• Fertility treatments are a costly, and oftentimes taxing, process.
  • Author Sharon Feiereisen spoke to several fertility experts and women who have undergone fertility treatments themselves for this list of things everyone should know about the topic.

It would be great if we could all get pregnant with candlelight and chocolate-dipped strawberries, but the reality is that for many couples estimates usually range from 10 to 15 % , but dubbed the "silent shame," some estimates are as high as 25% this isn't the case.

Most of us think that we know about the birds and the bees, but after spending weeks speaking with fertility experts, it's clear that the average person likely knows very little about how their own body works, let alone the various stages of the menstrual cycle.

There's nothing like facing months (often years) of popping pills, self-injecting meds and enduring near-daily transvaginal ultrasounds and blood tests to get you interested. And, with careers and dating woes delaying the age at which couples begin to think about a family it's now more relevant than ever to be educated on the topic.

Here's what fertility experts, and a few women who have undergone fertility treatment themselves, say is imperative to know.

1. Don't be fooled by Hollywood.

While some celebrities like Chrissy Teigen, Brooke Shields, and Courtney Cox have been honest about turning to in vitro fertilization (IVF), many celebrities in their mid-to-late 30s and 40s have likely not been as honest, leading people to have a false sense of just how easy it is to conceive after the age of 35, according to Dr. John Zhang, founder of New Hope Fertility Center .

With no health issues, a 30-year-old woman who is tracking her ovulation has a 20% chance of conceiving in any one month, according to the CDC . A 40-year-old has a 5% chance. Again, that is for a woman without any health issues some 10% of women have polycystic ovary syndrome (PCOS) , most of whomdon't find out that theyhave ituntil they'retrying to conceive.

You can see how chances for success quickly start to diminish, especially once you also factor in miscarriage rates. According to Dr. Jeffrey Klein, board-certified reproductive endocrinology and infertility specialist at RMA of New York , miscarriage rates for someone in their early 30s are around 12 to 15%, whereas by the time you're 40-plus the chance of staying pregnant is 1 in 3.

But that's not the whole story. "I think that celebrities who have a child much later on in their lives may mislead the general public due to them not revealing that donor eggs and donor sperm have been used, and so people may feel that because of modern technology they can have a baby as late as they want," Dr. Zhang said. "The general public, however, thinks see as long as you have money, you can have a baby anytime you want.'"

2. It's not all about age

Don't get it wrong, age is considered the most important factor when it comes to having a child because every day that goes by a woman's egg quantity and quality diminishes. "The most important thing for a woman who reaches her late 30s and early 40s is very simple, just hurry up because time is essential," Dr. Zhang said. "Once a woman reaches her 40s, the chances for the egg to make a good baby is only 5-10%." But it's not the whole story.

One of the most common reasons for troubles conceiving is PCOS as mentioned above, some 10% of women have it. "Unexplained infertility" is another very common reason. Many couples told me they wish they hadn't waited so long to seek treatment.

"I was put on birth control in my teens because of my irregular period. When I went off at 24 I didn't get my period back. I was told that I should give it up to a year I wish I hadn't waited so long," said Jennifer, a 28-year-old sales representative. "Once I did my ultrasound I found out I have PCOS and don't ovulate naturally meaning my chances for a child without treatments was pretty much zero." It's also worth noting that it's very possible for a younger woman to have diminished egg reserves get your numbers checked!

3. Fertility treatments take time

Many people think that if you're at the point where you need IVF you're pretty much guaranteed a baby, but that is not the case. Many women undergo multiple cycles, and even then, taking home a baby is never a guarantee.

Nearly all the women I spoke with have been doing treatments for over a year.

"Before I started my now three-year journey, I definitely wish I would've known that IVF is not a guarantee," said Alexis, a 35-year-old restaurant publicist. "Now five IVF cycles in I've been able to come to terms with this reality and embrace the idea that itcanwork,but certainly not without persistence, and plenty of blood, sweat, and tears (literally and figuratively!)."

4. You're going to need a lot of time off from work

There's a spectrum from least to most invasive when it comes to fertility treatments, even when you're on the least invasive side of that spectrum you can expect to need lots of time off from work, as you'll be going to your doctor or clinic every other day or so for transvaginal ultrasounds and blood tests.

"I had to decide: baby or job," said Sarah, 36, who works in marketing. "When you factor in the time to drive to and from the hospital and then the time waiting to get the ultrasounds and blood tests done I was consistently a few hours late for work, and that wasn't going to fly."

5. It may cause strain in relationships

This is the point that came up most often: fertility treatments often take a serious toll on relationships. "I wish I knew the strength and resolve I would need to keep going," said Danielle, a 43-year-old project manager. "It's such a rollercoaster and that can really strain a marriage."

But it doesn't exclusively effect marriages. "I was warned about the physical symptoms: being tired, bloated, in pain, etc., but for me it was the psychological effects of treatment that were WAY more difficult to handle," said Elinor, a 33-year-old tour operator. "The ups and downs of treatment, before and after transfer, the agony of waiting for results, how jealous I would get of people for whom getting pregnant was easy, how hard it was to go to brises and baby namings, how horrible I felt about myself when I wasn't happy about others having kids, and the list goes on and on."

Rena Stein, a licensed social worker at RMA of NY , was so affected by her journey she specialized in infertility after having her daughter. "I struggled for two years to conceive and it was one of the darkest periods of my life; people are always surprised when I tell them that research shows infertility has the same stress levels as AIDS, cancer, and heart disease," Stein said. "Like so many others, I had no insurance coverage for treatment and so I started going to Albany and lobbying for insurance reform.Being proactive helped me cope."

6. You need support

Family and friends are invaluable you need a strong support system. But they often have no idea what you're going through and don't know IUI from IVF, let alone Clomid from Femara, or Menopur from Gonal F.

Nor can they comprehend the physical and emotional trauma that results when, for example, you blow up like a balloon and look six months pregnant from all the hormones being pumped into your body.

"I wanted to go to work wearing a shirt that said No I'm not pregnant. No I'm not fat I'm just doing IVF,''" said Megan, a 32-year-old who works in advertisement.

It can be helpful to connect with people, via Facebook groups and website like Fruitful , who are in your same boat.

7. Wait for blood tests

Anyone undergoing fertility treatments knows what the two-week wait is. It's the period of time between finishing all your shots, tests, and procedures and the time in which you find out if you have a BFP ("big fat positive") or BFN ("big fat negative").

"There's such a thing as a false negative and a false positive on a pregnancy test spare yourself unnecessary grief and wait for the blood test to confirm whether you're pregnant or not," said Rachel, a 25-year-old who works in quality assurance.

8. Understand your chance of success

Whether it's popping daily Clomid pills or doing multiple hormone injections, anyone undergoing fertility treatments will tell you they wanted a baby like, yesterday.

Unfortunately, stats aren't clear-cut. The biggest misconception is that success rate means taking home a baby it just means getting pregnant. The reality is that the actual live birth rates are often significantly lower because of miscarriages and stillbirths.

According to Dr. Klein while IVF success rates are strictly regulated in the USA, most patients don't check websites like SART for the official numbers.

"Patients should do their due diligence. There are centers that have half the success rate within a particular age group when compared to another center a subway way. If you're seeing 20% success in a population where that number should be 40%, that's a red flag," Dr. Klein said. "However, it's also important to know that some centers are strict about who they accept. For example, some won't accept patients with low egg reserves even if they're young. Do your best to get to know the centers you're considering and how strict they are to accurately access their numbers."

9. Go with your instincts

Many people I spoke with told me they went to a few doctors before finding the one.

"When you go through fertility treatments, there's so much information out there, but doctors don't always feel the need to share that information with you or explain the reasoning for opting for a certain protocol," said Shaul, a 33-year-old research and development director. "I wish we didn't waste so much time with a doctor who didn't take the time to explain a long-term game plan. It caused needless anxiety and it's near impossible for success when there's distrust. We ended up opting for a doctor located totally out of the way, but it's worth it. You never want to feel like you're just a number or be in a position where you don't feel comfortable asking questions."

10. Knowledge is power

If you want to have kids and you're inching towards your 30s and certainly if you're 35 or above look into whether your insurance covers egg freezing. Your egg quantity and quality will never be better than it is today.

In the same vein, according to Dr. Paul Turek, board certified urologist, men's fertility specialist, and founder of The Turek Clinics , half the time infertility involves a female issue, the other half it's a male issue despite this, only 20% of U.S. men actually get a proper infertility evaluation.

Fertility treatments can be cost-prohibitive and they're far from a walk in the park, but knowledge is power. If you feel like something might be off or know you want a family but don't see it happening before your mid to late 30s, or later, see a doctor and start looking into your options.

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