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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.

Strenuous Exercise Temporarily Decreases Fertility

Thursday, February 13th, 2014

A study from NTNU (Norwegian University of Science and Technology) suggested that the combination of strenuous workouts and achieving pregnancy may be too much for the body to handle. Therefore, female athletes or heavy exercisers may want to ease up a little if they want to become pregnant.

It is well known that women who are involved in elite sports struggle with fertility more than others. Now it appears that women who participate in other types of extreme exercise may encounter more fertility problems as well. In a study that included 3,000 women, researchers at NTNU discovered that frequent and strenuous exercise may reduce fertility – but only temporarily, or while the hard training lasts.

None of the women in the study had experienced a history of problems with fertility, and all of them were of childbearing age and in good health. Two groups of women showed a higher risk of fertility problems: those who trained nearly every day, and the ones who exercised until they were completely exhausted. The ones who fell into both groups experienced the most fertility problems.

In addition, the effects of strenuous exercise on fertility appear to be transient, ending when the hard training slowed down.

The theory is that extremely demanding physical activity requires so much energy that the body can actually experience periods of a deficiency of energy, in which the amount of energy needed to maintain the mechanisms, hormonal and otherwise, to enable fertilization just isn’t there.

It is important to note that women who engaged in low to moderate activity had no fertility impairments, so there is no reason for women to stop exercising altogether while trying to conceive. In fact, exercise can reduce stress, which is good for fertility. Moderate exercise has been previously shown to improve insulin function and promote better fertility as compared to complete inactivity.

It appears that the worst choices for women trying to conceive fall at both ends of the spectrum: extreme physical activity and extreme sedentariness. Pinpointing what constitutes the perfect level of activity, however, can be tricky, because it can be unique to individual women. If your menstrual cycle is particularly long or nonexistent, this could be a sign that you are exercising enough to negatively affect your fertility.

A woman is considered to be infertile after a year of unprotected intercourse without a pregnancy occurring. In women older than 35, it makes sense to see a doctor sooner; perhaps after four to six months of trying unsuccessfully to conceive. There are many factors that can affect fertility in women, including problems with the fallopian tubes, the ovaries, or the uterus, problems with ovulation, and hormonal issues. Sometimes the reason for infertility cannot be pinpointed, and sometimes it may the male partner who has the fertility problem and not the woman. A doctor’s evaluation is the only way to find out for sure.

– Yvonne S. Thornton, M. D., M. P. H.