By Mary Sabatini, MD, PhD
- Having difficulty with conceiving is a very common medical problem. Approximately one out of every six couples will not be able to conceive after one year of trying. Thus any couple who has difficulty is not alone.
- Like any other medical problem, fertility troubles should not be ignored. In addition to being a problem in and of itself, fertility issues may sometimes be a manifestation of another serious medical problem. If you have been having unprotected intercourse with your partner for more than a year and have not conceived, both partners should be seen by a physician for a full physical exam and discussion of the problem.
- Taking care of yourself is essential prior to trying to conceive. Find time to get enough sleep, get a moderate amount of exercise and to cut back on alcohol consumption. Smoking can cause serious complications in pregnancy and can in fact cause issues with fertility. Thus, it is best if both partners stop smoking prior to conception. Folic acid (folate) taken prior to pregnancy reduces your risk of certain birth defects. The recommended dose is 400 micrograms which can be found in most over the counter multivitamins and prenatal vitamins. Certain medical conditions can put you at higher risk for these birth defects and may require that you take additional folic acid.
- Some over the counter medications and products can interfere with your ability to become pregnant. For example, various lubricants contain chemicals that are toxic to sperm. Another common medication that should be avoided while trying to get pregnant is ibuprophen.
- The internet can be a double-edged sword. While there is much good information to be found, there is also some that is frankly wrong. Guidance from your doctor, health care provider or non-profit like RESOLVE New England can be useful in navigating the educational resources online.
- The timing of intercourse around the time of ovulation is not quite as critically important as you may think. Certainly this is the most fertile time during the cycle; however, precision is not required during this process. Buying ovulation predictor kits can be very expensive and measuring basal body temperature can be cumbersome. If a couple is having intercourse at least two or three times a week, this should be sufficient. If a woman does not have regular, predictable cycles approximately every month, she should see a doctor.
- Unfortunately, fertility is age related for women. Despite the fact that magazines and newspapers commonly run stories about pregnancies in women over the age of 44, it is very uncommon for a woman to conceive after the age of 43 years old. Fertility starts to decline when most women are in their thirties. Social and financial pressures often can greatly influence reproductive decisions. Patients benefit from a carefully balanced and actively managed process for making these decisions.
- Fertility testing and treatment is generally very safe. Any medical test and treatment poses risks, but fortunately in most circumstances with regard to fertility, these are very rare and generally not serious, although there can always be exceptions. If you have concerns about any testing or treatments you are undergoing, ask your doctor specific questions.
- Undergoing fertility treatments can be time consuming and stressful. It is important to try to find ways to manage this stress. Despite the fact that the process can be time consuming, try to find time in your life to do things that you enjoy and focus on the things that are going well for you. If you are having difficulty managing stress, reach out to services that may be available such as a social worker or an organization such as RNE.
- Ask questions and be involved; being an educated participant in your care plan is vital to its success. Communicate openly and honestly with your doctor or team. They are there to help you.
Dr. Mary E. Sabatini is the Medical Director of the Third Party Reproduction Program and the Oncofertility Clinic of the Vincent Center for Fertility and IVF of Massachusetts General Hospital (MGH). A reproductive endocrinologist, Dr. Sabatini practices at MGH in Boston and Danvers and at North Shore Medical Center.