Infertility

Many women spend years of their reproductive life trying to prevent pregnancy, and then once they start trying for a family realize it’s not as easy as it seems. About 10% of couples in the U.S. have difficulty conceiving. There are four major components that must be functioning in order for a couple to conceive: a woman must be ovulating (releasing an egg), her partner must have enough sperm, the woman’s fallopian tubes must be open (fertilization of the egg by the sperm occurs here), and the timing of intercourse must be right. Even when everything is normal, the odds of a couple getting pregnant are only about 20% during any one menstrual cycle. This is why the diagnosis of infertility is usually not made until a couple has had unprotected sex for 12 months without achieving a pregnancy (6 months for women over 35).

Recommendations for Patients Trying to Conceive

1) Take a prenatal vitamin with folate every day. Avoid alcohol and smoking. Limit caffeinated beverages to less than 4 cups per day. Discuss any medications you are taking with your doctor.

2) Have intercourse frequently, everyday to every other day from the end of one period to the beginning of the next.

3) Keep track of the first day of each period which is considered "day 1" of the cycle. Determine your cycle length by counting the number of days from the start of one period to the start of the next. A normal cycle is generally 21-35 days. Most women ovulate 14 days before the period. To estimate your ovulation day, take your cycle length minus 14. (For example, if cycles are generally 30 days long, 30 - 14 = 16; this woman ovulates around cycle day 16). Look for signs of ovulation, such as mild cramping or pelvic discomfort (often one-sided) that lasts for a few hours or a clear, watery vaginal discharge that lasts for a few days. Ovulation predictor kits may provide further evidence of ovulation. However, women who are having regular periods, especially with other signs of ovulation, have good evidence that ovulation is occurring and do not necessarily need to repeatedly use ovulation predictor kits. Intercourse should definitely take place frequently around ovulation, especially in the few days before and during ovulation. However, to increase the chance of pregnancy, couples should have frequent intercourse throughout the cycle (see above) and not limit it to the few days around ovulation.

Evaluation of Infertility

Couples diagnosed with infertility (women under the age of 35 who have tried to conceive for 12 months; women 35 or older who have tried for 6

months) may be recommended to undergo an infertility evaluation. This often begins in the office with a review of your health history and a physical exam. Your doctor may recommend that you and/or your partner have additional testing, such as blood tests or an ultrasound. Special studies to evaluate the uterus, fallopian tubes and sperm count may be ordered. For additional information, click on the links below.