With today's busy lifestyles, couples assume that when they are ready to start a family, there shouldn't be any problems. Unfortunately, this is not the experience of many couples. One in every five couples is infertile, and for them, physician-assisted infertility treatment may be necessary.

Infertility is a condition of the reproductive system in which a couple has been unable to achieve conception after one year of unprotected, well-timed intercourse (six months if the woman is over 35) or the woman has been unable to carry a pregnancy to a live birth. A common myth is that infertility is a woman's problem. Infertility is a medical problem which affects both sexes. Approximately 40 percent of infertility is due to female factors, 40 percent is due to male factors and the balance due to either combined or unknown factors.

In recent years, great strides have been made in the diagnosis and treatment of infertility. Assisted reproductive technology (ART) includes several different techniques or procedures to help couples achieve pregnancy after surgical and hormonal methods have failed. For many couples, ART is their best chance and hope for achieving pregnancy.

The evaluation and treatment of infertility requires a great deal of time, resources and energy by the couple as well as physicians, nurses, technicians, counselors, and other support staff. Infertility is not only a physiological condition; it is also an emotional and social condition with accompanying feelings and apprehensions, which need careful support and consideration from the treatment team.

Initial evaluation

How long should a couple try before seeking help for possible infertility? It depends. An item in the medical history may warrant an immediate concern, such as irregular cycles or a history of tubal infections. In these kinds of cases, it makes sense to begin a basic exam and testing without waiting an entire year. Women older than 35 are advised to have an initial workup after only six months of trying, while those older than 40 probably should see a physician for baseline testing soon after they start trying, rather than wasting precious time.

Should a woman see her gynecologist or a specialist? Many obstetrician/gynecologists have ample training and interest in the basic infertility work-up, and will diagnose and treat infertile patients effectively. Others prefer to refer patients to a specialist. Usually the OB/GYN will start the workup and initiate basic treatment if appropriate, then refer to a fertility specialist shortly thereafter if not successful.

Read more about diagnosis.