Infertility effects 10 to 15 percent of couples. Infertility is defined as the inability to get pregnant over one year's normal efforts. The problem may be with the woman 40 percent of the time, the man 40 percent, and with a combination of the two for 20%. A cause is not always found. After trying to get pregnant for one year, it is reasonable to start testing for infertility.

Before your visit, keep a calendar of your periods and sexual efforts for 2 to 3 months. This will be helpful in planning further testing. Most of the testing can be done in the office, but some may require outpatient surgery.

The basic evaluation will include:
* a medical history,
* a social and sexual history, and
* a physical exam, including tests for infections for both partners.

For the man, a semen analysis, tests for the health of the sperm and the male system.

For the more complex female system:
* a test to check that the woman is making an egg each month,
* a cervical mucous test, to check on the ability of the womb to accept the sperm,
* a test to check that the uterine tubes are open, and
* a test to check the internal pelvic organs of the woman for scarring from such diseases as endometriosis.

At this point a review of the findings will help you decide on an action plan or if further testing is needed. The treatment will depend on the cause. Treatment may require a change in sexual habits, or assisted reproduction, such as in vitro fertilization with embryo transfer.

Check to see if your health plan covers infertility problems. Carefully consider the cost, the amount of intrusion on your body or life, and the risks of treatment. The success rates of treatment options should be reviewed. Working through a fertility problem with your partner and healthcare provider can be stressful, so open, sensitive communications are important at all times.

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