Most couples develop a willingness to conceive a child at some point in their life. Generally, couples conceive within the first year, and around 7% of couples conceive in the second year. The inability to conceive within 12 months is defined as infertility. It is recommended to seek help from a reproductive endocrinologist if you are unable to conceive within 12 months. Our modern technology in healthcare has opened a lot of options for women who are facing infertility issues.
I found that I couldn't avoid the sense that we were not yet all here, that there was a person missing. In one of those strange confluences, I was, at the same time, writing a novel about a woman who had just given birth. I was spending my days at the fertility clinic and my evenings writing about the strange, shadowy world of early motherhood. My husband, coming into my study and finding me in tears again, laid his hand gently on the manuscript and said, "Do you ever think that writing this book might not be helping?" But you don't choose the books; they choose you. And if I couldn't bring a baby into being in real life, I was damn well going to do it in fiction.

For most couples having difficulty achieving a pregnancy their chance of achieving a pregnancy is not zero, it is just lower than the average rate of conception—unless both Fallopian tubes are completely blocked, there is no sperm, or the woman never ovulates. Ovulation induction (or superovulation) with IUI helps patients to achieve pregnancy rates closer to the natural per cycle chance of pregnancy for women in their age group who do not have infertility (see fig 1).
From the patient experience perspective, IVF is a more time-consuming process overall, although the length of time before pregnancy is achieved varies greatly according to how many cycles are necessary. However, because IVF is a more direct and effective route to pregnancy than IUI, it is often a less time-consuming process. For example, a patient could spend many months trying to succeed at IUI, only to succeed during the first cycle of IVF. While many patients opt for IUI at the start of their fertility journey because it is less invasive and more affordable, success rates for IVF are considerably higher.
This chart is US national average data on success rates per IVF cycle by female age for 2014. The dark blue line (triangles) shows pregnancy rates per cycle by age. The orange line (circles) shows live birth rates per cycle by age. The rate of singleton live births per cycle is shown by the light blue line. The difference between "pregnancy" rate and "live birth" rate is due to miscarriages.
Vzhledem k tomu, že vertikální přenos a vliv koronaviru SARS-CoV-2 na graviditu není dostatečně prozkoumán, mezinárodní odborné společnosti doporučují zvážit možná rizika spojená s těhotenstvím v oblastech zasažených onemocněním SARS-CoV-2. Z tohoto důvodu preferuje naše klinika zamražení získaných embryí a odložení transferu. Strategie léčby bude vždy posouzena individuálně ošetřujícím lékařem s ohledem na aktuální situaci v ČR a specifika léčeného páru.
^ Damian BB, Bonetti TC, Horovitz DD (January 2015). "Practices and ethical concerns regarding preimplantation diagnosis. Who regulates preimplantation genetic diagnosis in Brazil?". Brazilian Journal of Medical and Biological Research = Revista Brasileira de Pesquisas Medicas e Biologicas. 48 (1): 25–33. doi:10.1590/1414-431X20144083. PMC 4288489. PMID 25493379.
3-6 months of treatment with Clomid pills (clomiphene citrate) might improve fertility by as much as 2 times as compared to no treatment. This is a very low level infertility treatment. Infertility specialists do not usually recommend Clomid treatment( without insemination) for unexplained infertility for women over the age of about 35. Most fertility specialists do not use it (without IUI) on any couples with unexplained infertility. If a woman is already having regular periods and ovulating one egg every month, giving Clomid, which will probably stimulate the ovaries to release 2 or 3 eggs per month (instead of one) is not really fixing anything that is broken - and is not likely to be successful.

Around one in 7 couples that require artificial reproductive treatment (ART) have "unexplained" infertility and doctors often first use approaches like ensuring the female partner's ovulation occurs at the same time as natural sex or artificial insemination/intrauterine insemination (IUI). They may then recommend IVF where thousands of the male partner's best sperm are purified and incubated with the egg — this is the preferred initial ART procedure in cases of "unexplained" infertility.
Studies show that sperm count and sperm movement decrease as men age, as does sexual function. But there isn't a cutoff age that makes a man too old to father a child. One study found that it took men age 45 or older longer to get a woman pregnant once the couple started trying. If your partner is older, you may want to talk to your doctor about ways to boost your chances.

We don't know what causes most cases of secondary infertility, says Jamie Grifo, M.D., Ph.D., program director of the New York University Fertility Center, in New York City. "The majority of the time, though, it reflects the fact that you're older now, so it's simply more difficult to get pregnant." The reality is that for women, fertility peaks at age 25 and drops by half between ages 30 and 40. As we age, egg quality declines and we're more likely to develop fibroids and endometriosis, which contribute to infertility. Other factors such as adding extra weight, taking new meds, or having surgery since your last pregnancy can be an issue. It may also be that your partner's sperm quality or production is now poor.
A Cochrane review came to the result that endometrial injury performed in the month prior to ovarian induction appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. There was no evidence of a difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggested that endometrial injury on the day of oocyte retrieval was associated with a lower live birth or ongoing pregnancy rate.[30]
In order for pregnancy to happen, sperm has to meet the egg. This normally takes place at the end of the fallopian tube, and this is called fertilization. There are a number of obstacles that can prevent this from happening, and the process itself even in healthy young fertile women is very complex- hence the low pregnancy rate each month. Obstacles such as cycle timing, low sperm count, poor sperm motility, blocked fallopian tubes, or endometriosis must be overcome to achieve a pregnancy. Timing is often the most common obstacle to conception. What does it mean for you when common causes of infertility are ruled out and you’re told you have unexplained infertility? It should mean a time of hope.
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