Waiting for that second line to appear on a pregnancy test can feel like the longest three minutes of your life. If you wait month after month with no results, it’s easy to feel demoralized. One of the most persistent and harmful myths about fertility issues is that fertility is a matter of luck. If you’re unlucky enough to have trouble getting pregnant, then it’s untreatable without costly procedures that are unlikely to work anyway.Nothing could be further from the truth. There are numerous paths to parenthood, and no right way to have a child. Indeed, many couples ultimately come to view infertility as a gift. It enables them to appreciate their child more when that child finally comes along -- whether through natural birth, artificial reproductive technology, a surrogate, or even adoption.
You can become a parent, and the journey might be much easier than you think. Here’s what you need to know, and how a fertility specialist can help you achieve your parenthood dreams.
Should You Keep Trying?
Perhaps the biggest fertility treatment challenge is deciding when to seek treatment. In general, we recommend that couples seek fertility counseling after a year of trying without any success. If the woman is over 35 or the man is over 40, consider seeking treatment after six months of trying.
But what if you’re not ready for fertility treatment? Some couples worry about the cost of seeing a fertility specialist. Others know that they are opposed to certain artificial reproductive technologies, such as IVF. It’s important to make decisions consistent with your own values, but it’s equally important to have reliable, accurate information.
Here’s the frustrating truth: Fertility inevitably declines with age. So if something is seriously wrong and you continue trying, you’re doing so as your fertility declines. Consider doing at least some preliminary testing to understand where you stand.
But what if you keep trying and aren’t getting anywhere? About 15% of couples are not able to get pregnant after a year of trying. At the two-year mark, about 10% of couples still can’t get pregnant. This means that around half of infertile couples may get pregnant with more trying. But is it worth the risk? You might be among the half who still don’t get pregnant, and then you’ve wasted another year.
How Can I Increase My Chances of Getting Pregnant?
If you’re determined to keep trying without fertility treatment, there are some things you can do to improve your chances of a pregnancy. First and foremost, educate yourself about how fertilization and implantation work. Read up on the menstrual cycle. Many couples mistakenly believe that the most fertile window is after ovulation. In reality, it’s the day before and the day of ovulation. Just a few hours after ovulation, most women are no longer able to get pregnant. So don’t miss this important window.
Some couples also operate under the mistaken assumption that ovulation always happens 14 days after the woman’s period. This is also untrue. Fourteen days is just an average. The actual day of ovulation varies from woman to woman and sometimes, from cycle to cycle. Tracking your cycle with charting and daily basal body temperature readings is one way to ensure you get the timing right. Ovulation predictor kits can also help. However, these methods aren’t failsafe. It’s possible to not ovulate and still get a positive result on an ovulation test. So if you double down your efforts and still don’t get pregnant, it’s time to see a specialist.
Although many infertile couples are perfectly healthy, fertility also acts as a reflection of overall health. Sometimes fertility issues are due to other health issues. So taking steps to promote better health may help you get pregnant faster.
Some things you and your partner can do include:
- Managing stress through therapy and meditation. Extreme stress may affect your menstrual cycle. It also makes the process of trying to get pregnant more emotionally draining.
- Get plenty of exercise. Exercise promotes a healthy menstrual cycle. It can also help you maintain a healthy body weight. If you or your partner are overweight, the odds of a successful pregnancy decrease.
- Eating a healthy, balanced diet. Avoid crash diets and very restrictive diets. Protein is especially important for your health as you try to get pregnant, so if you’re vegetarian or vegan, find ways to pump up your protein intake.
- Taking a multivitamin. This can compensate for minor deficiencies in your diet. Women trying to get pregnant should take a prenatal multivitamin that contains folate or folic acid.
- Avoid alcohol or illegal drugs. Substance abuse can cause many underlying issues. Be sure to speak up and let your doctor know if you have or have had substance issues. In order, to get the right help or diagnosis you must be as transparent as possible when it comes to your health.
- Talk to your doctor about any medications you take. Different medications can effect the body in many ways, be sure to go through any and all prescription medications you and/or your partner take with your doctor.
- Get any underlying medical conditions under control. Untreated infections are a major culprit in many cases of infertility.
- Use sperm-friendly lubricants. Traditional lubricants may damage sperm, or make it more difficult for them to travel to the egg.
Infertility Diagnosis: Choosing the Path That’s Right for You
The first step toward treating infertility is getting the right diagnosis. You might think that fertility testing is a one-size-fits-all undertaking. In reality, it’s all about choosing the path that’s right for you. You can get as much or as little testing as you want. Most doctors recommend, at the very minimum, testing the man’s sperm and doing blood work on the woman to ensure she is ovulating and to check her hormone levels.
If those tests uncover no major problems, then it’s up to you to decide whether you want to continue testing or try again for a few months. While many important fertility issues appear in the man’s sperm or the woman's hormone panels, not all do.
So if you choose to continue testing, you have other options. These include:
- Tracking and charting your cycle to gain insight into what might be going wrong.
- Imaging tests of the woman’s ovaries, uterus, and fallopian tubes.
- Physical exams of both the man and the woman.
- Hormone testing of the man.
- Other tests, as appropriate. For example, a doctor might suggest post-coital testing to see how the man's sperm behaves inside the woman’s body.
In some cases, a doctor cannot diagnose the cause of infertility. The more tests you do, the less likely this becomes. But some couples do not want to participate in endless testing. So if you end up with a diagnosis of unexplained fertility, take heart. There are still treatment options, even if the precise cause is unclear.
Fertility Treatment Options
Once you’ve undergone some testing, a doctor will help you narrow down your treatment options. In many cases, you can choose from several different options.
Some treatment options include:
- Medication to regulate hormone levels. For example, some women don’t produce enough progesterone. This can make it difficult to sustain an early pregnancy and may cause early miscarriages. Hormones can also induce ovulation in women who don’t ovulate, or who ovulate irregularly. For men, testosterone treatments may address some fertility issues.
- Medication for other fertility issues. Dozens of conditions can affect fertility, and many are treatable with medication. A man who struggles to impregnate his partner due to erectile dysfunction may improve with a treatment such as Viagra.
- Treatment for underlying infections. STDs are a major culprit in infertility. Infections may also cause chronic inflammation that weakens fertility. Medications such as antibiotics may help.
- Fertility-related surgeries. Some conditions damage the reproductive system. For example, pelvic inflammatory disease can block a woman’s fallopian tubes. Endometriosis can damage the ovaries or make it difficult for an egg to implant in the uterus. Surgery can treat many of these issues.
IVF and Other Forms of Artificial Reproductive Technology (ART)
Artificial reproductive technology is not technically a treatment. Instead, these procedures circumvent pre-existing fertility issues. The two most commonly used forms of ART are in vitro fertilization (IVF) and intrauterine insemination (IUI).
Both options can use the couple’s gametes (sperm or eggs), or can also use donor sperm if there is an issue with the man’s sperm. If there is an issue with the woman’s eggs, IVF is the better solution because IVF allows the use of donor eggs.
IVF fertilizes the egg outside of the woman’s body. The egg then grows into an embryo, and a doctor implants it back into the woman’s body. In most cases, a woman will take hormones beforehand to increase her egg production, as well as hormones to ensure her body is in the optimal state for a pregnancy.
About 25% of IVF cycles produce a pregnancy. The clinic you use can be a major predictor of whether IVF works. So ask your clinic for their success rates, and ask your doctor what your odds of success are.
IUI is a less invasive procedure that fertilizes the woman’s egg inside of her body with the man’s sperm. A doctor implants the sperm at the time of ovulation. The woman often takes hormones similar to those used in IVF. IUI has a slightly lower rate of success, but can still be an excellent option. Many couples opt to try IUI first because it’s more affordable and less invasive. If several IUI cycles fail, a doctor might recommend trying IVF.
Both procedures are excellent options for couples with unexplained infertility. They can also be good options when:
- The man has low sperm count or weak sperm motility.
- The woman ovulates infrequently.
- There are chemistry issues that cause the woman’s body to attack the man’s sperm.
- The woman has damaged pelvic organs.
When IVF or IUI fails, there may be another option: surrogacy. Having someone else carry a pregnancy made from you and your partner’s gametes (or some combination of your gametes and the gametes from a donor) is a very successful option if the woman has structural issues with her body or cannot safely get pregnant or give birth. The right fertility specialist can help you determine whether surrogacy is a viable option for you.
How Long Do Fertility Treatments Take?
If you’ve already spent months or years trying to have a baby, you probably want to spend as little time pursuing fertility treatments as possible. The truth is that there’s no “average” when it comes to fertility treatments. Here again, you have options.
Some couples want to spend as much time and as much money as it takes. Others only want to try for a limited period of time or are only interested in specific treatments.
Before you begin fertility treatment, spend some time discussing the following with your partner:
- How much you are willing to spend on an infertility specialist.
- How long you feel comfortable trying.
- Whether and when you would be willing to consider giving up.
- What you are willing to put your body through.
- Whether there are any treatments you want to avoid.
- Whether you’re comfortable using donor sperm or eggs.
When you begin treatment, it’s important to have an open, honest conversation with your doctor.
Some things to ask include:
- What do you think my diagnosis is? How long do you think it will take to get an accurate diagnosis?
- What are the odds of a successful pregnancy with this treatment and with this diagnosis?
- Can I see your success statistics for this treatment?
- What are the risks of this treatment?
- Are there any alternatives to the recommended treatment?
- Is there any possibility of pregnancy without treatment?
- Is there anything we can do to improve the chances of a successful pregnancy? Could lifestyle changes help?
After you begin treatment, have regular meetings with your doctor to discuss how treatment is progressing. This can help you decide how long you want to try, and whether and when it’s time to try another treatment.
You are Not Alone
Most couples can have a biological child with the right treatment. But not all can and there’s no shame in that. There are many ways to have a child.
It doesn’t matter how you become a parent. What matters is that you choose the path that feels right to you. At the Center of Reproductive Medicine in Houston, Texas, we specialize in helping you do exactly that. Give us a call.
We’ll talk candidly about your options and work on a plan that helps you become a parent as quickly as possible, in a way that is consistent with your values and lifestyle.