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If you and your partner have been diagnosed as having fertility problems, it means you've been trying to get pregnant for at least a year without success. It doesn't mean you'll never be able to have a baby. There are no guarantees, but there are treatments that can help.

If you've been trying to get pregnant for at least a year, your doctor will be able to suggest some tests to find out what the problem is. Women over 35 will probably be able to get help sooner. You can get help whether or not you've had a child before.¹

Being unable to have a baby is hard to cope with. Tests and treatments for infertility can be a strain, both physically and emotionally. It may help you and your partner to talk to a special counselor.

See How infertility can make you feel.

• Infertility is very common. In the United States, about 1 in 5 couples seek medical help to have a baby.¹
• The most common causes in women are ovulation problems and damaged or blocked tubes.
• The most common causes in men are a low sperm count and poor-quality sperm.
• In up to one-third of infertile couples, doctors cannot find a reason for the infertility.
• To improve your chances of getting pregnant, your doctor may advise you to have sex every two or three days.
• If you're a woman age 35 or older and you're having problems getting pregnant, don't wait more than a year before you seek help. Many treatments don't work so well when a woman is older.

It's useful to know a little about how a pregnancy normally begins. This can help you understand what can go wrong.

To get pregnant:

• The woman has to produce an egg
• The man has to produce healthy sperm
• The egg has to travel from the woman's ovary into her fallopian tube
• The sperm have to swim up through the vagina and womb into the fallopian tube, toward the egg
• The egg has to be fertilized by the man's sperm
• The fertilized egg has to travel down the fallopian tube and embed (plant itself) in the woman's womb.

To find out more, see:

• Getting pregnant: the woman's role
• Getting pregnant: the man's role.

Nearly 90 percent of couples trying to get pregnant are successful within one year. And 95 percent get pregnant within two years.²

When a man ejaculates inside a woman, one of his sperm may fertilize the egg. Here is what happens:³

• The man's semen (containing sperm) gets pushed up into the vagina
• About 1 percent of sperm (that's about 400,000) swim up to the cervix, the neck of the womb. The rest die or fall out of the vagina
• If a woman is in her fertile period, the mucus is thin and watery, helping the sperm swim up to the fallopian tubes
• If there is an egg inside one of the tubes, the sperm try to push through the egg wall
• The first one through will fertilize the egg
• The genes from the egg and sperm combine inside a single cell.

• The fertilized egg moves down the fallopian tube to the womb. This takes several days.
• It starts growing and embeds in the lining of the womb, called the endometrium.
• Now it's called an embryo. It forms the placenta to get food from its mother.
• The placenta makes a hormone to make the lining of the womb thicken. The hormone also prevents the woman from having her period.

A woman is most likely to get pregnant (most fertile) from four or five days before she ovulates until up to a few hours afterward. This is the likeliest time that the sperm will fertilize an egg.

Many couples who are trying to have a baby concentrate on having sex around this time. There are various ways you can work this out. Some women use special hormone kits from the pharmacist. Other women take their temperature or check the fluid in their vagina. This fluid tends to be thin and stretchy when she is fertile.

Still, it's easy to miss the most fertile time of the month. The length of a woman's menstrual cycle can vary and some women ovulate earlier in their cycle than others. So it's very difficult to be precise, even if you are using hormone kits. Having sex by the calendar can also be stressful and disappointing.

For these reasons, doctors usually advise couples not to try to have sex at certain times of the month, but instead to have sex every two or three days, every week. That way, you're less likely to miss the time that you are ovulating.

Talk with your doctor about when to have sex and whether to use a kit.

There are many reasons why a couple may find it hard to get pregnant. Either or both partners may have a problem that doctors can identify with tests.

• In 2 out of 10 infertile couples, the man has a problem.
• In about 4 out of 10, the woman does.
• In a further 3 or 4 out of 10, both partners have a problem.

Sometimes, doctors can't work out why you're finding it hard to get pregnant. This is called unexplained infertility.

Here are the most common problems that stop a woman from getting pregnant:⁴

• Problems ovulating
• Early menopause
• Low hormone levels
• Blocked or damaged tubes
• Endometriosis
• Fibroids.

Here are the most common reasons why men have fertility problems:⁵

• Problems with sperm
• Problems getting sperm to the right place
• Sperm antibodies.

Things that lower your chances of getting pregnant are called risk factors. Here are the main risk factors for infertility:

• Getting older
• Smoking, alcohol and drugs
• Being overweight or underweight
• Testicles too warm
• Illness
• Radiation or dangerous chemicals.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.