It’s often said by many women who are trying to conceive that they never knew it would be hard. The irony is not lost that many among us spent much of our lives trying to not-get pregnant, and now when its deeply desired, it can be difficult. If you’re struggling to conceive, when exactly is the time to reach out for help? And what kind of help is out there?
We asked Dr. Daniel Shapiro, M.D. Reproductive Endocrinologist at Prelude Fertility for his expert advice.
If pregnancy has not yet been attained “the old-fashioned way,” it’s imperative to make sure you’re doing everything right. (Having sex once does not automatically lead to a baby, no matter what your high school health teacher might have told you.) As with many things in life, timing, is in fact everything.
Dr. Shapiro explained, “There is a classic study done in fertile couples about 15 years [ago] that showed that a single act of intercourse up to a week prior to ovulation could initiate a pregnancy. The highest likelihood of pregnancy in the study occurred in couples who had sex in the 24-hour period immediately prior to ovulation.” Knowing when and if you ovulate is a key indicator of your fertility.
He advises, “The general rule of thumb is that healthy couples have sex 2-3 times a week ‘just because.’” In this case, the couple wouldn’t have to use any trackers or “predictor kits because there will always be viable sperm in the woman’s reproductive tract waiting for the egg to drop.”
After how long?
After a few months of trying without success, you might be eager for some assistance. However, the recommended time frame is actually longer than you might think. Dr. Shapiro advises, “A couple should consult a fertility doctor if they are under 35 and have tried to conceive for a year without success, or they are over 35 and have tried for six months.” He also recommends seeking a specialist if you already know or have a suspicion you may have an existing fertility issue. Additionally, he recommends seeing a specialist if you have had two or more unexplained pregnancy losses.”
Luckily, in the overwhelming world of infertility, you have options for testing, beginning with the least invasive. Dr. Shapiro says, “For couples who are struggling, the best way to start an evaluation is to track basal body temps or use an ovulation predictor kit to confirm ovulation is occurring.” What follows next would be AMH testing for the Anti-Mullerian hormone that can provide an estimation of your ovarian reserve in a female, and a male would have an analysis of his semen performed. “If both of those tests are reassuring, the next step is evaluation of the woman’s uterus and fallopian tubes by hysterosalpingogram, saline sonogram or in some cases laparoscopy/hysteroscopy,” adds Dr. Shapiro while adding that these tests and procedures would take place only after a woman’s GYN or Fertility specialist has been consulted, and a full medical history provided to the physician.
In regard to fertility treatments, he details, “Historically, fertility treatments usually start with either ovulation induction and/or intrauterine insemination. Younger patients with open tubes and normal male factor are good candidates for this approach.” If a patient is older or it is already known they have a tubal blockage in the female or low sperm counts in the male, “REIs [ Reproductive Endocrinologists] usually recommend that patients move quickly to IVF. For men, we would take a simple semen analysis, which is affordable and easy to obtain. This is still the most reliable assessment of male factor."
Regardless of your circumstances, there are ample options and resources for couples wanting to start their families. Dr. Shapiro advises, “Starting to think about family planning options should start when you start having the conversation about growing your family with your partner. Especially if you want children, but the time won’t be ‘right’ for quite a while, I suggest freezing eggs!”