Preconception medical care and counseling is advisable for all those planning a pregnancy. In many cases, the recommendations provided can greatly increase a couple's chances of conceiving, avoiding miscarriage, and delivering a healthy baby.
If a couple having unprotected, well-timed intercourse does not conceive after 6 to 12 months, a more strategic approach may be appropriate. The process can begin with a visit to a gynecologist/obstetrician, urologist specializing in infertility (andrology), reproductive endocrinologist (certified infertility specialist), or fertility clinic. Women over age 30 are often advised to start having tests sooner because success after age 40 is particularly difficult. Medical work-ups for males are often conducted by an andrologist or reproductive endocrinologist.
When seeking medical assistance for fertility treatment, the long-term emotional commitment must be addressed early in the process. The couple must recognize from the outset that, even after all testing has been completed, the outcome may not be what they desire. Because treatment is not always successful, other alternatives may be considered: the couple may choose to remain childless, consider adoption, employ a non-spousal sperm or egg donor, or use of a surrogate.
A fertility treatment plan, involving both the man and woman, may include changes in nutrition, lifestyle, and environmental factors. Drug therapies (such as bromocriptine or clomiphene citrate), hormone therapy (e.g., Perganol), surgical intervention, and assisted reproductive technologies may be used, depending on the problem and diagnosis. Assisted reproductive technologies (ART) include intra-uterine insemination (IUI), in vitro fertilization (IVF), gamete intra-fallopian transfer (GIFT), GIFT-ET (a combination of GIFT and IVF), zygote intrafallopian transfer (ZIFT), and intracytoplasmic sperm injection.