A doctor or WHNP takes a medical history and gives a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy. If necessary, they refer patients to a fertility clinic or local hospital for more specialized tests. The results of these tests help determine the best fertility treatment.
Generally, the best chance of pregnancy is when sex happens 1-2 days before ovulation. If you have a regular 28-day cycle, count back 14 days from when you expect your next period to start. Plan on having sex every other day around that time -- say, days 12 and 14.  Keep in mind that having sex every day may lower a man's sperm count. Your cycle may be longer or shorter, so an online ovulation calculator may help you figure out the likely day.
Post transfer – You’ll likely take progesterone and estrogen to improve implantation and pregnancy rates. If the transfer is successful, a blood pregnancy test will be positive in 10-14 days. From there, ultrasounds are used to ensure the implantation site as well as check for a heartbeat. The good news is that once a heartbeat is detected, the pregnancy has a 90-95% probability of the pregnancy resulting in a live birth.
The Fallopian tubes are the site for fertilization before the embryo makes its way to the uterine cavity for implantation. If the Fallopian tubes are damaged, fertilization may not occur. If one Fallopian tube is blocked, it may be due to inherent disease involving both Fallopian tubes; even if the other Fallopian tube is open, it may not be able to provide the appropriate nurturing environment for fertilization and early embryo growth to take place.
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. 

^ 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.
In 2006, Canadian clinics reported a live birth rate of 27%.[11] Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.[12] Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, since it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.
Israel has the highest rate of IVF in the world, with 1657 procedures performed per million people per year. Couples without children can receive funding for IVF for up to two children. The same funding is available for women without children who will raise up to 2 children in a single parent home. IVF is available for women aged 18 to 45.[153] The Israeli Health Ministry says it spends roughly $3450 per procedure.
Availability of IVF in England is determined by Clinical commissioning groups. The National Institute for Health and Care Excellence recommends up to 3 cycles of treatment for women under 40 years old with minimal success conceiving after 2 years of unprotected sex. Cycles will not be continued for women who are older than 40 years old.[156] CCGs in Essex, Bedfordshire and Somerset have reduced funding to one cycle, or none, and it is expected that reductions will become more widespread. Funding may be available in "exceptional circumstances" – for example if a male partner has a transmittable infection or one partner is affected by cancer treatment. According to the campaign group Fertility Fairness at the end of 2014 every CCG in England was funding at least one cycle of IVF".[157] Prices paid by the NHS in England varied between under £3,000 to more than £6,000 in 2014/5.[158] In February 2013, the cost of implementing the NICE guidelines for IVF along with other treatments for infertility was projected to be £236,000 per year per 100,000 members of the population.[159]
With egg donation and IVF, women who are past their reproductive years, have infertile male partners, have idiopathic female-fertility issues, or have reached menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. After the IVF treatment some couples are able to get pregnant without any fertility treatments.[3] In 2018 it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.[4]
A study presented at the British Fertility Society Annual Conference and covered by The Guardian reported that transferring two embryos where one is of poor quality would reduce the chance of pregnancy by 27%. It is thought that a bad embryo is rejected by the endometrium, compromising the implantation of both embryos. Cumulative research has supported the notion that egg quality outweighs quantity.
^ Baker VL, Luke B, Brown MB, Alvero R, Frattarelli JL, Usadi R, et al. (September 2010). "Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System". Fertility and Sterility. 94 (4): 1410–6. doi:10.1016/j.fertnstert.2009.07.986. PMID 19740463.
In 2006, Canadian clinics reported a live birth rate of 27%.[11] Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.[12] Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, since it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.

4. Significant Hair Growth (or Hair Loss): Polycystic ovarian syndrome causes small cysts to form on the outside of the ovaries, and it also causes the body to produce an excess of male hormones. If you notice hair growing in unusual places like your face, arms, chest or back, this could be a warning sign. On the flip side, hair loss or thinning could be a sign of other infertility related conditions like thyroid issues, anemia or autoimmune disorders.
Success rates vary with the number of embryos transferred. However, transferring more and more embryos at one time does not increase the chance of live birth significantly, but may only increase the risk of a multiple pregnancy, and its associated risks. The impact of the number of embryos that are transferred also varies with the age of the woman.  

The NHS recommends that, after trying and failing to get pregnant for a year, you should see your doctor; if you are over 35, you should go after six months. Help is out there, if you want it, and takes many forms. West stresses the importance of investigating both the women and the men, "even if they have previously had a healthy sperm analysis because situations and lifestyles can change". There is also the alternative therapy route: acupuncture, hypnotherapy, reflexology, meditation. Or, if all else fails, you could, like me, go for in-vitro fertilisation (IVF).
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.
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