Fertility treatment: Getting started
By the BabyCenter editorial staff

My partner and I have a fertility problem. What are our treatment options?

You have a number of choices, so you and your doctor will devise a treatment plan, starting with the least invasive options first. Your impulse may be to head straight for the most advanced and expensive treatments such as in vitro fertilization (IVF), thinking you'll get pregnant faster. But cheaper therapies, such as fertility drugs or surgery, are often very effective. In fact, 85 to 90 percent of couples with fertility problems who go on to have children are treated with drugs or surgery only.

Here's a rundown of your treatment options, from the least to most invasive:
• Fertility drugs
If your hormones are out of balance or in short supply, these drugs (for women and men) can get your reproductive system back on track. They might even help if the cause of your fertility problem is unknown. And you can take them in conjunction with another treatment such as artificial insemination.

• Artificial insemination
If your partner's sperm just need help getting to your egg, placing a concentrated dose of sperm in your uterus will improve your odds of getting pregnant.

• Surgery
If you have blocked fallopian tubes, endometriosis, fibroids, genetic defects, or ovarian cysts, a type of minor surgery performed with a fiber-thin tube (called a laparoscope) can help clear the way for you to conceive. Surgery can also be more extensive and require an incision in your abdomen.

• Assisted reproductive technologies (ART)
If your partner has a low sperm count or if you have ovulation problems or blocked fallopian tubes, a hi-tech ART procedure (such as IVF, GIFT, ZIFT, or ICSI) can help you make a baby. Otherwise, you might consider using an egg donor or a gestational carrier (otherwise known as a surrogate mother), depending on the cause of your fertility problem.

How will we pay for treatment?

Fertility treatment isn't cheap — assisted reproductive techniques can run as high as $17,000 for a single try. Since many health insurance policies don't cover fertility therapies, check your policy carefully before you do anything. Currently, 14 states — Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia — require insurers to cover diagnosis and some treatments, but even within a state, policies can vary. For example, certain states cover fertility drugs but not assisted reproductive techniques. Check the American Society of Reproductive Medicine Web site for information about your state's laws.

If your policy doesn't cover the treatment you're seeking, you'll have to pay the entire cost up front. Watch out for clinics that advertise "money-back guarantees" — it's just a lure to get you in the door. Reputable clinics remind patients that there are no guarantees with fertility treatment. No matter which clinic you choose, make sure you ask about the cancellation policy first. You want one that'll charge you only for services performed and be willing to refund the cost of cancelled treatments.

What are my chances of getting pregnant with treatment?

On average, more than half the couples who seek fertility treatment go on to have a baby. Making certain lifestyle changes, such as quitting smoking, limiting alcohol and caffeine, and improving your diet, can go a long way toward bettering your odds of getting pregnant (a dad-to-be's diet matters, too). But your success depends largely on the severity of your condition and your age (women over 40 have a harder time getting pregnant than younger women).

Meanwhile, don't gloss over the emotional stress involved. Find a willing friend, support group, or professional to talk to before, during, and after your treatment. To see therapists' top ten tips for coping with a fertility problem, click here. To get support from others in your same situation, visit our Fertility Tricks and Treatments bulletin board.

My doctor mentions success rates for various treatments. What do they mean, exactly, and can I trust them?

Throughout your treatment, you'll be given statistics on everything from your chances of having twins to your likelihood of having an ectopic pregnancy. Most important are the pregnancy rate (the odds that the treatment will help you get pregnant) and live birth rate (the odds that the treatment will enable you to give birth to a healthy baby). The live birth rate is always lower than the pregnancy rate because it factors in the possibility of a miscarriage or loss.

Keep in mind that success rates are national averages and don't take into account the number of attempts made with each method. Your doctor may suggest you move on after three to six tries with any treatment because some experts believe that what hasn't worked by your third round probably isn't going to work at all. But each couple's case is individual; six attempts with IVF is certainly not unheard of.

Also, be aware that the success rates clinics give you can be extremely misleading. When you investigate clinics, consider how they screen their clients. Some clinics turn away women over age 40, or couples with complicated problems, to boost their success rates. Others place up to six embryos in their patients (when the average is two to four), especially in older women.

Finally, don't assume bigger clinics are better. The Centers for Disease Control and Prevention's first comprehensive report on fertility clinics found no difference in success rates between large and small. (Click here to see the most recent report.) Instead, concentrate on learning about a clinic's reputation and expertise by talking to former patients and outside doctors. Ask for references and call them.