So you have finally decided to take the plunge. You and your partner are ready to have a baby! You stop using birth control but months and months pass with regular periods and negative pregnancy tests.
Mixed in with the disappointment is a growing concern: why aren't I pregnant yet?
You are not alone. According to the CDC (Centers for Disease Control and Prevention), more than 6 million women in the U.S. have had trouble getting pregnant. Emily Evans-Hoeker, M.D., Carilion Clinic’s reproductive medicine specialist, sees couples in her office every day that are struggling to conceive. In fact, she also had trouble getting pregnant.
“No one ever thinks they are going to need a fertility specialist,” she said. “I was actually completing my fellowship in reproductive endocrinology and infertility at University of North Carolina when I found out I would need to undergo fertility treatments to conceive. So, I understand how emotional and frustrating it can be for my patients.”
Increase Your Chances of Conceiving Naturally
If you have been trying to conceive for a couple months with no luck, Dr. Evans-Hoeker noted that there are a few things you can do on your own to help increase your fertility.
1. Have intercourse frequently. Reproductive efficiency increases with frequency, ideally every one to two days.
2. Take advantage of the fertile window. The fertile window for most women spans the six-day interval ending on the day of ovulation. Dr. Evans-Hoeker explained that many couples think that they should wait until the day of ovulation to have sex, but for most women with regular menstrual cycles, intercourse every one to two days during the fertile window can help maximize conception.
The "fertile window" is the six days leading up to the day of ovulation.
3. Maintain a healthy weight. Fertility rates have been shown to decrease in women who are either very thin or have excess weight.
4. Stop smoking. Smoking has substantial negative effects on fertility, and it also increases the risk of miscarriage.
5. Cut down on caffeine. High levels of caffeine have been associated with decreased fertility, so don’t consume more than the equivalent of one to two cups of coffee per day.
6. Ditch the lubricant. Some commercially available water-based lubricants have been shown to inhibit sperm motility by 60 to 100 percent.
When to See a Specialist
But you could be doing everything right and might still have difficulty conceiving without some sort of medical intervention. If you are under 35, have regular cycles, have been following the suggestions above and you are still not pregnant after a year of trying, Dr. Evans-Hoeker explained that it is probably time to see a reproductive medicine specialist such as herself. And if you are 35+ and have been trying for six months without success, it is a good idea to seek help.
If you are under 35 and have been trying for 12 months, or 35+ and trying for 6 months, it may be time to consult with a fertility specialist.
However, if you have already been diagnosed with an obvious fertility issue such as blocked fallopian tubes or you do not have regular cycles, then you do not need to try for a year before seeking the help of a specialist.
Common Causes and Treatments
Contrary to popular belief, infertility is not just a female problem. Besides anovulation (a menstrual cycle in which an egg is not released), male factor fertility is another very common reason for infertility.
“Unlike women, men don’t necessarily have any symptoms,” said Dr. Evans-Hoeker. “If a woman does not get her cycle, then we know something is wrong, but you won’t necessarily know if there is something wrong with a man’s semen or if he has an anatomical abnormality unless you look for it.”
Therefore, Dr. Evans-Hoeker noted that it was important to meet with both partners at the initial consultation to get a thorough history on both the man and the woman.
“When I sit down with a couple, I explain the causes of infertility and through an examination and work-up, we determine the most likely cause,” she explained. “I give them their various treatment options and try to get started right away since most of the time the couple has been trying for a long time and don't want to wait any longer.”
Treatments can range from fertility drugs to super ovulation (ovulating more than one egg per cycle) with intrauterine insemination (placing sperm into the uterus) to in vitro fertilization, or IVF. IVF has become a well-known and popular fertility treatment and involves combining eggs and sperm outside the body in a laboratory. Embryos are formed in a lab and then placed back into the uterus. Dr. Evans-Hoeker explained that aside from a skilled reproductive medicine specialist, having access to a state-of-the-art lab with high success rates is crucial for IVF to be successful.
“The eggs cannot survive outside of the body in the typical every day environment for very long. Once removed, the eggs must be handed directly over to the lab, which has a very controlled environment. The same goes for the embryo,” she said. “Much of the success of IVF has to do with how things are done in the embryology lab.”
For this reason, Carilion's Reproductive Medicine and Fertility Clinic in Roanoke recently formed a partnership with University of North Carolina (UNC) Fertility, an excellent embryology lab with high success rates. Through the partnership, Dr. Evans-Hoeker is able to perform most of the IVF process in Roanoke, but then travels to UNC Fertility to perform the egg retrieval and embryo transfer on her patients.
“What we do is not your typical medicine. It is very personal to people and it is very emotional,” explained Dr. Evans-Hoeker. “My partnership with UNC Fertility allows me to perform every step of the IVF process for our patients, rather than sending them to another physician that they do not know to perform parts of the IVF cycle, which is something that we were not previously able to do.”
If you suspect that you may have a fertility issue, speak to your OB/GYN or visit a reproductive medicine specialist about the next steps that you could take. Just think, with a little time, patience, and perseverance you could take home the greatest gift of all, a baby.