You may be infertile if you have not been able to get pregnant after trying for at least 1 year.

A woman's fertility drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

As a woman's eggs get older, the risk of miscarriage increases.

Most cases of infertility are caused by a problem with the reproductive system. This can include:

• Problems with the eggs or releasing an egg (ovulating).
• Problems with the uterus or the fallopian tubes. This may result from things like endometriosis or pelvic inflammatory disease.
• Problems with the sperm. These problems may include how sperm is made, how it functions, or how it moves.
• An unknown issue. Sometimes the cause of infertility is not known.

It can be stressful to find out the reason for infertility. Knowing where the problem is may create feelings of guilt and blame and may put strain on your relationship. Not being able to find any cause can also create stress. You may want to talk with a counsellor or join an infertility support group before you make your decision. Talking with other people can help you feel less alone.

Infertility treatment usually starts with making sure you are having sex during your 6-day fertile window, which is your day of ovulation and the 5 days before it. This is called fertility awareness. If that doesn't work, then you may choose surgical, hormonal, or assisted reproductive technology (ART) treatment to help you get pregnant. Some of these treatments can be stressful, costly, and painful.

Depending on what is causing the problem, you can:

• Take medicine that helps a woman ovulate. A man can take medicines to increase sperm count.
• Have a procedure that puts sperm directly inside the woman (insemination).
• Have surgery that corrects a problem caused by endometriosis or blocked fallopian tubes.
• Try in vitro fertilization (IVF). During an IVF, eggs and sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor puts one or more fertilized eggs into the woman's uterus.

The success of IVF depends on your age and your doctor's skill and experience. For women, the older you are, the less likely it is that IVF will work unless you use donor eggs. Also, the cause of your infertility can affect the success of IVF.

What else do you need to know about fertility treatments?

Keep in mind that some infertility problems are more easily treated than others. In general, as a woman ages, especially after age 35, her chances of getting pregnant decrease and her risk of miscarriage increases.

Treatment for fertility problems can be stressful, costly, and hard on your body. Before you start testing, make some decisions about what you want to do. You may change your mind later, but it's a good idea to start with a plan.

• Learn all you can about the tests and treatments, and decide which you want to try. For example, some people agree to try medicines but don't want surgery or other treatments.
• Find out how much the treatments cost and whether your provincial health plan or private insurance will pay for them. Decide what you can afford.

Treatments for infertility can increase your chance of getting pregnant. But they also increase your chance of having more than one baby at a time (multiple pregnancy). Be sure to discuss this risk with your doctor.

There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques. Talk with your doctor about these possible risks.

Even though many fertility clinics give information about how many babies have been conceived, those numbers can be misleading. They may not include how many pregnancies miscarry. Treatment for infertility doesn't guarantee that you will have a baby.

Your doctor may recommend treatment if:

• You have a known problem that can be fixed with infertility treatment.
• You have unexplained infertility, and your doctor has proposed a treatment that can increase your chances of having a healthy pregnancy.