Today, Parents Ask expert Dr. Jason Rothbart tackles a big question from a concerned reader regarding infertility:

Q: I got pregnant with my first child almost immediately. But am starting to worry that it's not going to be that easy again as we've been trying for a few months already. On average, how long does it take to get pregnant? How do I know if I have fertility problems?  At what point should I see a fertility specialist? What things should I do first (ovulation kits, temperatures, different positions, etc.)? Please help!



Whether or not there will be fertility problems is one of the biggest anxieties a couple can face. But for any couple who wants to concieve: Before any monitoring, any charting, any crazy positions are tried, it's important to remember to just go for it the old fashioned way first, 2-3 times a week. With no underlying issues, after 3 months of trying, 50% of couples will get pregnant; after 6 months, about 75% will get pregnant and by one year, 95% of couples will have gotten pregnant. The most difficult aspect of this is that for a woman's entire sexual life leading up to this point, everytime she has sex, at least somewhere in her brain is, "I hope I didnt just get pregnant!" And when that switch is turned, and she and her partner are ready, even a day of waiting for pregnancy feels like a lifetime. But the truth is, things have to line up just right, and even if everything is perfectly normal, it may take a few months or longer. The definition of true infertility is trying for one year without success.

 

But if age is an issue (Fecundibility, or the chance of getting pregnant in a given month, starts to decline at age 30 and very much so over 40), then waiting an entire year may just be too long for comfort. The first thing a woman can do is track her ovulation. This can be done following temperature or cervical mucous, but there is a lot of variation with those methods and the most foolproof way to monitor ovulation is with an ovulation kit. For if she is not ovulating, ie releasing an egg, nothing else will matter. Furthermore this will enable "Timed Intercourse", which means having sex at the optimal time (about 12-36 hrs before ovulation, which is when the ovulation kits turn positive) to ensure that "the sperm is waiting for the egg." The ovum or egg is able to be fertilized for only about 8-12 hours, whereas the sperm can fertilize an egg for up to 4-5 days.

 

If well-timed intercourse doesnt result in pregnancy, the next step can be to have her physician do lab tests which indirectly tests the quality and quanitity of good eggs that are being ovulated, as well as testing that ovulation is occurring at an optimum level. We can also check an xray test (hysterosalpingogram or HSG) to see if her tubes are open, and the male partner can have a semen analysis, as male factor infertility makes up a much larger proportion of infertility than people realize.

 

If all of these tests are normal and a year has gone by (or shorter if age is an issue), then a diagnosis of unexplained infertility can be made. There are a few different treatments and methods of dealing with this, and discussing them with your primary obgyn is appropriate (clomid, artificial insemination etc.) If there are specific problems that are found (blocked tubes, abnormal sperm, ovulatory problems not fixed with clomid), it may be time to see an infertility specialist.

 

As always, any woman or couple planning on starting a family can benefit from a pre-conception counseling visit with her obgyn. This visit helps to map out a plan and also allows the woman to take steps to optimize her health for a future pregnancy (start prenatal vitamins, change diet if necessary, stop certain medications if necessary etc.)