You've heard all the horror stories about how hard it is to conceive. Here's the latest news to help you: how often to have sex, when to do it, which ovulation kits work best — and what you absolutely must do first.
On the face of it, making a baby seems rather simple. After all, the basic "how to" is probably something you've more or less been doing for some time now. Yet when it comes to the finely tuned sequence of events that must take place for conception to occur, there's plenty of room for foiled attempts — and confusion. "Because most women's cycles vary from month to month, it's no wonder most couples have some mistaken notions about predicting when ovulation will occur and when you're most fertile," says Allen Wilcox, M.D., chief of the epidemiology branch at the National Institute of Environmental Health Sciences.
Lack of knowledge doesn't always hamper your efforts, of course, but it can add unneeded frustration and delay. For instance, many women assume that the minute they stop using birth control, they'll conceive. Or that if becoming pregnant with their first child was a snap, things will go like clockwork the second time around. When it doesn't, they panic.
A visit to your gynecologist can help clear up some of the confusion. In fact, it's essential to visit your doctor before trying to conceive; you need to make sure you've had a German measles vaccine and that you're getting enough folic acid (both critical for preventing birth defects). Your doctor may also suggest testing for certain genetic diseases.
But since it's tough to get every last question answered (and sometimes even to know which ones to ask), our guide gives you the lowdown on baby-making — from the latest research to time-honored advice you can, in fact, forget.
The very first thing you need to do to make pregnancy happen is figure out when you're most fertile. According to a groundbreaking 1995 study by the National Institute of Environmental Health Sciences a woman's fertile period lasts six days: the five days leading up to, and the day of, ovulation — the time of the month, about midway between menstrual cycles, when an egg is released from one of your ovaries. What's more, the study showed that the likelihood of pregnancy decreased from about 36 percent (if intercourse occurred two days before and/or on the day of ovulation) to 10 percent (if it occurred four to six days before). Since sperm may live up to five days, even "old" sperm can fertilize an egg, although it's not as likely.
There are a few ways to time sex to correspond with when you ovulate, explains Susan Board, M.D., a gynecologist at the Spence Center for
Women's Health in Chevy Chase, Maryland. One method is to have intercourse every other day between days 10 and 18 of your cycle (counting the first day of your period as day 1), since this is the time during which ovulation typically occurs.
You can also detect ovulation by watching for changes in your cervical mucus, the fluid normally released from your vagina, says Dr. Board. "At the start of the menstrual cycle, this mucus is sparse, tacky, and dense, but around the time of ovulation it becomes increasingly plentiful and slippery, with qualities very similar to the white of a raw egg," she explains.
At-home ovulation prediction kits are also effective. The kits are much more precise than the old basal body temperature method, which involves taking your temperature every morning. And unlike the BBT method, which only identifies ovulation after the fact (your temperature is .8 degrees higher after you ovulate), ovulation predictor kits give you advance notice of about a day to a day and a half.
Still, many experts feel couples shouldn't rush out to buy these kits.
"There's no reason to get into the business of getting pregnant right away — it puts too much pressure on the process," says Joe Leigh Simpson, M.D., professor and chairman of obstetrics and gynecology at Baylor College of Medicine in Houston. "I think it's better to simply make love slightly before the time you think you might be ovulating and let the whole project be relaxed for the first months." What's more, you could be hurting your efforts. "If you've gotten to the point where you're anxious about your ability to conceive, it's time to see a doctor, who will tell you if, when, and how you need to begin testing for ovulation," says Alan H. DeCherney, M.D., chairman of obstetrics and gynecology at the University of California at Los Angeles.
It's long been thought that a man should abstain from sex for several days prior to his wife's fertile time in order to "build up" his sperm count. Part of this presumption is true — studies have shown that the more frequently a man ejaculates over a period of several days, the lower his sperm count.
But as it turns out, it appears not to matter. Although your husband's sperm count may get lower the more often he has intercourse, it's still plenty high enough for achieving pregnancy. In fact, the Environmental Health Sciences study found that the more sex you have, the greater your chances of getting pregnant.
So does that mean you need to make love every day to maximize your baby-making potential? No, says Dr. Wilcox, senior author of the study: "We found that couples who had intercourse every other day during their fertile days still had very high odds of conceiving" — specifically, a 22 percent chance of conceiving per cycle, compared to 25 percent for those who had sex every day. However, couples who made love weekly reduced their chances of conception to 10 percent per cycle, since they were more likely to miss the key baby-making window of opportunity.
For some women, the first clue to pregnancy comes in a pretty obvious form: a missed period. But others insist that, even before skipping a period, they "feel" pregnant — that is, they experience a range of symptoms including headaches, fatigue, queasiness, bloating, breast tenderness, mild cramps, a sudden return of acne, heightened sensitivity to smells and an increased urge to urinate.
"There's no reason to doubt that it's possible to experience pregnancy symptoms soon after conceiving," says Dr. Board. "After all, sophisticated blood tests can confirm a pregnancy as early as a week after conception." What many women may be feeling is the effect of human chorionic gonadotropin — the pregnancy hormone responsible for morning sickness, among other things — which may be produced a good week before you even miss your period.
Of course, the best way to confirm your hunch is to check in with your doctor, who will generally perform a blood test after you've missed a period. Or use a home pregnancy test, making sure to wait until at least day 28 of your cycle; testing any earlier could result in a false negative.
What if you're not conceiving as quickly as you thought (or hoped) you would? First, remember that if you recently discontinued use of oral contraceptives, it may take at least a month for your cycle to get back to normal. And if you used Depo-Provera for birth control, it can take up to six months to a year for you to start ovulating normally again. Smokers, especially, may find it tougher to get pregnant. In a British study of more than 17,000 women aged 25 to 39, smokers were 22 percent less likely to conceive per cycle compared to nonsmokers. (In addition, several studies have shown that smokers have a higher miscarriage rate.)
Finally, just because you conceived your first child quickly, that doesn't necessarily mean things will be the same with your second or even your third. Experts advise giving yourself a year to get pregnant if you're under 30. "If you're older, the risk of there being a problem increases, so it makes sense to seek medical advice sooner," explains Dr. Board. The age-specific guidelines: Women aged 30 to 35 should see a doctor after six to nine months of unprotected intercourse; women between 35 and 40, after six months; and women over 40, after three months.
In most instances, your gynecologist should be able to perform a preliminary fertility workup (see Trouble Getting Pregnant?). Your gynecologist may even be able to treat the problem, but if you haven't conceived under your doctor's care within six months, see a fertility specialist, who can help you take advantage of the plethora of new treatments available.
Once you're all revved up to make a baby, it's easy to become concerned if you don't conceive the first month you try. But the fact is, the chances that a normal, healthy woman regularly having intercourse will get pregnant are only 20 to 40 percent during any given cycle.
What's going "wrong" the other 60 to 80 percent of the time? "We don't really know, but it may be that the quality of the egg or sperm is too poor to allow for fertilization — or that fertilization occurs but the embryo doesn't survive beyond a few days," says Joe Leigh Simpson, M.D., of the Baylor College of Medicine in Houston. In fact, the odds that you'll conceive are actually quite good once you look at them over the span of a year of unprotected intercourse, according to data from the National Center for Health Statistics:
Your age Your chances of conceiving in a year
Under 25 96%
25-34 86%
35-44 78%
Think you know how to sort out fertility fact from fiction? See how many of these old notions you buy into.
1. Don't drink coffee. About 10 years ago, a small study drew a lot of attention when it found that women who consumed more than one cup of coffee daily were half as likely to get pregnant per menstrual cycle as those who drank less. But in the ensuing years more than a dozen studies have yet to confirm these results. "Coffee drinking in moderation is probably not something to worry about," says Allen Wilcox, M.D., of the National Institute of Environmental Health Sciences.
2. Take Robitussin. The active ingredient in many over-the-counter cough preparations — guaifenesin — has a thinning effect on cervical mucus that is purported to help sperm swim through the reproductive tract. But if you're ovulating normally, your cervical mucus becomes watery naturally — and if you're not ovulating normally, having watery mucus won't help, say experts.
3. Keep your husband out of briefs. A 1997 study conducted at Los Angeles Medical Center found that men who wore even close-fitting, polyester-lined underwear did not have lower sperm counts, thus throwing some cold water on the notion that if testicles become slightly overheated, sperm production will plummet. What can affect his sperm count, however, is smoking (just half a pack a day lowers his count by 20 percent, some studies suggest). Fever (for instance, from the flu) is also thought to have an effect.
4. Give up strenuous exercise. If you have normal, regular menstrual cycles, there's no reason to stop working out. Even athletes who skip periods don't necessarily have to stop exercising when they want to conceive. Instead, they can often jump-start their fertility by eating more and decreasing their activity level somewhat in order to resume menstruation.
How the Best Doctors Test
You don't necessarily have to make a beeline to an infertility specialist if you're finding it tough to conceive, but you do have to make sure your gynecologist does the right preliminary fertility workup. These, say experts, are three common mistakes.
Waiting too long to order tests: Many doctors tell couples to keep basal body temperature charts for six months, "which can be a waste of time," says Gary S. Berger, M.D., medical director of North Carolina's Chapel Hill Fertility Center and author of The Couple's Guide to Fertility. A good preliminary workup includes a detailed health history from both of you (your medical and sexual past may hold clues), a semen analysis, and instruction in using at-home ovulation kits (to see if you're ovulating).
Mistiming your tests: A blood test of the level of serum progesterone (the hormone that readies your uterus for implantation of the fertilized egg) should take place exactly seven days after you ovulate. A postcoital exam (a check of the quality of your cervical mucus and how well sperm penetrate it) needs to occur within 24 hours of when your lutenizing hormone level surges (see Ovulation Predictors). Too many doctors, however, still schedule these tests based on a hypothetical 28-day cycle, rather than the results of home ovulation monitoring.
Getting stuck on Clomid: Doctors prescribe Clomid if it's thought that a woman isn't ovulating; the drug stimulates the ovaries to release an egg. But if it doesn't work after two or three cycles, the physician should be looking for other solutions, says Dr. Berger. You might need the more powerful drug Pergonal or to be tested for other problems, since infertility is usually due to a combination of factors.
by Janis Graham
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