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    Infertility: Should I Have Treatment?

    Infertility: Should I Have Treatment?

    You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

    Infertility: Should I Have Treatment?

    Get the facts

    Your options

    • Try infertility treatment.
    • Don't try treatment. Keep trying to get pregnant on your own, or think about other options for parenting.

    Key points to remember

    • Infertility treatments can increase your chances of getting pregnant.
    • Treatment can be stressful, costly, and painful. If you decide to have treatment, set your limits before you start. Talk with your partner about how long you want to try to have a baby with medical help. Decide how much money you can afford to spend.
    • Infertility treatment doesn't guarantee that you will have a baby.
    • Treatment increases your chances of having more than one baby at a time (multiple pregnancy). Be sure to discuss the risks with your doctor.
    • In 10 out of 100 couples who are tested for infertility, no cause is found. 1 Of these 10 couples, even without treatment, about 3 will get pregnant within 3 years and about 5 will get pregnant within 7 years. 2
    FAQs

    What is infertility?

    You may be infertile if you have not been able to get pregnant after trying for at least 1 year.

    A woman's fertility drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

    As a woman's eggs get older, the risk of miscarriage increases.

    What kinds of problems lead to infertility?

    In about 35 out of 100 couples, testing finds a male fertility problem, such as a problem with sperm production or ejaculation. 1

    In about 50 out of 100 couples, testing finds a female fertility problem with ovulation , fallopian tube function, or other pelvic problems. 1

    Some couples find that both partners have a fertility problem.

    In 10 out of 100 couples, no cause is found. 1 Of these 10 couples, even without treatment, about 3 will get pregnant within 3 years and about 5 will get pregnant within 7 years. 2

    It can be stressful for you and your partner to find out the reason for infertility. Knowing where the problem is may create feelings of guilt and blame and may put strain on your relationship. Not being able to find any cause can also create stress. You may want to talk with a counselor or join an infertility support group before you make your decision. Talking with other people can help you feel less alone.

    What types of infertility treatment are available?

    Infertility treatment usually starts with making sure you are having sex during your 6-day fertile window, which is your day of ovulation and the 5 days before it. This is called fertility awareness. If that doesn't work, then you may choose surgical, hormonal, or assisted reproductive technology (ART) treatment to help you get pregnant. Some of these treatments can be stressful, costly, and painful.

    Depending on what is causing the problem, couples can:

    • Take medicine, such as clomiphene, gonadotropins, or gonadotropin-releasing hormone (GnRH), that helps a woman ovulate. A man can take medicines to increase sperm count.
    • Have a procedure that puts sperm directly inside the woman (insemination).
    • Have surgery that corrects a problem caused by endometriosis or blocked fallopian tubes .
    • Try in vitro fertilization (IVF). During an IVF, eggs and sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor puts one or more fertilized eggs into the woman?s uterus.

    The success of IVF depends on your age and your doctor?s skill and experience. For women, the older you are, the less likely it is that IVF will work unless you use donor eggs. Also, the cause of your infertility can affect the success of IVF.

    What else do you need to know about fertility treatments?

    Keep in mind that some infertility problems are more easily treated than others. In general, as a woman ages, especially after age 35, her chances of getting pregnant decrease and her risk of miscarriage increases.

    Treatment for fertility problems can be stressful, costly, and hard on your body. Before you start testing, make some decisions about what you want to do. You may change your mind later, but it?s a good idea to start with a plan.

    • Learn all you can about the tests and treatments, and decide which you want to try. For example, some couples agree to try medicines but don't want surgery or other treatments.
    • Find out how much the treatments cost and whether your insurance will pay for them. If you don't have insurance, decide what you can afford.

    Treatments for infertility can increase your chance of getting pregnant. But they also increase your chance of having more than one baby at a time (multiple pregnancy). Be sure to discuss this risk with your doctor.

    There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques. Talk with your doctor about these possible risks.

    Even though many fertility clinics give information about how many babies have been conceived, those numbers can be misleading. They may not include how many pregnancies miscarry. Treatment for infertility doesn't guarantee that you will have a baby.

    Why might your doctor recommend infertility treatment?

    Your doctor may recommend treatment if:

    • You have a known problem that can be fixed with infertility treatment.
    • You have unexplained infertility, and your doctor has proposed a treatment that can increase your chances of having a healthy pregnancy.

    Compare your options

    Compare

    What is usually involved?









    What are the benefits?









    What are the risks and side effects?









    Have fertility treatment Have fertility treatment
    • You take medicines, have surgery, try insemination, or have in vitro fertilization (IVF) to help you get pregnant.
    • With most infertility treatments (except surgery), you won't have to stay overnight in the hospital and you will recover quickly.
    • If you have surgery, you may stay in the hospital for 2 to 4 days. Depending on the type of surgery you have, your recovery may take a few days to several weeks.
    • Depending on the cause of your infertility, medicines and other treatment can increase your chances of getting pregnant.
    • You may not get pregnant. Your chances of pregnancy with IVF depend on how good your eggs are. (Donor eggs may improve your chances).
    • Treatment can be stressful, costly, and painful. It can take months or years.
    • Treatments can increase your chances of having more than one baby at a time.
    • There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques.
    • Medicines to stimulate ovulation (clomiphene) or increase sperm (gonadotropin) have side effects. Some studies have found an increased risk of miscarriage when either of these drugs is used.
    Don't have treatment Don't have treatment
    • You keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant.
    • You consider other options for parenting, such as adoption or raising a foster child.
    • You avoid the cost, stress, and risks of infertility treatments.
    • You may not get pregnant without treatment.

    Personal stories

    Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

    Personal stories about infertility treatment decisions

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    We have been trying for awhile to have a baby on our own. Now that we've had some tests, our doctor has recommended treatments that will give us a better chance. We are much more hopeful now. We feel very good about the clinic where we will have the treatments done, and their live birth rates are above the national average.

    Jamie, age 33

    We can't afford some of the expensive ART treatments. We have one child, and we need to think about his future needs, like college. I don't know where we would get $10,000 or maybe even $15,000 for treatment, since our insurance doesn't cover the costs. Luckily, some of the more successful treatment options for our problem are covered by our insurance. We feel fortunate about that.

    George, age 45, and Bonita, age 40

    We have had every possible test to try to find out why we can't get pregnant. There doesn't seem to be anything wrong. After almost 2 years, we don't have a baby yet. We know there is still a chance that we will get pregnant, and that gives us hope. Knowing that there isn't anything wrong, at least anything that the doctors can find, helps some. We've heard about the side effects of treatment, and the stress involved, and we just aren't sure that we want to put ourselves through that. We are going to try for a few more months, and then consider our treatment options.

    Frank, age 37

    My husband has sperm problems, so our least costly option is to use donor sperm. We are trying to decide if we want to spend the money for treatment or use it to adopt. It's a hard decision. Each of us feels differently about having a child that isn't biologically related to us, so we are talking about it a lot. We feel lucky because at least we have some options and enough time to consider them before we finally decide what's best for us.

    Carole, age 29

    I feel so guilty for having waited so long to try to have a baby. I can't help wondering if something I did when I was in my 20s is the reason why I can't get pregnant now. My husband really wants kids, and I feel like I'm letting him down and that he is disappointed in me. My husband has started talking about taking a break from all of this treatment. He said he doesn't like what this is doing to me emotionally and physically and thinks that a break might help. I worry that if we take a break I will feel like I am being lazy and just expecting to get pregnant without putting any work into it. But maybe it would be best, even for a couple of months. Every month just seems so precious!

    Gail, age 36

    What matters most to you?

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    Reasons to have infertility treatment

    Reasons not to have infertility treatment

    Having a biological child is very important to me.

    I need to think about how important having a biological child is to me.

    More important
    Equally important
    More important

    I'm not concerned about the cost of infertility treatment.

    I'm worried about how I will pay for treatment.

    More important
    Equally important
    More important

    I think I can handle the emotional stress of treatment.

    I'm not sure I can handle the stress of treatment.

    More important
    Equally important
    More important

    I accept that I may not get pregnant even with treatment.

    I don't want to have treatment if I might not get pregnant.

    More important
    Equally important
    More important

    My other important reasons:

    My other important reasons:

    More important
    Equally important
    More important

    Where are you leaning now?

    Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

    Having infertility treatment

    NOT having infertility treatment

    Leaning toward
    Undecided
    Leaning toward

    What else do you need to make your decision?

    Check the facts

    1.

    Does having infertility treatment guarantee that you will deliver a baby?

    • Yes No, that's wrong. Infertility treatment does not guarantee that you will have a baby.
    • No You're right. Infertility treatment does not guarantee that you will have a baby.
    • I'm not sure It may help to go back and read "Key points to remember." Infertility treatment does not guarantee that you will have a baby.
    2.

    Can infertility treatment increase your chances of getting pregnant with more than one baby at a time?

    • Yes You're right. Infertility treatments can increase your chances of getting pregnant. But they also increase your chance of having more than one baby at a time.
    • No Sorry, that's not right. Infertility treatments can increase your chances of getting pregnant. But they also increase your chance of having more than one baby at a time.
    • I'm not sure It may help to go back and read "What else do you need to know about fertility treatments?" The treatments can increase your chances of getting pregnant. But they also raise your chance of having more than one baby at a time.
    3.

    If you decide to start treatment, is it important to know how far you are willing to go with it before you get started?

    • Yes You're right. If you decide to have treatment, you should define your limits before you start. Talk with your partner about how long you want to use medical help to try to have a baby.
    • No Sorry, that's not right. If you decide to have treatment, you should define your limits before you start. Talk with your partner about how long you want to use medical help to try to have a baby.
    • I'm not sure It may help to go back and read "What else do you need to know about fertility treatments?" If you decide to have treatment, talk with your partner and define your limits before you start.

    Decide what's next

    1.

    Do you understand the options available to you?

    2.

    Are you clear about which benefits and side effects matter most to you?

    3.

    Do you have enough support and advice from others to make a choice?

    Certainty

    1.

    How sure do you feel right now about your decision?

    Not sure at all
    Somewhat sure
    Very sure
    3.

    Use the following space to list questions, concerns, and next steps.

    Your Summary

    Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

    Your decision

    Next steps

    Which way you're leaning

    How sure you are

    Your comments

    Your knowledge of the facts

    Key concepts that you understood

    Key concepts that may need review

    Getting ready to act

    Patient choices

    Credits and References

    Credits
    Credits Healthwise Staff
    Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
    Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

    References
    Citations
    1. Fritz MA, Speroff L (2011). Female infertility. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1137?1190. Philadelphia: Lippincott Williams and Wilkins.
    2. Lobo RA (2012). Infertility: Etiology, diagnostic evaluation, management, prognosis. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 869?895. Philadelphia: Mosby.
    You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

    Infertility: Should I Have Treatment?

    Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
    1. Get the facts
    2. Compare your options
    3. What matters most to you?
    4. Where are you leaning now?
    5. What else do you need to make your decision?

    1. Get the Facts

    Your options

    • Try infertility treatment.
    • Don't try treatment. Keep trying to get pregnant on your own, or think about other options for parenting.

    Key points to remember

    • Infertility treatments can increase your chances of getting pregnant.
    • Treatment can be stressful, costly, and painful. If you decide to have treatment, set your limits before you start. Talk with your partner about how long you want to try to have a baby with medical help. Decide how much money you can afford to spend.
    • Infertility treatment doesn't guarantee that you will have a baby.
    • Treatment increases your chances of having more than one baby at a time (multiple pregnancy). Be sure to discuss the risks with your doctor.
    • In 10 out of 100 couples who are tested for infertility, no cause is found. 1 Of these 10 couples, even without treatment, about 3 will get pregnant within 3 years and about 5 will get pregnant within 7 years. 2
    FAQs

    What is infertility?

    You may be infertile if you have not been able to get pregnant after trying for at least 1 year.

    A woman's fertility drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

    As a woman's eggs get older, the risk of miscarriage increases.

    What kinds of problems lead to infertility?

    In about 35 out of 100 couples, testing finds a male fertility problem, such as a problem with sperm production or ejaculation. 1

    In about 50 out of 100 couples, testing finds a female fertility problem with ovulation , fallopian tube function, or other pelvic problems. 1

    Some couples find that both partners have a fertility problem.

    In 10 out of 100 couples, no cause is found. 1 Of these 10 couples, even without treatment, about 3 will get pregnant within 3 years and about 5 will get pregnant within 7 years. 2

    It can be stressful for you and your partner to find out the reason for infertility. Knowing where the problem is may create feelings of guilt and blame and may put strain on your relationship. Not being able to find any cause can also create stress. You may want to talk with a counselor or join an infertility support group before you make your decision. Talking with other people can help you feel less alone.

    What types of infertility treatment are available?

    Infertility treatment usually starts with making sure you are having sex during your 6-day fertile window, which is your day of ovulation and the 5 days before it. This is called fertility awareness. If that doesn't work, then you may choose surgical, hormonal, or assisted reproductive technology (ART) treatment to help you get pregnant. Some of these treatments can be stressful, costly, and painful.

    Depending on what is causing the problem, couples can:

    • Take medicine, such as clomiphene, gonadotropins, or gonadotropin-releasing hormone (GnRH), that helps a woman ovulate. A man can take medicines to increase sperm count.
    • Have a procedure that puts sperm directly inside the woman (insemination).
    • Have surgery that corrects a problem caused by endometriosis or blocked fallopian tubes .
    • Try in vitro fertilization (IVF). During an IVF, eggs and sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor puts one or more fertilized eggs into the woman?s uterus.

    The success of IVF depends on your age and your doctor?s skill and experience. For women, the older you are, the less likely it is that IVF will work unless you use donor eggs. Also, the cause of your infertility can affect the success of IVF.

    What else do you need to know about fertility treatments?

    Keep in mind that some infertility problems are more easily treated than others. In general, as a woman ages, especially after age 35, her chances of getting pregnant decrease and her risk of miscarriage increases.

    Treatment for fertility problems can be stressful, costly, and hard on your body. Before you start testing, make some decisions about what you want to do. You may change your mind later, but it?s a good idea to start with a plan.

    • Learn all you can about the tests and treatments, and decide which you want to try. For example, some couples agree to try medicines but don't want surgery or other treatments.
    • Find out how much the treatments cost and whether your insurance will pay for them. If you don't have insurance, decide what you can afford.

    Treatments for infertility can increase your chance of getting pregnant. But they also increase your chance of having more than one baby at a time (multiple pregnancy). Be sure to discuss this risk with your doctor.

    There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques. Talk with your doctor about these possible risks.

    Even though many fertility clinics give information about how many babies have been conceived, those numbers can be misleading. They may not include how many pregnancies miscarry. Treatment for infertility doesn't guarantee that you will have a baby.

    Why might your doctor recommend infertility treatment?

    Your doctor may recommend treatment if:

    • You have a known problem that can be fixed with infertility treatment.
    • You have unexplained infertility, and your doctor has proposed a treatment that can increase your chances of having a healthy pregnancy.

    2. Compare your options

    Have fertility treatment Don't have treatment
    What is usually involved?
    • You take medicines, have surgery, try insemination, or have in vitro fertilization (IVF) to help you get pregnant.
    • With most infertility treatments (except surgery), you won't have to stay overnight in the hospital and you will recover quickly.
    • If you have surgery, you may stay in the hospital for 2 to 4 days. Depending on the type of surgery you have, your recovery may take a few days to several weeks.
    • You keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant.
    • You consider other options for parenting, such as adoption or raising a foster child.
    What are the benefits?
    • Depending on the cause of your infertility, medicines and other treatment can increase your chances of getting pregnant.
    • You avoid the cost, stress, and risks of infertility treatments.
    What are the risks and side effects?
    • You may not get pregnant. Your chances of pregnancy with IVF depend on how good your eggs are. (Donor eggs may improve your chances).
    • Treatment can be stressful, costly, and painful. It can take months or years.
    • Treatments can increase your chances of having more than one baby at a time.
    • There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques.
    • Medicines to stimulate ovulation (clomiphene) or increase sperm (gonadotropin) have side effects. Some studies have found an increased risk of miscarriage when either of these drugs is used.
    • You may not get pregnant without treatment.

    Personal stories

    Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

    Personal stories about infertility treatment decisions

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    "We have been trying for awhile to have a baby on our own. Now that we've had some tests, our doctor has recommended treatments that will give us a better chance. We are much more hopeful now. We feel very good about the clinic where we will have the treatments done, and their live birth rates are above the national average."

    ? Jamie, age 33

    "We can't afford some of the expensive ART treatments. We have one child, and we need to think about his future needs, like college. I don't know where we would get $10,000 or maybe even $15,000 for treatment, since our insurance doesn't cover the costs. Luckily, some of the more successful treatment options for our problem are covered by our insurance. We feel fortunate about that."

    ? George, age 45, and Bonita, age 40

    "We have had every possible test to try to find out why we can't get pregnant. There doesn't seem to be anything wrong. After almost 2 years, we don't have a baby yet. We know there is still a chance that we will get pregnant, and that gives us hope. Knowing that there isn't anything wrong, at least anything that the doctors can find, helps some. We've heard about the side effects of treatment, and the stress involved, and we just aren't sure that we want to put ourselves through that. We are going to try for a few more months, and then consider our treatment options."

    ? Frank, age 37

    "My husband has sperm problems, so our least costly option is to use donor sperm. We are trying to decide if we want to spend the money for treatment or use it to adopt. It's a hard decision. Each of us feels differently about having a child that isn't biologically related to us, so we are talking about it a lot. We feel lucky because at least we have some options and enough time to consider them before we finally decide what's best for us."

    ? Carole, age 29

    "I feel so guilty for having waited so long to try to have a baby. I can't help wondering if something I did when I was in my 20s is the reason why I can't get pregnant now. My husband really wants kids, and I feel like I'm letting him down and that he is disappointed in me. My husband has started talking about taking a break from all of this treatment. He said he doesn't like what this is doing to me emotionally and physically and thinks that a break might help. I worry that if we take a break I will feel like I am being lazy and just expecting to get pregnant without putting any work into it. But maybe it would be best, even for a couple of months. Every month just seems so precious!"

    ? Gail, age 36

    3. What matters most to you?

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    Reasons to have infertility treatment

    Reasons not to have infertility treatment

    Having a biological child is very important to me.

    I need to think about how important having a biological child is to me.

    More important
    Equally important
    More important

    I'm not concerned about the cost of infertility treatment.

    I'm worried about how I will pay for treatment.

    More important
    Equally important
    More important

    I think I can handle the emotional stress of treatment.

    I'm not sure I can handle the stress of treatment.

    More important
    Equally important
    More important

    I accept that I may not get pregnant even with treatment.

    I don't want to have treatment if I might not get pregnant.

    More important
    Equally important
    More important

    My other important reasons:

    My other important reasons:

    More important
    Equally important
    More important

    4. Where are you leaning now?

    Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

    Having infertility treatment

    NOT having infertility treatment

    Leaning toward
    Undecided
    Leaning toward

    5. What else do you need to make your decision?

    Check the facts

    1. Does having infertility treatment guarantee that you will deliver a baby?

    • Yes
    • No
    • I'm not sure
    You're right. Infertility treatment does not guarantee that you will have a baby.

    2. Can infertility treatment increase your chances of getting pregnant with more than one baby at a time?

    • Yes
    • No
    • I'm not sure
    You're right. Infertility treatments can increase your chances of getting pregnant. But they also increase your chance of having more than one baby at a time.

    3. If you decide to start treatment, is it important to know how far you are willing to go with it before you get started?

    • Yes
    • No
    • I'm not sure
    You're right. If you decide to have treatment, you should define your limits before you start. Talk with your partner about how long you want to use medical help to try to have a baby.

    Decide what's next

    1. Do you understand the options available to you?

    2. Are you clear about which benefits and side effects matter most to you?

    3. Do you have enough support and advice from others to make a choice?

    Certainty

    1. How sure do you feel right now about your decision?

    Not sure at all
    Somewhat sure
    Very sure

    2. Check what you need to do before you make this decision.

    • I'm ready to take action.
    • I want to discuss the options with others.
    • I want to learn more about my options.

    3. Use the following space to list questions, concerns, and next steps.

    Credits
    By Healthwise Staff
    Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
    Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

    References
    Citations
    1. Fritz MA, Speroff L (2011). Female infertility. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1137?1190. Philadelphia: Lippincott Williams and Wilkins.
    2. Lobo RA (2012). Infertility: Etiology, diagnostic evaluation, management, prognosis. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 869?895. Philadelphia: Mosby.

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