Ovarian hyperstimulation is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction by e.g. age, antral follicle count and level of anti-Müllerian hormone.[60] The resulting prediction of e.g. poor or hyper-response to ovarian hyperstimulation determines the protocol and dosage for ovarian hyperstimulation.[60]

Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that. More about success rates with IUIs is on the insemination page and on the Clomid for unexplained infertility page. The insemination component boosts fertility more than the Clomid does - but success rates are higher when both are used together.

If you're overweight or obese, losing weight can boost your chances of getting pregnant. A study found that women whose body mass index (BMI) was above normal took twice as long to get pregnant as those with a normal BMI. But a drop in weight of 5%-10% can dramatically improve ovulation and pregnancy rates. Obesity can also cause infertility and low testosterone in men. Being significantly underweight can also lead to infertility.

In egg donation and embryo donation, the resultant embryo after fertilisation is inserted in another woman than the one providing the eggs. These are resources for women with no eggs due to surgery, chemotherapy, or genetic causes; or with poor egg quality, previously unsuccessful IVF cycles or advanced maternal age. In the egg donor process, eggs are retrieved from a donor's ovaries, fertilised in the laboratory with the sperm from the recipient's partner, and the resulting healthy embryos are returned to the recipient's uterus.
A recent controversy in California focused on the question of whether physicians opposed to same-sex relationships should be required to perform IVF for a lesbian couple. Guadalupe T. Benitez, a lesbian medical assistant from San Diego, sued doctors Christine Brody and Douglas Fenton of the North Coast Women's Care Medical Group after Brody told her that she had "religious-based objections to treating her and homosexuals in general to help them conceive children by artificial insemination," and Fenton refused to authorise a refill of her prescription for the fertility drug Clomid on the same grounds.[111][112] The California Medical Association had initially sided with Brody and Fenton, but the case, North Coast Women's Care Medical Group v. Superior Court, was decided unanimously by the California State Supreme Court in favour of Benitez on 19 August 2008.[113][114]
1. Changes to Your Menstrual Cycle: This may be an absence of your period, heavier than normal flow or irregular menstrual cycles may be signs of infertility. Consider tracking your menstrual cycle to help you identify patterns or changes early on. This will also be helpful in case you ever seek guidance from a physician, as he or she will inquire about your medical history.
Ovulation induction (in the sense of medical treatment aiming for the development of one or two ovulatory follicles) is an alternative for women with anovulation or oligoovulation, since it is less expensive and more easy to control.[7] It generally involves antiestrogens such as clomifene citrate or letrozole, and is followed by natural or artificial insemination.
In a lab, your eggs are mixed with sperm cells from your partner or a donor — this is called insemination. The eggs and sperm are stored together in a special container, and fertilization happens. For sperm that have lower motility (don’t swim as well), they may be injected directly into the eggs to promote fertilization. As the cells in the fertilized eggs divide and become embryos, people who work at the lab monitor the progress.
Initial blood work, cycle tracking and fertility analysis is done. To begin IVF, your doctor or fertility specialist will evaluate your hormone levels and menstrual cycle to determine what medications and plan of action may be needed. You may also undergo a transvaginal ultrasound to examine your ovaries and reproductive system, ensuring that they are healthy.
It is possible that a significant contributor to unexplained infertility can be attributed to changes in sperm epigenetics. Methylation patterns in sperm DNA which affect the expression of various genes may be the missing link for this unique patient population. By employing epigenetic analysis, we may be able to identify more causes of infertility and suggest the optimal course of therapy. Preliminary evidence even suggests that these epigenetic signatures influence the probability of conception, embryogenesis, and successful carrying of pregnancy to term. Future research on sperm epigenetics holds the promise of revolutionizing reproductive medicine and empowering patients in the process.
Many people of sub-Saharan Africa choose to foster their children to infertile women. IVF enables these infertile women to have their own children, which imposes new ideals to a culture in which fostering children is seen as both natural and culturally important. Many infertile women are able to earn more respect in their society by taking care of the children of other mothers, and this may be lost if they choose to use IVF instead. As IVF is seen as unnatural, it may even hinder their societal position as opposed to making them equal with fertile women. It is also economically advantageous for infertile women to raise foster children as it gives these children greater ability to access resources that are important for their development and also aids the development of their society at large. If IVF becomes more popular without the birth rate decreasing, there could be more large family homes with fewer options to send their newborn children. This could result in an increase of orphaned children and/or a decrease in resources for the children of large families. This would ultimately stifle the children's and the community's growth.[134]
A review in 2013 came to the result that infants resulting from IVF (with or without ICSI) have a relative risk of birth defects of 1.32 (95% confidence interval 1.24–1.42) compared to naturally conceived infants.[48] In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived through IVF, notably septal heart defects, cleft lip with or without cleft palate, esophageal atresia, and anorectal atresia; the mechanism of causality is unclear.[49] However, in a population-wide cohort study of 308,974 births (with 6,163 using assisted reproductive technology and following children from birth to age five) researchers found: "The increased risk of birth defects associated with IVF was no longer significant after adjustment for parental factors." [50] Parental factors included known independent risks for birth defects such as maternal age, smoking status, etc. Multivariate correction did not remove the significance of the association of birth defects and ICSI (corrected odds ratio 1.57), although the authors speculate that underlying male infertility factors (which would be associated with the use of ICSI) may contribute to this observation and were not able to correct for these confounders. The authors also found that a history of infertility elevated risk itself in the absence of any treatment (odds ratio 1.29), consistent with a Danish national registry study [51] and "implicates patient factors in this increased risk." The authors of the Danish national registry study speculate: "our results suggest that the reported increased prevalence of congenital malformations seen in singletons born after assisted reproductive technology is partly due to the underlying infertility or its determinants."
One in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Infertility is defined as the inability to get pregnant after regular sexual intercourse without the use of any contraceptive methods for 6 months for those 35 years old or over, or 12 months for those under 35.(1)  Under normal circumstances the ability to get pregnant is at the most 25% each month. This number declines over time and starts to decline more rapidly once a women reaches her thirties, so that by age 35, the likelihood of getting pregnant each month is down to about 15%, and by age 40 it’s down to less than 10%.
The live birth rate is the percentage of all IVF cycles that lead to a live birth. This rate does not include miscarriage or stillbirth; multiple-order births, such as twins and triplets, are counted as one pregnancy. A 2017 summary compiled by the Society for Assisted Reproductive Technology (SART) which reports the average IVF success rates in the United States per age group using non-donor eggs compiled the following data:[10]

^ Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM (2013). "The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis". Human Reproduction Update. 19 (6): 696–713. doi:10.1093/humupd/dmt026. PMC 3796945. PMID 23814102.
Obviously, if the same couple decides to have more children at age 38, the chances won't be 25% anymore; it is likely that they are about 10%, which translates into a reduced pregnancy chance. This does not mean the couple has become infertile. Since they weren't absolutely fertile at age 32, it is only logical that their pregnancy chances at 38 are so low.
No matter how many times you've been asked, "When will you have another baby?" the query still stings. Try coming up with a quick comeback—like 'We actually love having an only child'—and commit it to memory, says Dr. Davidson. Another heartbreaker: your child's pleas for a sibling. Try, "You're so wonderful we don't need anyone besides you." Or maybe admit, "We'd like nothing more than to make you a big brother. We hope it'll happen."
Intracytoplasmic sperm injection (ICSI): This procedure involves direct injection of a single sperm of the male partner into the eggs of the female for fertilization. Just like IVF procedure, in ICSI, the sperm and egg are collected from both the partners. The only difference is the fertilization process as in IVF the sperms and egg are mixed naturally, and in ICSI the sperms are injected into the egg using a needle.

I conceived my first child, a son, with no trouble at all. When he was two, we thought we might have another. A year or so later, when nothing had happened, we saw a fertility specialist, who gave us every test there was. We passed each one, as the consultant put it, "with flying colours". Which left us relieved but also confounded. All I had was a new adjective to add to my diagnosis: Unexplained Secondary Infertility.
If a physician believes infertility is a concern, a number of tests will be administered. For women, these may include ovulation testing, ovarian reserve testing, hormone testing, and hysterosalpingography (X-rays of the fallopian tubes) or other imaging tests. Assessing male infertility involves semen analysis, which examines the number of sperm, as well as their motility and morphology (shape). Other tests for men may include hormonal and genetic testing, testicular biopsy, and additional imaging.
Gathering the eggs. Your doctor gives you an anesthetic and inserts an ultrasound probe through your vagina to look at your ovaries and identify the follicles. A thin needle is then inserted through the vaginal wall to remove the eggs from the follicles. Eight to 15 eggs are usually retrieved. You may have some cramping and spotting for a few days afterward, but most women feel better in a day or two.
The percentage of cycles cancelled between egg retrieval and embryo transfer is an indication of failed fertilization. This figure is halved with ICSI as compared to conventional IVF, indicating that it can indeed improve fertilization when the sperm is at fault. However, there are no differences in pregnancy, miscarriage or live birth rates between conventional IVF and ICSI, indicating overall similar success rates1.
For many years, intrauterine insemination (IUI) was felt to be the best first choice of treatment in patients who have unexplained infertility or mild problems with the fallopian tubes or sperm. Arizona Reproductive Medicine (ARMS) has made significant advances in the cost effectiveness of in vitro fertilization (IVF) through higher IVF success rates and innovations in treatment medications and efficiency. IVF now far exceeds IUI as the best first choice of treatment for all age groups.
Risk of ectopic pregnancy. Women who have difficulty getting pregnant have an increased risk for ectopic pregnancy, regardless of how they conceive. And all assisted reproductive technology treatments, including IVF, also make an ectopic pregnancy more likely. An ectopic pregnancy occurs when an embryo implants in a fallopian tube or the abdominal cavity rather than in the uterus. It's treated with the medication methotrexate or by surgically removing the embryo to prevent it from severely injuring the mother by continuing to grow.
If a couple has been actively trying for over a year, it may be time to consider seeing a specialist. One thing we hear time and time again from our Glow Fertility Program partner physicians is that they wish their patients would come in sooner. Seeing a specialist as soon as you suspect you may have a problem trying to conceive can save you both time and money.
Treating secondary infertility, like primary infertility, will depend largely on any underlying medical conditions. Through the Couples Clinic at UW Health's Generations Fertility Care, both members of the couple undergo a routine evaluation. Since infertility is not simply a woman's problem, evaluating both members ensures the most effective treatments can be recommended.  
Repeated failed rounds of IVF can help identify causes of infertility. For example, if sperm and egg quality are normal, then the conception issue may be rooted at the embryonic or implantation level. In other words, if IVF fails to result in pregnancy despite successful fertilization, embryonic development or implantation may be to blame. Still this is a very expensive way to start getting answers.