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Many couples will have to wait a while before conceiving, and this is normal! But if you and your partner have tried for 1 year without getting pregnant, it's time to discuss your concerns with your obstetrician. They can discuss possible causes for infertility and help you think about your next steps. While it's not a good idea to turn to fertility treatments just to conceive twins, you should be aware that these treatments will slightly raise your chances of having multiples. It can sometimes be difficult to figure out exactly what's behind a couple's fertility troubles. About 25% of infertility remains unexplained even after tests. In order to rule out common fertility issues, your doctor will ask about you and your partner's medical history, sexual activity, symptoms, medications, and lifestyle choices (like stress levels, smoking, or drinking alcohol). Your doctor may also run the following tests:  A blood test to check on levels of hormones that stimulate ovulation. Chlamydia tests (a urine test for men and a cervical swab for women), as this STI can affect fertility. An ultrasound to see if there are blockages, scarring, or other issues (like endometriosis or fibroids) in the ovaries, womb, or fallopian tubes. If the doctor sees possible problems, they may order a follow-up X-ray or laparoscopy. A semen analysis to check for a low sperm count or improperly moving sperm. You and your doctor will decide together whether fertility medications are right for you. You'll also work together to pick which medication you should take. Be aware that most of these medications will raise your chances of conceiving multiples. It will generally cost between $1000 and $6000 USD to do these treatments under medical observation (routine ultrasounds and checkups). Some common options include:  Clomiphene citrate (CC), usually taken in 50 mg/day doses for 3-6 menstrual cycles. Synthetic Human Chorionic Gonadotropin (hCG), which is an injection. This type of drug has no known side effects, unlike other fertility medications. Follicle Stimulating Hormone (FSH), which is also an injection. Human Menopausal Gonadotropins (hMG), also an injection and the strongest ovulation medication that you can take. Surgery may be recommended if you have blockages or scarring in your fallopian tubes, or if you have endometriosis or fibroids. If there's a blockage preventing sperm from being ejaculated normally, surgery may be able to correct this issue, as well. Doctors can also surgically extract sperm, if necessary. Some of these surgeries may be covered by your insurance. Discuss your payment options with your doctor and insurance provider before committing to a particular treatment. Intrauterine Insemination (IUI) involves placing sperm inside a woman's uterus to help along conception. It may be recommended for men with low sperm counts or limited sperm mobility. It's also an option for couples with unexplained infertility problems. IUI usually costs between $300-$1000 USD. With In Vitro Fertilization (IVF), the mother will start by completing a round of fertility medications to encourage ovulation. An egg will then be harvested and mixed with the father's sperm. This fertilized embryo will be implanted into the mother's uterus.  IVF treatment may be recommended if the mother has blockages in her fallopian tubes. It's also often a last-resort treatment for couples with unexplained infertility. Since most doctors will now only implant 1 embryo at a time, the chances of multiples due to IVF treatment has dropped significantly since the late 1990s.  IVF is an expensive treatment option, usually costing at least $30,000 USD.
Discuss your fertility issues with your OB/GYN after 1 year of trying. Consult with your doctor to determine possible causes of infertility. Use fertility medications to assist with ovulation issues. Look into surgical options to correct internal issues. Try IUI to address sperm issues or unexplained infertility. Turn to IVF once you've tried other treatments.