Sperm meet egg in this photo illustration.
With 6.8 billion people on the planet and hundreds of thousands of babies born every day, pregnancy might seem like a cinch. But the road to conception can be bumpy for many women.
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Dr. Kirstiaan Nevin is an obstetrician/gynecologist with Reiter, Hill, Johnson and Nevin in Washington, D.C., and sees a lot of women who have difficulty conceiving. She says the best natural fertility rate for women is about 20 percent in each monthly cycle. For women under the age of 35, it can take as long as a year to get pregnant. But, she says, women 35 or older who haven't gotten pregnant after about six months should probably see a doctor.
There are a few things women who want to conceive should keep in mind before they start trying. (For the most complete list, consult your own doctor.)
- Smoking won't do you any favors. The American Society for Reproductive Medicine notes that women who smoke are much more likely to be infertile and take longer to conceive than nonsmokers; they're also more likely to hit menopause earlier, have an increased risk of miscarriage, and give birth prematurely. Guys aren't off the hook either: Smoking can affect a man's sperm court.
- Check the meds. Nevin says that women on long-term medications might need to adjust dosage to ensure a healthy pregnancy.
- Get vaccinated. If you haven't had chickenpox and have never been vaccinated, now's the time to do it. You should also be screened for rubella, known as German measles, before you get pregnant. While the odds of coming into contact with rubella are very low in the U.S., it can cause pregnancy to end in miscarriage. It can also cause various birth defects and abnormalities in babies. Other vaccines to double-check include tetanus, hepatitis B and influenza.
- Take your vitamins. Nevin says the most important prenatal supplement to take is folic acid, a B-complex vitamin that's present in nearly all multivitamins and prenatal vitamins. It helps prevent fetal defects of the brain and spinal cord, like spina bifida.
- Consume in moderation. That's true in general, and especially while you're trying to get pregnant. If you consume lots of coffee, junk food or alcohol, cut down or cut it out altogether. It's hard to define what "moderate" drinking is, but it's typically defined as one drink a day for women, and two for men.
Know Your Cycle
A chart like this one can help keep track of when you're ovulating.
A chart like this one can help keep track of when you're ovulating. iStockphoto.com
- If you're trying to get pregnant, it's important to know when you're ovulating and most fertile — usually 14 days before the start of your period. For women with a 28-day menstrual cycle, it's day 14. If your cycle is 30 days, it's more likely to be day 16. That doesn't mean you can only get pregnant on that day. Nevin says most doctors recommend having sex every day or every other day for a few days before ovulation, and continue until a few days after. If you ovulate on day 14, for example, you would start having sex on day 11 of your cycle, then continue until day 16. "It is generally better to 'front load' and have the sperm there when the egg is released," she says.
- If your cycles are very short (less than 21 days) or very long (more than 35 days), Nevin suggests seeking medical evaluation sooner rather than later. And, she says, the older a patient is, the earlier she should seek advice.
- Get scientific (optional). Some women buy ovulation predictor kits, available at most drug stores. A basal body temperature chart can also keep track of cycles based on body temperature at rest. During ovulation, the temperature may rise. But, Nevin cautions, all of this tracking isn't necessary until there appears to be a problem. "I try to advise patients to try and relax and not drive themselves crazy with intensive monitoring early in the process," she says.
If you've followed your doctor's guidelines and you're still having trouble conceiving, there's a chance other medical issues may be at play. Nevin says they usually fall into four categories:
- Problems with sperm. Sometimes there just aren't enough, or they're not the right size, or they're not good swimmers. Men can help matters by taking multivitamins, eating lots of fruits and veggies, exercising regularly, watching their weight, limiting their alcohol and tobacco intake, and even limiting the amount of time they spend on their bicycles (especially, the Mayo Clinic points out, if you wear tight bike shorts).
- Tubal problems. The Fallopian tubes carry eggs from the ovaries to the uterus, but sometimes they get blocked or scarred. There could also be some rare uterine anomalies.
- Ovulation disorders. One of the most common is polycystic ovary syndrome, in which a woman has cysts on the ovaries.
- Unexplained infertility. If you haven't been able to conceive, but not for any of the reasons listed above, you may fall into this category.
So, how to deal with these issues? Some OB/GYNs might prescribe Glucophage, which prompts ovulation and may also reduce first trimester miscarriages for women with disorders.
Clomid, Nevin says, is the "drug of choice" for ovulation disorders like PCOS, and like Glucophage, it stimulates ovulation. She says it's relatively safe and cost-effective, but can lead to twins about 10 percent of the time.
Still no luck? That's when an infertility specialist, or reproductive endocrinologist, might come into the picture. They specialize in treatments that go beyond medication, including IVF. Later this week, we'll talk to one of those doctors.