If you've been trying to have a baby for a year, or are over 35 and have been trying for six months, experts advise a fertility checkup (for both sexes). Chances are you won't be alone. More than a million women see a fertility specialist each year.
Here, some recent advances you might want to bring up during your doctor's office visit if you decide to explore in vitro fertilization (IVF). While an increasing number of insurance companies are covering IVF procedures, it's a good idea to check with your provider beforehand to see what you'll have to pay for out of pocket.
Improved fertility drugs
Menopur, a newly approved drug that stimulates the production of eggs, may boost pregnancy rates by about 50 percent compared to existing meds, finds a European study released last year. Shots cost an average of $2,000 per cycle, which is comparable to the cost of other fertility drugs.
But there are some downsides. Menopur can increase the risk of multiple births, and it can cause bloating, headaches, and ovarian hyperstimulation (which could result in a missed cycle, pain, and bleeding).
Lowered risk of twins or triplets
Multiple births don't just mean there's a minivan in your future. Carrying more than one child increases health risks -- such as pregnancy hypertension or gestational diabetes for you and prematurity for your babies.
New advances -- including the discovery of a telltale genetic marker in the fluid surrounding an embryo, and the ability to increase incubation periods for embryos -- make it easier to spot the hardiest ones. As a result, doctors can implant just one per cycle with more confidence. That technique is called single-embryo transfer (SET), and studies show that pregnancy success is nearly as high as with multiple implantations. As part of a backup plan, any healthy leftover embryos can be frozen in case they're needed in another cycle.
Genetic disease testing
Preimplantation genetic diagnosis (PGD) can help couples who are at risk of hereditary disorders have healthy babies. One cell from an embryo is screened for more than 50 genetic and chromosomal abnormalities, such as Down syndrome, Tay-Sachs disease, cystic fibrosis, Huntington's disease, and sickle-cell anemia. Costs for the procedure can run high; they start at around $2,500.
Because the test itself can, in rare cases, harm a developing embryo, it's not for everyone. But it's strongly recommended for people with inherited or gender-linked genetic defects (like Duchenne muscular dystrophy), for women who have had multiple failed IVF attempts or miscarriages (which is often the result of a genetic disorder), and for women who are nearing or older than 40.
The chance to choose your child's sex
PGD techniques can also be used to determine an embryo's gender with almost 100 percent accuracy. It's expensive -- adding $2,000 or more per cycle to test dozens of embryos -- and ethically murky. IVF clinics offering the technique note that many of their patients who already have children choose it to balance the boy-girl ratio. But the American Society for Reproductive Medicine discourages it except for couples with gender-linked genetic disorders.