When couples are first starting out on their journey to parenthood, many will be delightfully surprised at how quickly they conceive. However, for others it doesn’t happen this way and they find themselves questioning their own fecundity, not to mention many phone calls from concerned family members.
Approximately 85% of couples will achieve pregnancy within the first year of trying to conceive. A majority of these pregnancies will occur in the first six months.
When you are first trying to conceive it’s normal to not consider timing of intercourse with ovulation. Regular unprotected sex twice a week is sufficient for conception. If you have not conceived after 3 or 4 months (assuming that menses are approximately once a month), then using an ovulation predictor kit (OPK) that can be bought at any pharmacy is a good idea. I am a fan of this OPK because of its ease of use. Some women will start checking an early morning temperature for signs of ovulation, but I find that the restrictions on when and how the temperature should be taken to be cumbersome.
For many women it is recommended to undergo a fertility workup after 6 unsuccessful months. If a woman is under the age of 35, it is reasonable to wait for one full year without conception prior to starting a medical evaluation.
An initial fertility evaluation will include testing for both the female and male partner. Because this can be very stressful for any couple, having both partners present during the initial office consultation is ideal. It is helpful to bring a record of your menstrual cycles, including dates of suspected ovulation, along with a list of current medications, a record of any new medical problems or surgeries and any pertinent family history.
The initial fertility evaluation may include:
- Blood tests done in conjunction with your cycle on either cycle day #2 or 3 for ovarian reserve and then on cycle day #21 for a luteal progesterone level
- Other hormone levels, such as thyroid and prolactin
- Semen analysis
- Pelvic ultrasound to check for ovarian cysts or uterine fibroids
- Hysterosalpingogram (HSG) to check for fallopian tube damage
- In some couples, diagnostic laparoscopy or hysteroscopy may be recommended
During this time, it’s also a good idea to make lifestyle modifications such as smoking cessation, decrease alcohol consumption, start regular light exercising and find ways to reduce stress.
If a cause for infertility has been identified, then therapies can be instituted to correct the underlying issue. If no issues are identified, couples are frequently given the option to try simple medical therapies such as superovulation with Clomid or intrauterine insemination. For more complicated cases or couples who have failed early therapies, then the next step may be to visit to a fertility specialist who can offer more advanced options such as ovulation induction with injectable hormones and in vitro fertilization.