Now that you have completed the testing stage, you have probably received an explanation of why, as a couple, you have not yet been able to have a child. There is also a chance that, despite all the tests and investigations, no explanation has yet been found (unexplained subfertility). Depending on the proposed diagnosis, your age and the length of time you have been trying to have a child, your doctor will develop a treatment plan taking into account your personal wishes and desires.

This chapter deals with the phase in which you embark on fertility treatment. However, you don’t always have to begin treatment as soon as the testing phase is concluded. A key consideration is how great your chance of achieving a spontaneous pregnancy is, and potentially how much greater that chance will be if fertility treatment is undertaken.

This chapter provides information about currently used fertility treatment. A distinction is drawn between treatments involving drug therapy only, surgical intervention (which will sometimes be performed in order to increase fertility), and assisted reproductive techniques. One other important option that is also discussed is not starting a fertility stimulating treatment (yet), but undertaking so-called expectant management.

On average, 80-90% of women trying to become pregnant will succeed within a year. There is however a large variation between the fertility of individual couples. Some couples will repeatedly achieve pregnancy within a month (super-fertility) whereas others will never achieve spontaneous pregnancy (infertility) - everyone else falls somewhere in between. Although most "normally" fertile couples, will achieve pregnancy within a year, it is important to point out that some will take more than a year to become pregnant.

If it becomes apparent from the tests and examinations that, as a couple, you meet the basic criteria needed for pregnancy, you may be advised to continue trying for a certain period of time to see if a spontaneous pregnancy can be achieved. This waiting period is called “expectant management”. The age of the woman and the duration of actively trying for children will play a critical role in deciding whether this option is advisable or not. Embarking on fertility treatments only makes sense if the chance of achieving pregnancy is greater than if you adopt such a “wait-and-see” approach.

At first, some couples view expectant management as a disappointment. However, if you consider that firstly, active attempts to become pregnant are still being made and you are actually giving nature the best possible chance; secondly, that fertility treatment in no way guarantee pregnancy; and thirdly, that fertility treatments have side effects and risks of their own, then most couples can see the positive side to this approach. Obviously for each treatment, you must weigh up the potential side effects and risks against the desired result.