Infertility can be treated with medicine, surgery, artificial insemination or Assisted Reproductive Technology (ART). Most of the time, these treatments are used in combination to create a specific protocol. In the majority of cases, infertility is treated with drugs or surgery. Doctors recommend specific treatments for infertility based on test results, length of time the couple has been trying to get pregnant, age of the man and woman, overall health of the partners and preference of the partners.

Sometimes doctors can find the cause of the infertility easily by doing a complete couple’s fertility evaluation. This process usually begins with health and sexual histories, physical exams and blood work. Finding the cause of infertility can sometimes be a long, complex and emotional process because it could take months for you and your specialist to complete all the needed tests and exams. Don't be alarmed if the problem is not found right away.

For a woman the process is much more involved. The first and easiest step in testing is to find out if she is ovulating each month. A woman can track her ovulation at home by:

• recording changes in her morning body temperature (basal body temperature)
• recording the texture of her cervical mucus
• using a home ovulation test kit

Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If everything checks out okay with normal ovulation, more tests are needed.

In some infertile couples, no specific cause is found (unexplained infertility). Couples receiving the diagnosis of unexplained infertility are more likely to seek multiple health care providers’ opinions, be influenced by family and friends personal experiences or literature. One word -- hope. These couples are on a quest to get answers and most of the time will “turn over every stone” before actually accepting and moving on. Although infertility is unexplained, the pregnancy rate for these couples with infertility treatment is among the highest.

Some most common tests of fertility in women include:

• Hysterosalpingography: In this test, doctors use an x-ray with dye to check for physical problems of the uterus and fallopian tubes. The special dye is injected through the vagina so that it can be seen on screen as it flows into the uterus and through the fallopian tubes. With these x-rays, doctors can usually find blockages that may be causing infertility. Blockages can prevent the egg from moving from the fallopian tube to the uterus or it can keep the sperm from reaching the egg. This test allows the radiologist to evaluate the shape and structure of the uterus, the openness of the fallopian tubes, and any scarring within the peritoneal cavity.

This procedure can be used to investigate repeated miscarriages that result from congential abnormalities of the uterus and to determine the presence and severity of these abnormalities, including:

• tumor masses or adhesions
• uterine fibroids

Hysterosalpingography is also used to monitor the effects of tubal surgery, including:

• tubal ligation
• the closure of the fallopian tubes in a sterilization procedure and a sterilization reversal
• the re-opening of the fallopian tubes following a sterilization or disease-related obstruction

Hysterosalpingography only sees the inside of the uterus and fallopian tubes. Abnormalities of the ovaries, wall of the uterus, and other pelvic structures may still be needed to evaluate with a MRI or ultrasound.

• Laparoscopy: During this surgery doctors use a tool called a laparoscope to take a look inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors usually find scarring and endometriosis by laparoscopy.

• Hormone Testing: These tests may be done to check the levels of ovulatory hormones, as well as, thyroid and pituitary hormones.

• Ovarian Reserve Testing: This approach often begins with hormone testing early in a woman's menstrual cycle. Testing may be done to determine the potential effectiveness of the eggs after ovulation.

• Genetic Testing: May be done to determine whether there's a genetic defect causing infertility.

• Pelvic Ultrasound: Pelvic ultrasound may be done to look for uterine or fallopian tube disease.

• Endometrial Biopsy: This biopsy is done in the doctor’s office, where the lining of the uterus is sampled via removing a portion of the endometrium and checked to see its receptivity to an embryo and how it correlates with the woman’s blood hormone tests.

• Post Coital Test (PCT): This test is utilized to determine the ability of the survival rate of the man’s sperm in the partner’s cervical mucus. The couple has intercourse no less than two hours and no more than four hours before going to their RE specialist’s office. This test is usually done around the time of ovulation, normal between cycle days 12-15. A sample of the cervical mucus is taken and the status of the sperm is evaluated. Sometimes the male or the female will produce antibodies to the sperm causing it to be incapacitated. The presence of numerous dead or nonmoving sperm in the PCT may indicate an antibody problem.

• Chlamydia Antibody Testing: Chlamydia is an organism that is sexually transmitted to the female and could cause damage to the fallopian tubes. Sometimes the fallopian tubes will appear normal through a hysterosalpingography, but what is not seen is the microscopic damage that chlamydia has caused. It is therefore important to know if exposure to this organism has occurred in the past. With the detection of an antibody to chlamydia in the blood, a suspicion of tubular damage may arise.

• Clomiphene Citrate Challenge Test (CCCT): A CCCT may be helpful to determine ovarian reserve, that is, how many remaining, viable eggs a woman has stored in her ovaries, and/or oocyte quality. Women are born with a limited number of eggs (oocytes), which decrease in number and diminish in quality as they grow older. The test involves analyzing the level of follicle-stimulating hormone (FSH) in a woman's blood on both the 3rd and 10th day of her period. During this time, she takes clomiphen citrate each day. Abnormal FSH levels can indicate poor ovarian reserve and provide guidance for treatment. If FSH levels are up to 15, women still may conceive, although not always with their own eggs. In these patients, acupuncture may be effective. Acupuncture improves blood flow to the ovaries and increases the delivery of hormones, oxygen, and nutrients, and decreases the excretion of dead cells. This frequently improves egg quality and can naturally normalize, or at least lower, FSH levels and increase fecundity (ability to conceive).

In some cases, doctors will use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery. Various fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of the medicines prescribed. You need to understand the risks, the benefits and the side effects.