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The Fertility Diaries: 3 Friends, 3 Paths to Pregnancy

Fertility Treatment: First Steps continued...

Medications: If you're not ovulating regularly — caused, for instance, by menstrual irregularities or polycystic ovarian syndrome, a hormonal disorder — your doctor may prescribe oral fertility drugs, like Clomid or Serophene, which induce regular periods and stimulate egg production; they help 20 percent to 30 percent of women conceive within six cycles. If that doesn't work, you may undergo injections of gonadotropins, hormones that stimulate the ovaries to develop multiple eggs, for eight to 12 days; this helps 30 percent to 40 percent of women to conceive.

Surgery: Anatomic problems such as blocked fallopian tubes or fibroids in your uterus may require corrective surgery using a laparoscope (a thin tube with a tiny camera that's inserted through an incision) or lasers. "But surgery is less common now because IVF can be a quicker and more cost-effective way to bypass the problem area," says Adamson. Success rates of different surgical procedures range from 10 percent to 80 percent, depending on the problem's severity.

Intrauterine insemination (IUI): If you have cervical problems such as infection, or if your partner has a low sperm count, your doctor may suggest IUI, a straightforward outpatient procedure in which highly mobile sperm are injected directly into the uterus. Pairing IUI with fertility meds that precisely time ovulation doubles the pregnancy rate for the procedure, to 10 to 20 percent.

In vitro fertilization (IVF): In about 5 percent of infertility cases, especially those involving blocked fallopian tubes and male infertility, couples proceed to IVF. After fertility meds are injected to stimulate egg production, the eggs are removed with a thin needle and combined with sperm in a laboratory dish for fertilization. Three to five days later, the resulting embryos are placed directly into your uterus via a catheter that's passed through the vagina. About 30 percent of women who try IVF will have a baby.

How to Find the Right Fertility Doctor

Choosing a specialist that you trust can make all the difference in your comfort level — and therefore, the outcome. "It's not just money and time at stake — it's your hopes, your dreams, your life," says David Keefe, M.D., chair of ob/gyn at the University of South Florida. Start by checking a clinic's success rates on the Society for Assisted Reproductive Technology (SART) Website (sart.org). Even if rates are high — above 45 percent for women under 35 — don't stop there. "The clinic may not be highly skilled in the procedures you need," Keefe says. Here, what to ask:

Are you board certified as a reproductive endocrinologist? A "yes" means she's had four years of training in ob/gyn and three in infertility procedures, plus she has passed rigorous national exams.

Does your clinic belong to SART? Member clinics must follow strict ethical guidelines and use up-to-date procedures.

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