Trying to Conceive

by Mona Saint MD

I am 34 and we’ve been trying to get pregnant for about 6 months and I’m not sure whether to be worried. I had an early miscarriage 3 years ago and have a healthy 2 year old at home. Both times I got pregnant right away. Should I be concerned?

I can imagine your concern over the situation but I am optimistic for you given the information I have. You easily conceived a healthy child, a reassuring sign of your proven fertility. Even for those who have never had a baby, remember that the odds are on often your side. It can often take 6 months or longer to conceive — 85% of couples will conceive in 1 year. After that, 50% of the remaining couples will get pregnant on their own over the next 36 months, and the remaining 7% have a lower chance of conceiving naturally. Infertility is defined as 12 months of frequent intercourse without conception.  Everyone has friends who tell you that they got pregnant each time on their first try. These may be the same people who eat whatever they want and never gain weight. Don’t worry about their stories. People exaggerate, and comparing notes can add to your stress. Find a few supportive people whom you trust and confide in them. 

We typically recommend seeing your gynecologist after 6 months of trying to conceive for women age 35 and older and after 12 months for women under 35. For those over 40, you can go in right away. If you’re not ovulating or not having regular menstrual cycles, if you have significant pain or bleeding, have a known history of large fibroids, endometriosis, or had a history of prior infertility, it is worth seeing your doctor sooner.  When you see your doctor, it is helpful to bring your menstrual calendar and ovulation charting. She will get a detailed history, check blood tests, do a pelvic ultrasound and/or an HSG (tubal dye study) to check the tubes and anatomy, and usually request a semen analysis on your partner. Usually after the initial workup, you will get a referral to a reproductive endocrinologist (REI) for a consultation. Even if you know that you never want to do fertility treatments, it can be helpful to have even one visit to get their expert assessment on what the issues might be and what the options are. Be sure to find someone with a good bedside manner and excellent referrals from your doctor and any friends or nurses.

To maximize your chances at home,  ovulation kits are helpful. Clear Blue Easy is a reliable brand. Many wait until they ovulate to start having intercourse, however studies show that the best chance of success is by starting about 5-6 days before ovulation. Also, if you start to notice any mucous in your early to mid-cycle this is a good time to start trying. Sperm can stay alive for several days but once released the egg is usually around for only about 12 hours. So, the goal is to make sure the sperm is there waiting for that golden egg. You can time intercourse every other day leading up to ovulation and then for a couple more days to maximize your chances. Finally although not scientifically proven, lying down for 15 minutes after intercourse (and even propping your bottom up on a pillow) can let gravity help the cause.  Avoid non-steroidal anti-inflammatory medicines like Advil which can interfere with ovulation, and most lubricants should be avoided if you’re having trouble conceiving. Tobacco, heavy alcohol, and more than 2 cups of coffee per day can decrease fertility, and aerobic exercise over 7 hours a week can decrease ovulation. Being overweight or underweight can also diminish ovulation, and the optimal body mass index (BMI) while trying to conceive is 18-25.

Stress can play a role in fertility, and it is often difficult for my patients to figure out easy ways to reduce their stress levels.  Acupuncture can be excellent for fertility enhancement and stress reduction, and I have seen outstanding results with the acupuncturist we refer patients to. Yoga and meditation can also help, as can listing the people and situations that are causing the most stress in your life and seeing what can be changed. Mindfulness exercises and breathing techniques can be helpful with those that can’t be changed. And remember, this isn’t just about trying to get pregnant; it is also about creating a less stressful life for yourself. I recommend nurturing yourself and using positive thoughts for each milestone, like “I am grateful I had a normal ultrasound and I ovulated this month” and “we’re having a beautiful, healthy baby.” I know it may sound silly, but many elite athletes, surgeons, and top executives use this positive visualization and, hey… it can’t hurt.

In the meantime, hang in there and be proud of yourself for getting this far and working so hard. Best of luck and I am hopeful for you!