pregnant if you've been trying for some time can be heartbreaking. But there are steps you can, and should, take. Sometimes the cause of infertility is easy to diagnose and can be treated.

How do you know when to seek help? 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. 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 a baby for an entire year.

Step 1: 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. In fact, most clinics prefer you have a referral from your primary gynecologist or physician. 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 you menstruate like clockwork. If you've been keeping a fertility calendar or body basal temperature chart, bring the last six months' information.
  • A list of all 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 the "embarrassing" ones as well, such as painful sex, unwanted hair growth, or low libido. These can all by symptoms of a fertility problem. Include any symptoms your male partner may be experiencing as well. Up to 40 percent of infertile couples face male infertility.

Step 2: Begin Basic Fertility Testing

Fertility testing includes blood work for the woman and a semen analysis for the man. Depending on your symptoms, testing also may include an HSG, vaginal ultrasound, or diagnostic laparoscopy. Your doctor will also likely perform a basic pelvic exam, pap smear, and some test you for certain sexually-transmitted infections or diseases.

Basic fertility tests may or may not lead to a diagnosis. Up to 30 percent of couples never find out why they can't conceive, in which case they are diagnosed with unexplained infertility.

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.

Step 3: (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. He may feel, for example, that you could have success by taking a fertility medication such as Clomid (clomiphene), Femara (letrozole), a breast cancer drug that increases estrogen levels, or Metformin, an insulin-sensitizing drug primarily used to treat diabetes that also 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 and perhaps refer you directly to a fertility specialist or reproductive surgeon.

Keep in mind that certain lifestyle changes may help greatly increase your chances of getting pregnant while you go through treatment (and even if you choose not to). These include quitting smoking, cutting back on drinking alcohol, losing weight if you're overweight or obese (note that obesity also can be triggered by a hormonal imbalance), and even dialing back on the amount of exercise you do if you tend to work out excessively or are underweight.

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, she 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. 

When you begin calling fertility clinics or looking at their websites, 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. Consider travel and lost work time if you're considering a clinic that's not close by.

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 another ovarian reserve testing. If you've ever had a miscarriage, your gynecologist may have sent the tissue from the miscarriage for analysis, while the fertility clinic may suggest karyotyping or a hysteroscopy.

Step 6: 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. After you meet with her, 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.

Step 7: Begin Fertility Treatment Plans

Infertility treatments range from relatively simple to complicated and involved. 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 a while.

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.

One failed cycle isn't a sign that treatment 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 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.

Step 9-A: 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.

Step 9-B: Deciding to Move On

Not all infertile couples will conceive. If ultimately you're unable to get pregnant or must stop treatment for financial reasons, it can be heartbreaking. If your disappointment is overwhelming, be sure to see a counselor or join a self-help group.

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Article Sources
  • 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)