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Most specialists recommend that couples with no known reproductive health problems try to get pregnant naturally for 12 months before seeking medical advice.

However, if a woman is 35 or older, has menstrual or ovulatory irregularities, known tubal problems, a history of miscarriages or thyroid conditions, she should consult a specialist much earlier in the process, probably at the beginning.

Men with known sperm deficiencies or a history of infections, cancer treatment or scrotal surgery should also consult a specialist early in the process.

Once you receive a diagnosis of infertility, you and your partner should:

• Consult a specialist early on. This is typically a reproductive endocrinologist (for women), a doctor who specializes in infertility, and/or a urologist (for men).

• Educate yourself as much as possible about all aspects of infertility.

• Be assertive and ask questions.

• Know your treatment options and what is financially and emotionally possible.

Fertility specialists are sub-specialists in the field of obstetrics and gynecology known as reproductive endocrinology. There are only about 600 board-certified reproductive endocrinologists in the U.S., compared to nearly 28,000 obstetrician/gynecologists.

Urologists with a sub-specialty in andrology are specialists who diagnose and treat male infertility.

Some ob/gyns may have gained significant on-the-job experience in treating infertility, combined with specialized coursework to enhance their knowledge. There are many fertility tests and treatments a competent ob/gyn can perform.

Fertility specialists are highly knowledgeable about all aspects of reproduction and treatment options, however. Additionally, their office staff, hours of operation and equipment are available exclusively to support infertility treatment.

Finding board-certified physicians in reproductive endocrinology—which means they completed extensive training and passed both oral and written examinations in the subspecialty—is one way to ensure that your health care professional is truly a specialist.

When looking for a specialist, be sure to ask:

• What is your training and how long have you been practicing?

• What is your center's clinical pregnancy rate?

• What exclusion criteria does your center use in order to select patients for in vitro fertilization?

• How many embryos does your center routinely implant? (Centers that implant more than two or three may have good pregnancy rates, but they will also have more multiple pregnancy rates, which can be risky to both mother and babies).

• What are the center's success rates for different types of procedures, particularly those I might face? Figures should represent live birth rates, not just pregnancies.

• Is the center still working with the same laboratory and specialists as when the statistics were generated?

To see a summary of ART success rates and fertility clinic reports from fertility clinics around the country, check the statistics reported by the Centers for Disease Control and Prevention at www.cdc.gov.

As with most medical evaluations, identifying potential fertility problems should begin with the easiest, least expensive and least invasive approach. An initial evaluation should include:

• Medical histories of both partners, including questions about pelvic infections and sexually transmitted diseases (STDs)

• Blood tests to screen for certain hormonal abnormalities in men or women

• An assessment of how often you ovulate

• A assessment of the quantity and quality of the man's sperm

• Hysterosalpingogram (HSG). A special dye is injected into the uterus through the vagina during an x-ray. This helps your health care professional to see both the uterine cavity and the fallopian tubes.

• Saline-infusion sonogram (SIS). Sterile saline is placed in your uterine cavity so the doctor can check for any abnormalities in your uterus or endometrium. There is no radiation required, only ultrasound; however, it is not as effective as HSG in evaluating the health of the fallopian tubes.

• Transvaginal ultrasound examination allows your health care professional to look at the thickness of your endometrium and the blood flow to your uterus to see how well an egg could implant in the uterine lining. During normal menstrual cycles, uterine blood flow rises just after ovulation, at the same time a fertilized egg would implant. There's some evidence that the higher the uterine blood flow rate, the higher the rate of implantation.

• Laparoscopy: During a laparoscopy, the surgeon inserts a scope through a small incision below the belly button to view the outside of the uterus, ovaries and fallopian tubes. If the surgeon finds endometriosis or adhesions, he or she will remove them during the procedure. Laparoscopy is usually performed under general anesthesia.

• Insurance coverage varies for these diagnostic procedures. While some plans may cover some tests and specialized treatments, most are far from comprehensive. Check out your insurance coverage carefully so you understand what tests are covered during the diagnosis and treatment stages.