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Trying to Conceive? Read This

Monday, March 17th, 2014

Making the decision to have a baby can be overwhelming and frightening, but it can also be extremely exciting. Most people are able to conceive without difficulty. For some women, it happens very quickly, but for others it can take longer. Around 30% of women trying to conceive will do so within one month; 75% will succeed within six months. For some women, it can take as long as a year.

The first thing you should do is schedule an appointment with your gynecologist and inform him or her that you are planning to become pregnant. Talk to your doctor about any medical conditions you may have and how they may affect your pregnancy, such as diabetes, high blood pressure, heart problems, or a family history of any hereditary conditions such as sickle cell anemia.

Be sure to discuss any medications you are taking with your doctor, and do not stop taking them without talking to your doctor first, particularly if you are taking them for a medical condition. Obviously, you should not be taking any recreational drugs if you are trying to get pregnant; you should also avoid alcohol and tobacco, as should your partner.

Once you stop using contraception, your fertility will return to normal, as will your periods. There may be a short delay in ovulation after you stop hormonal contraception, but after this, your fertility will not be affected by these methods of birth control. It’s also fine if you get pregnant very quickly after stopping a hormonal method of birth control. This is not dangerous to your baby.

You can improve your chances of getting pregnant by making healthy lifestyle choices – both you and your partner.  I have found in my practice that if a woman is having difficulty conceiving and she is obese, the first order of business is to lose weight and to attain a normal body mass index (BMI = 18.5–24.9;kg/m2 ) before she pursues pregnancy.  One of the most important things you can do is to make sure you are eating a healthy, balanced diet. Eat a wide variety of fresh, whole foods to help ensure that you get all the vitamins, minerals, and other compounds you need. You should also have a pre-conceptional visit with your gynecologist and most likely (s)he will recommend you start taking folic acid (0.4 mg per day) – and not just an all-purpose multivitamin.

Some patients want to know when they can expect to be fertile. I personally believe that this is a recipe for disaster, i.e., trying to calculate when you are fertile rather than enjoying your partner and having intercourse at least three times a week.  My dictum is, “A watched ovary never ovulates.” Nonetheless, you may want to be familiar with your menstrual cycle. The “average” length of the menstrual cycle is 28 days, but this can vary pretty significantly from woman to woman and still stay within the realm of perfectly normal. The key is to know your individual cycle. Count the first day of your period as day one. If you haven’t already, start keeping track of this on a calendar (a menstrual calendar). After a few months’ worth of counting, you will get an idea of the timing of your menstrual cycle..

This is important, because ovulation will occur somewhere around 14 days before your next period starts, so this can give you an idea of when you will be most fertile. I am not a fan of patients sticking their fingers into their vaginas in order to assess their cervical mucus.  But, some are compelled to do so.  The character of the cervical mucus  changes with the timing of ovulation: around the time of ovulation, it becomes clear, slippery, and stretchy (Spinnbarkeit). At other times it may be creamier and thicker.  Whether thick or thin mucus, a patient should engage in sexual intercourse frequently throughout the month if she wants to conceive.

If patients want to get the Cadillac of tests detecting ovulation, they purchase an ovulation kit. These kits are used to test the urine for the luteinizing hormone, which will increase a day or so before you ovulate. If your partner feels forced into intercourse based on these ovulation kits (“performance anxiety”), then there needs to be a serious discussion about the ovulation kit’s effect on the dynamic of the relationship.  Many women find that these kits are unnecessary and that getting to know their own bodies and menstrual cycles is enough.

Despite their best efforts, many women aren’t able to get pregnant within the first few months of trying. Several factors can affect whether or not you conceive, including whether or not you ovulate (see your doctor if you think you might not be ovulating), whether implantation takes place successfully, your weight (obesity is a deterrent to conception, as is severe anorexia), your age (women over 35 may find that it takes longer to conceive), and the quality or quantity of your partner’s sperm.

If it seems to be taking too long for you to conceive (a year for most couples, six months or so if you are over 35), talk to your doctor about the possibility of fertility testing (for both you and your partner) to determine whether there is a physical problem that may need to be addressed. Finally, if you do conceive but have a miscarriage, the odds of you having a successful pregnancy in the near future are still very good.

– Yvonne S. Thornton, M. D., M. P. H.

Studies Show Lack of Evidence that IVF Causes Birth Defects

Monday, June 24th, 2013

From the moment a woman realizes she is pregnant, she is overwhelmed with worries about the health of her future child. These worries are only compounded when the woman in question has had a difficult time becoming pregnant. Those women who have undergone infertility treatment in order to conceive have perhaps the most difficult task ahead of them as they await the delivery of their child—a wait that is made only more difficult by the belief that many people have that infertility treatments cause birth defects and birth complications at a higher rate than among women who conceived naturally.

It certainly raises a lot of questions. If it were true that births after infertility treatment produced higher rates of birth defects, it would also raise quite the moral dilemma. Do doctors and potential parents have the right to produce children that may suffer health problems and defects? Infertility treatments have been the subject of much debate since the first test-tube baby was born, and many people are still uncomfortable with the idea. However, for millions of parents who would have been unable to conceive, IVF is a blessing. It’s my opinion that everybody has the right to become a parent, and thought it is wonderful that many parents can conceive naturally, it is also wonderful that there is an option for parents who face more difficulty in having children.

Thankfully, studies have shown that the worries people have about children produced through IVF may be unfounded. The rate of birth defects in children born through IVF are no higher than the rates among children born through natural conception once parental factors have been taken into account. People who are still worried about the health “risks” of IVF for children in this day and age need to learn to trust the research rather than the propaganda, and they need to stop spreading misinformation that might lead parents who turn to treatment to conceive to feel guilty about their decision.

– Yvonne S. Thornton, M. D., M. P. H.

Daily sex for healthier sperm?

Monday, July 6th, 2009

A new study by an Australian fertility expert, Dr. David Greening of Sydney IVF, has caused a bit of a stir. Greening studied 118 men whose sperm had greater than average DNA damage and found that, when they ejaculated daily, the resulting sperm was healthier.

All well and good so far but Greening’s prescription for greater fertility success made me cringe in empathy for my patients who are trying to get pregnant.

Greening recommends that couples engage in sex every day to improve their chances of conceiving.

Maybe it takes a woman to understand that this isn’t the greatest advice in the world. Too many women come to my office, sore and miserable, because their husbands want to do it every day. They don’t want to say no when they’re on a mission to conceive. And now, this (male, you’ll notice) doctor is saying this is the best way to go?

All right ladies, sit down (if you’re not too sore), because you don’t have to take Greening’s advice. Greening’s findings were that daily ejaculation improves sperm quality, not daily sex.

If you and the man you love want to improve your chances of conception, having intercourse three times a week is plenty.

Don’t look at clocks; don’t look at calendars and yell, “Honey, get in here quick, I’m ovulating.” That causes so much performance dysfunction for men. And it’s completely unnecessary.

All it takes is one sperm. Men ejaculate about 60 million of those little guys at a time. And the sperm hang around, ready to jump on that egg when it appears, for up to seven days. So, even though, when we ovulate, the egg is only fertilizable for up to 24 hours, it doesn’t mean that conception is now or never. With up to 60 million sperm hanging around waiting, one of them is likely to be in the right spot when the ovum shows up.

Most important for couples who want to conceive is to remember that sex, even when you’re on a baby-making mission, should never be a chore. Make sure neither of you skimps on romance, cuddling and cooing. In other words, keep the love in making love. It should be as much fun today as it was the first time (even if that first time was in the back seat of a vintage Chevy). Relax and enjoy the experience and each other. Soon enough, if neither of you has problems with fertility, baby will make three.

– Yvonne S. Thornton, MD, MPH