If some of the simpler steps do not seem to be helping there are additional methods for helping a couple conceive. If the woman does not ovulate (release an egg from an ovary), there are medications she can take to cause ovulation. Even if a woman is ovulating, she may need to release more eggs in order to get pregnant. The medication used most often to cause ovulation is Clomiphene Citrate. It may be used for several cycles. The dosage may be increased over time if ovulation does not occur.

Ovulation or pregnancy may not occur after treatment with Clomiphene Citrate. If not, medications called Gonadotropins may be given by injection. These drugs stimulate the eggs to develop. Blood tests and ultrasound are used to track the development of eggs. If too many eggs develop, your doctor may stop that cycle. Most women who take drugs to cause ovulation start to ovulate regularly. If there are no other problems, more than half of such women get pregnant within 6 treatment cycles. If a woman does not start ovulating, other tests may be needed. There is a chance of having a multiple pregnancy and the risk is higher with Gonadotropins than with Clomiphene Citrate. If this happens, your doctor will explain your options.

Your gynecologist will be able to discuss all of the options, costs, and risks with you and help you determine which is the best method for helping you conceive.

Surgery
If the fallopian tubes are blocked, surgery may be done to open or remove them. Surgery also may be done to remove growths such as polyps or fibroids, to remove scarring and to treat endometriosis if necessary. If the problem is with the man's sperm, surgery can sometimes fix it. The success of surgery depends on the type and extent of the problem.

Artificial Insemination
With insemination, sperm is placed in a woman's uterus by means other than sex. In most cases, the sperm are treated in a lab. The goal is to decrease the risk of infections and increase the chance that an egg will be fertilized. Around the time the woman ovulates, the doctor places the sperm into the uterus.

The woman's partner or a donor may provide the sperm for insemination. Sperm from a donor is frozen, and the donor is checked to make sure he is free of certain medical problems. These problems include some genetic disorders and STDs, including human immunodeficiency virus (HIV). Talk with your doctor about the specific tests that are done at the lab where you are treated.

Assisted Reproductive Technologies
Assisted reproductive technologies (ART) are ways to process eggs and sperm to help an infertile couple conceive a child. This is usually done in a lab and the ART treatments can use the sperm from your partner or donor eggs or sperm. In some cases, sperm may be obtained surgically by sperm aspiration or testicular biopsy. Following are some of the ART treatments that are available to couples trying to conceive.

In Vitro Fertilization.

In vitro fertilization (IVF) uses sperm to fertilize eggs from the woman in a lab. The fertilized egg then is placed in the woman's uterus to grow. For IVF, eggs are removed from an ovary just before a woman ovulates. Usually, she first takes medication to make more than one egg mature. Eggs are removed with a needle that is inserted through the vagina and into the ovary. Ultrasound is used to guide the needle. The eggs then are withdrawn through the needle. Pain relief or a sedative may be given.

The success rate of IVF depends on the woman's age and the reason for the infertility. As with ovulation drugs and other procedures, side effects of IVF can include multiple pregnancy and ovarian hyperstimulation syndrome. Fetal reduction is an option in multiple pregnancies.

Intrafallopian Transfers
Rarely, two other treatments may be used for women who have certain conditions of the cervix. In both, eggs are removed using a needle.

One is called gamete intrafallopian transfer (GIFT). With this procedure, eggs are fertilized in the woman's body. The eggs and sperm are placed in the fallopian tube using laparoscopy and fertilization may result. Zygote intrafallopian transfer (ZIFT) also may be an option. With ZIFT, the eggs are fertilized in a lab. One or more embryos then are placed in a tube using laparoscopy and pregnancy may result.

Both treatments are more costly than IVF because they require surgery. Possible side effects are the same as for IVF and ovulation medications. As with any surgery, though, there are additional risks, such as infection or problems related to the anesthesia. Before having either of these procedures, talk to your doctor about the risks.

It is important to discuss all of the treatment options, costs and risks with your spouse and gynecologist. If you are hesitate to proceed with some of the more advanced medical techniques then you may consider taking a break from treatments for a while to let your body rest and to think things over. It is important to stay hopeful but also to stay realistic. Struggling with infertility can be an emotional rollercoaster and it’s important to be in communication with someone you can trust and who you can be honest with. It can also put a strain on even the best of relationships. It is important to communicate with each other and to be honest about your emotions. Make sure to take time to appreciate and enjoy one another. Keep in mind that if you decide to end treatments altogether there are still many options that can allow you to experience the joys of being a parent.