The first question that should be asked is whether the woman is medically fit to carry a pregnancy. There are many protective mechanisms within the body that reduce fertility if the woman is in poor condition to conceive. Hormone therapies can often overcome these protective mechanisms without correcting the underlying problem and increasing the risk that there will be a poor outcome for mother or baby. An obese woman who has ceased to ovulate may not want to hear that she must lose weight to become pregnant. It is much easier to give her pills to stimulate ovulation. This apparently simple solution can lead to respiratory compromise and weeks of hospitalization for which the physician may be held liable. The physician should exercise the same caution in recommending fertility treatment as any other hazardous procedure.

Studies on the products of spontaneous abortions point to a higher than normal rate of genetic problems. Given that the human body eliminates fetuses with genetic diseases in many cases, women who have had several unsuccessful pregnancies should be considered at risk for genetic disease. This is another situation in which medical science can sometimes overcome natural protective mechanisms. The couple who is disappointed at their lack of children may not realize that there could be a genetic problem with the babies. They should have a careful evaluation to rule out the presence of a genetic disease that might be complicating their efforts to carry a fetus to term.