Four Steps to Navigating Infertility before Choosing a Treatment

When you have been trying to get pregnant and it’s not happening, trying to figure out the next step can feel overwhelming at best. If trying to conceive or carry a pregnacy doesn't seem to be happening naturally, how far will you go to get pregnant? Dr. Don Aptekar, who has been in practice for over 30 years, said "nothing really surprises me anymore,  but the uterine transplant to support a pregnancy certainly did!" He said the woman nearly died and had to have it removed from complications shortly after giving birth (read more here)

The clinical definition of infertility is not being able to conceive after having unprotected intercourse for 12 months. The part that gets confusing is that infertility does not necessarily mean that you can’t have children on your own. Many infertility factors do not make it impossible to conceive but simply lower the chance with each cycle. So unless you have a clear diagnosis or situation, such as no sperm or two ectopic pregnancies, what to do next, can be very confusing.

What to Try Before IVF when Trying to Conceive

In the past, when couples could not conceive, they had two choices, to learn to love their life together without children or to adopt. Now couples have far more opportunities to conceive if infertile and go to great lengths to seek fertility help, even when it's way beyond their financial means.

Sterility is the total inability to produce a pregnancy and may be reversible or irreversible. Subfertility is infertility without an absolute barrier to having a baby. Subfertility or unexplained infertility makes it less clear-cut on whether to use IVF or other treatments. 

No diagnosis of infertility is easy. Even a clear diagnosis that points to IVF as the only solution to conceive is hard because there is still no guarantee that it will work. There is a guarantee, however, that it will cost a lot of money and be emotionally taxing. Yet, there is also a chance that you end up with a baby and that is a chance many couples are opting to take.  

Below we interviewed Dr. Aptekar on how he recommends couples navigate the process. 


Step One: Try and pinpoint the problem by working backward: 

There are factors that make it impossible for conception. These factors include no eggs, no sperm and that the sperm and egg are not able to meet. For example, you have two blocked fallopian tubes, or partner has azoospermia (zero sperm). In those cases, natural conception has a statistical probably of nearly zero. 

In the simplest forms, to get pregnant, the following have to happen:

·       Having sex during your fertile window.

·       You are ovulating

·       Partner’s sperm is viable for conception

·       The egg and sperm can get together


Start by eliminating factors and try to reduce the variability by changing one thing at a time. You will need to take into consideration your age and menstrual cycle patterns. For example, if you are irregular, yet still ovulating, you may have 4 chances a year versus a woman who has 12 chances a year to conceive. If you are 38 years old, it will statistically take you longer to get pregnant and to keep a pregnancy, but it also means that you will need to see a specialist sooner to not waste precious time.

If you are ovulating, timing intercourse correctly and your partner has checked his sperm for viability, it's time to evaluate the next variables such as if the egg and sperm have opportunity to meet and your ovarian reserve.  


Step Two: Before heading off to the fertility clinic (either for the first time or for another cycle) make a plan

Keep in mind that you are at an extremely vulnerable place. Before heading off to the fertility clinic, sit down with your partner and discuss how much money you are willing to spend and look at your individual statistical success rates. For example, if you are told that you have a 12% success rate trying IVF, that means that you may have an 88% chance of NOT getting pregnant. If your chance of conception naturally, however, is around 1%, that may be a risk you are willing to take. Many couples move forward with that risk, after all, we are talking about having a baby here.

Out of all the couples that went ahead and took that risk, 33% were successful in 2014.  If you understand that you may end up in that 67% that did not end up with a baby and have a plan B, it may help to feel more in control (source).


Did you know? Secondary infertility is even more common than infertility in couples who never achieved pregnancy.


Step Three: Understand your Diagnosis and Chances of Conception

People who have been trying for a year and have normal sperm and prove that they ovulate and have open tubes are people who may simply not be getting pregnant as fast as they hoped and are having an infertility problem. Or there is a problem that has not been detected.  Infertile does not necessarily mean it’s impossible to get pregnant. 

Also, as mentioned above, even if you have a diagnosis, your own individual situation determines the chance of success. For example, a woman who is overweight and 38 years old with blocked tubes will have a much lower chance than a woman who is a healthy weight and 32 years old with the same diagnosis. For reliable data and an individual assessment click here for a Patient Predictor tool.

Not every infertile couple needs IVF, they simply may need to time the fertility window better and try for a longer period of time.  Some lifestyle interventions may be required such as losing or gaining weight, eating a better diet and changing exercise habit.    

Read this article with Dr. Aptekar on How to Become a Parent if Diagnosed with Unexplained Infertility 


Step four: Something to keep in mind for a peace of mind

"I highly recommend while going through infertility to meet with a couple who adopted. I met a new friend and he made it clear to me that his adopted child was his child. My wife and I found some much needed peace knowing that if the cycles did not work, we still could make our dream of having kids come true." - a husband on infertility during an interview  

Your options may not be limited to only ovulation medication and IVF, they may include donor eggs or sperm,  a donor embryo or adoption. "Some people get extremely upset with me when I tell them, 'you can always overcome the problem even if you can't get pregnant'. There have been several times in my career that I've recommended adoption and the husband says 'we are never going to see that guy again' and then the following year I'll get a letter saying that they adopted and are extremely happy."

What may be an option for one couple may not be an option for another, whether due to financial strains or personal feelings. This is your own journey and you are doing a great job empowering yourself through education. Take one step at a time and stay connected by taking a break each day from thinking about what you don't have to remind yourself of things you do have that you love.