Fertility Facts and Considerations when Trying to Conceive
by Dr. D’Andrea Bingham
For pregnancy to occur, an egg is released from the ovary, fertilized by sperm as it travels from the ovary to the uterus, and then implants into the uterine lining. Women can have trouble getting pregnant if there is a problem with any of these steps. Sometimes these steps all appear to be normal, and a woman still may have problems conceiving. Certain things such as age, cigarette smoking, obesity, and excessive caffeine or alcohol intake in both women and men can decrease fertility.
Most couples will not conceive immediately when they start trying. You should see your doctor if you do not get pregnant after having unprotected intercourse for one year. If you are over 35 years old, see your doctor if you do not conceive after 6 months of trying. This is because a woman’s fertility begins to decline after age 35.
A general obstetrician/gynecologist can do initial testing for infertility. At the first office visit, it is helpful to bring a menstrual calendar from the last 6-12 months, which is a calendar that indicates what days your period starts and ends. This can be written down, or recorded with one of several apps available. Ovulation predictor kits can also be useful. These are available over-the-counter and test for a hormone in the urine that precedes ovulation by about 24 hours. They can be used to time intercourse when chances of conception are highest. It will help your doctor if you also record the results of the ovulation predictor kits on your menstrual calendar.
At the initial visit, your doctor will usually do a detailed history of you and your partner and a physical exam. Evaluation includes testing of the male and female. For a man, this usually starts with a semen analysis to see how many sperm he makes and how healthy those sperm are. For the woman, tests may include:
- blood tests to check hormone levels
- ovulation tests to see if eggs are being released from the ovaries
- Tests to check the uterus and fallopian tubes- These can include ultrasounds, x-rays to see if the fallopian tubes are open (hysterosalpingogram), or even surgeries to look at the inside of the uterus and/or the tubes and ovaries.
After the tests are done, your doctor may or may not be able to identify a problem. Treatment is usually aimed at fixing whatever problem is identified. Even if a problem cannot be identified (unexplained infertility) there are still treatment options available that can help a woman get pregnant.
Many initial treatments can be done by your local gynecologist. For patients that need more advanced treatments, referral may be made to a reproductive endocrinologist, which is a doctor that treats infertility. In Texarkana, we usually refer to specialists in Shreveport, Dallas, or Little Rock.
Fortunately, the majority of couples who desire pregnancy do end up conceiving. However, it can be very stressful and frustrating when it takes longer than normal. It may be helpful to talk to a counselor or support group for couples who are having trouble getting pregnant. The American Society for Reproductive Medicine has an excellent website that provides additional resources and information for patients about infertility (www.asrm.org).
