When I was in university it seemed as if my friends were doing everything they could NOT to get pregnant. Discussions centered around spermicidal jellies, extra safe condoms and how much estrogen was in your pill. How things change. As my circle of friends gets closer to the average age of 40, discussion has turned to ovulation, hormone injections and in vitro fertilization.

For a foreigner, everyday life in Tokyo can be quite frustrating, so big decisions are often left deferred. If we are here for a short stay, we learn to put off certain things like buying a house or having knee surgery until we get back to our home countries. But when you are here for the long term, or you are pushing 40, putting off things like having children is not an option. And most women can't go home to do this. "This was my home," says Sara, a 40-year-old mother of twins. "My husband was here, my friends were here. I couldn't just go back to the States for fertility treatments."

Sara's story is one that I heard repeated over and over again by other foreign women. She and her husband tried for eight months to get pregnant until finally they decided to get help. She started at the Tokyo Medical Clinic. The doctors there referred her to one of the large university hospitals where she spent hours waiting in lines only to see the harried doctor for minutes at a time. She was started on hormones to hyper stimulate her ovaries. Four months later, they tried artificial insemination, then daily hormone injections. She finally went to the US to find out if anything was wrong; they found nothing. That's when Sara started to talk.

"My biggest mistake was not talking to any of my friends from the beginning. It would have saved us a lot of time and frustration." Sara says that most good information about fertility treatments in Japan is still word of mouth. She asked everyone she knew about information and was referred to friends of friends until she finally talked to a woman who, as luck would have it, was visiting a new fertility clinic that day. "'I'm coming with you,' I said. I didn't care what she thought of me, but I was going."

The clinic was the brand new Odawara Women's Clinic. The doctor was young, from a large university hospital, and willing to answer Sara's endless questions. It took her another six months to get pregnant, but it was a lot less stressful after she started treatment with Dr. Odawara because he was willing to give her the time and answers she needed.

Dr. Odawara is now the man. Talk to any gaijin woman who's had fertility treatment here and she will most likely mention his name. But Sara suggests still being very proactive about getting pregnant: "Do your research beforehand. I must have the best non-professional library on fertility in Japan. Research, and have questions ready to ask the doctor." Other women suggest using your "gaijinity" in your favor. "We've all heard about Japanese doctors not sharing information with their patients. Actually they will," says Katy, a 33-year-old mother of two. "Just keep asking and prepare your questions. They sort of expect it from foreigners and, surprisingly, they will give you answers."

The last bit of advice I got from women who have been through the fertility gauntlet is to have a doctor in your home country-preferably someone who is reachable by email and is willing to discuss your situation.

Many of the women I spoke with said that things are much better now. There are more resources for women who are having trouble getting pregnant. They lament, however, that there is still no formal support group. "It's OK, though," says Sara. "You form your own support groups through word of mouth. If you are having trouble getting pregnant, chances are, you are not the only one. Talk to other women. They are your best resource."

Next week: You're pregnant - where to go, what to expect, pre- and postnatal care, resources and delivery.