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Planning for a child can be a joyous and exciting experience. But if the attempts to become pregnant are not successful, other emotions can take over. Fear, anger, guilt, resentment, frustration and other painful feelings can wash into the lives of those longing for a child of their own. When nature doesn't cooperate, month after month, a couple may suspect a problem with fertility. Often times, the infertility problem can be diagnosed and treated. Reproductive medicine has become a highly specialized field, bringing successful pregnancies to many awaiting parents. If you suspect a problem with infertility, the first important step is making an appointment with a specialist who can provide you with the answers and guidance that you need.

In order to better understand the problems that can cause infertility, let's first look at the physiology of normal reproduction.

Physiology of Normal Reproduction
Despite how easy becoming pregnant appears to be for some people, reproduction is actually a very complex process. A detailed sequence of events must take place in the woman's body to produce an egg. This egg must be united with a sperm cell, which is produced in the man's body, in an equally detailed and complex process. Fertilization of the egg by the sperm requires a specific cascade of events to occur. These events are orchestrated by important hormones and chemical reactions. Even when both the woman and the man are fertile and without any reproductive problems, the chance of getting pregnant in any given month is about 20 %. It often takes six months to a year for a couple to conceive, even under the best circumstances.

About Infertility
Infertility is defined as the inability to become pregnant, or to carry a pregnancy successfully to delivery, after one year of trying to become pregnant. In the United States, about 10-15 % of couples experience infertility. Approximately 30% of these cases are due to problems surrounding ovulation, another 30 % of infertility cases are from problems with the fallopian tubes, and about 30 % of infertility cases can be attributed to problems with sperm production, function or delivery. The remaining 10 % of couples have infertility of unknown cause, and no obvious problem is diagnosable. Regardless of the cause, the problem of infertility should be held as a problem to the couple, and not blamed on one or the other partner.

Preconception Counseling
Some fertility clinics offer preconception evaluation and counseling. This type of counseling can help improve a woman's chance of getting pregnant and having a healthy pregnancy. Additionally, nutritional guidelines and vitamin-mineral recommendations are usually made to help prepare the woman's body for a new life.

Psychological support might also be provided at this early stage of consultation. The difficult emotions resulting from infertility can put a strain on a relationship. The financial cost incurred with ongoing infertility treatments can add another burden. Dealing with emotions and choices associated with unexpected infertility can be overwhelming and consultation with a trained couple's therapist may be beneficial.

Diagnosing and Treating Infertility
If the couple wishes to proceed with medical evaluation, an infertility workup is the next step. This will involve an extensive interview with the couple, along with physical exams and a number of tests to detect fertility problems related to the woman, the man or both. Once tests are completed, a diagnosis can usually be made and treatment begun.

The cause of the infertility may lie with the woman, the man, or a combination of both. Unfortunately, about 10 % of the time the cause for infertility cannot be determined. Without a diagnosis, there are no good treatment options. However, some of undiagnosed couples do spontaneously get pregnant, in time. For those individuals who receive a diagnosis, infertility is often treatable. In recent years, there have been encouraging advances in treating female as well as male infertility. Many are helped with fertility drugs used to correct many infertility problems. A relatively new and high-tech medical field called Assisted Reproductive Technology (ART) has enabled many hopeful individuals and couples to become parents.

Unfortunately, infertility treatments are not successful for all couples. It's important for couples to know when to 'let go' and stop treatment. The fertility clinic or specialty physicians involved can offer guidance about when the time for this is right. When the decision is reached, couples face painful disappointment and must somehow cope with the realization that they are not likely to conceive a child. Counseling or support groups can help couples and individual partners learn to accept infertility, learn about options, and find joy, meaning and purpose in life again.

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