Fertility treatment: practical options, tests, and next steps

About 1 in 6 couples will need help to get pregnant. If that sounds like you, this page gives clear, useful steps you can act on today — no fluff, just what works and what to ask your doctor.

When to see a specialist and key tests

If you're under 35, try for 12 months before a fertility workup. If you're 35–39, try for 6 months. If you're 40 or older, or you have irregular cycles, severe endometriosis, prior cancer treatment, or known problems, see a specialist right away.

Basic tests are straightforward and usually start with both partners. For women: blood tests (AMH to estimate ovarian reserve, FSH if needed), thyroid (TSH) and prolactin levels, and confirmation of ovulation (period tracking, LH kits, or midluteal progesterone). Imaging often includes a pelvic ultrasound and a hysterosalpingogram (HSG) to check fallopian tube openness. For men: a semen analysis is the first and most important test.

Main treatment options and what to expect

Lifestyle matters: stop smoking, limit alcohol, keep BMI in a healthy range, and time intercourse around ovulation (the 5 days before ovulation give the best chance). These changes alone help many couples.

Ovulation induction. If ovulation is the issue, your doctor may prescribe letrozole or clomiphene. Letrozole is a common first choice because it often works better and has fewer side effects. You’ll need monitoring with ultrasound and blood tests.

IUI (intrauterine insemination). IUI places sperm directly into the uterus around ovulation. It’s simpler and cheaper than IVF and can help when sperm count or motility is suboptimal or when unexplained infertility is diagnosed. Success per cycle is usually modest — often in the low double digits.

IVF (in vitro fertilization) and ICSI. IVF creates embryos in the lab; ICSI injects a single sperm into an egg and is used for severe male factor infertility. IVF gives the best chance per cycle, especially for older patients. Success falls with age — many clinics report much higher live-birth rates for women under 35 than for women over 40.

Surgery and other options. Laparoscopy can treat endometriosis or remove fibroids. Donor eggs, donor sperm, and gestational carriers are options when own-gamete treatments aren’t suitable. Each has emotional, legal, and financial implications to discuss ahead of time.

Risks and realities. Treatments can cause side effects (hot flashes, mood swings), and IVF carries a small risk of ovarian hyperstimulation syndrome (OHSS). Multiple pregnancy risk rises with some treatments; many clinics now recommend single embryo transfer to lower that risk.

Practical tips: pick a clinic with transparent success data and accreditation, ask about average cycle costs and what’s included, and get a clear plan with milestones. Avoid buying prescription fertility drugs from unverified websites — always use a licensed pharmacy with a proper prescription.

Bring your partner to appointments, keep a cycle log, and write down questions before visits. Fertility care is a stepwise process — tests first, then the least invasive treatment likely to work. Keep control of the process by asking for clear timelines and next steps at every visit.