After we decided that we wanted to have a child together, we found a perplexing maze of options before us. Bookstore shelves creaked with advice, radio ads for infertility clinics tantalized us, and anecdotes about couples and their multi-year odysseys toward parenthood ran amok. It was a perplexing time, but looking back, here's four pieces of advice that can help you navigate the maze.

1. Be realistic about your situation. For us, the clock was ticking. His vasectomy was 15 years earlier when his daughter was born. We knew that success rates for a vasectomy reversal decline with time, especially after 10 years.

Maternal risk also increases over the age of 35, and I was nearly 35 at the time we made our decision to have a child. For in-vitro fertilization, success rates drop dramatically after the woman turns 37.

There was no hiding from these facts, but at the same time, we knew of many couples who had successfully conceived a child together against much greater odds.

2. Talk to other people. It can be easy to feel a bit shy and self-conscious about this topic - you may worry that people will think you are nuts or selfish to pursue having a child together. But keeping quiet doesn't get you the information you need. I talked with a friend who wrestled with infertility for years. She had gone through in-vitro fertilization for her first child, and then amazingly, became pregnant naturally – to this day – she refers to her second daughter as the “freebie.” Now they were trying to decide what to do with their frozen embryos, and we talked about how she felt about going through fertility treatments.

We also talked to our doctors and urology specialists. Our family doctor was not optimistic, and felt it was a risky gamble to try to reverse the vasectomy. He also pointed out something we already knew – that fertility treatments would not be covered by our health insurance and could cost us $5,000-$10,000. The urologist we saw was personable, answered all our questions, suggested others we could talk to, and ultimately, was the one we chose to do the reversal surgery.

It was also really important for us to talk with my husband’s children. For our own peace of mind, we wanted to know that they supported the idea of adding a new child to our family, and they had questions about what their dad would go through in a surgery.

3. Investigate your options. There are lots of options out there for couples facing infertility – from vasectomy reversal and in-vitro fertilization, to surrogacy and adoption.

In our area, several fertility clinics offer a “baby promise,” saying that if you go through fertility treatment cycles five times and don’t have a baby, you’ll get your money back and can use it for adoption.

According to the American Urology Association, there’s a 30-35% success rate for in-vitro fertilization used in combination with intracytoplasmic sperm injection. Basically this means they will wig me out on drugs to produce eggs and extract them, aspirate sperm from my husband, then try to implant the resulting embryos into my uterus. For us, in-vitro fertilization seemed like an impersonal way to conceive a child, and we feared the emotional strain of going through five cycles of fertility treatments.

At the same time – vasectomy reversal carries some risk – not just because it’s a major surgical procedure – but because fertility can’t always return. Sperm return to semen in 75-99% of men undergoing the procedure, and pregnancy results 30-75% of the time. However, the wild card in the mix is the amount of time since the original vasectomy – the longer it’s been, the less likely fertility can be restored.

Surrogacy was scary to us – and adoption was something we weren’t ready to consider yet. I was adopted by my stepfather as a child, and know personally the deep and wonderful familial bonds that can exist. There are many needy children in the world who need a good home filled with love – and we may yet turn to adoption if another option does not work for us.

4. Make the decision that feels right for you. Fertility is a multi-million dollar industry today – and there are plenty of people who will take your money and promise you a baby. But life doesn’t work that way – even these sellers cannot guarantee the results. Adoptions can go awry. Surrogates might change their minds. Surgeries may not work, and advanced medical procedures can fail.

It’s important to make the decision that feels right for you, your spouse, and your situation. We decided to try vasectomy reversal. Even if the surgery doesn’t result in pregnancy for us, we know we tried and gave it our best shot. We still have the other options available to us down the road, but we won’t regret our choice.

Dawn Miller writes a column on life in blended families at thestepfamilylife.com. 
Visit Dawn's blog for a daily dose of life in the blender.
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