The best strategy is to target treatment appropriately; which first requires the investigation and identification of the causes of infertility.
Treating the cause, not the symptom
To achieve pregnancy you need eggs, sperm, a womb, no blockages in the reproductive system connecting them, and no diseases interfering in the process. A fertility assessment looks at these fundamentals to try to identify reasons for the delay in pregnancy.
The first point of treatment should then be therapy targeted at the cause.
For example, 30 per cent of women have an abnormality of egg production (ovulation) identified. The problem is that eggs are not being produced when expected, if at all.
In most cases, fertility drugs can help to successfully release the eggs, which would bring women in line with the expected pregnancy rate of 20 per cent, though a few treatment cycles may be necessary.
Then we consider blockages. Whilst ultrasound scanning can check normal female reproductive anatomy, testing for blockages is not so simple. Techniques such as ultrasound (HyCoSy) or x-ray (Hysterosalpingogram) involve injecting fluid into the womb and looking to see if it has flowed through the tubes connecting the womb to the ovary.
The alternative is to use a blue dye and a keyhole surgery technique called laparoscopy.
Endometriosis is a common cause of infertility found in as many as one third of infertile couples.
In fact, in couples who have no symptoms and a normal fertility assessment, more than 50 per cent are found to have endometriosis at laparoscopy.
You may ask; why bother with laparoscopic investigation or surgery to treat tubal blockages and endometriosis when IVF can circumvent these conditions? Other than being more affordable, the risk of serious complications from a laparoscopy is far less than the risks associated with the high-level hormone therapy required for IVF. Over-hyperstimulation Syndrome is still a serious concern for everyone undergoing IVF.
Endometriosis removal also offers patients the chance to conceive the old-fashioned way, which is preferable for every couple.