It’s no secret that many couples struggle to conceive. While this used to be a topic barely anyone discussed, thanks to the incredible community of women and healthcare professionals the world of fertility is becoming much more open and transparent.
It is estimated that 1 in 8 couples in the U.S. struggles to get pregnant or sustain a pregnancy. As an OB-GYN, my office is usually one of the first stops for a woman when she thinks something may not be going according to plan and she begins to face fertility problems.
Often times, when a patient comes to me with an issue related to fertility or pregnancy struggles, it’s actually the first time I’m meeting that person. Naturally, they’re anxious and typically meet me with a nervous smile and some hand wringing. (I don’t blame them; they’re about to talk to a total stranger about something incredibly intimate and sensitive). She’ll look at me and share that she would like to understand why she and her partner haven’t been able to conceive. It’s clear to me every time that it’s a difficult conversation, and that it has taken a lot of courage and strength to make this appointment at all.
I reassure her that she is in the right place and that I will be able to help her start this journey. Although I’m not a fertility specialist, I am a gynecologist, and I can help figure out some of the “why” behind fertility issues. It’s all connected. There are a variety of questions that I will ask when chatting with a woman for the first time about infertility:
How long have you been trying?
There are time frames we as gynecologists look at when a couple is trying to conceive. Sometimes, it can seem to couples who are struggling to conceive that everyone around them is getting pregnant just by glancing at each other! You may even think that these couples got pregnant the minute they stopped using contraception. In reality, some do, but most don’t.
In a couple that is considered to have “normal” fertility, we believe that the couple has a 20% chance of conceiving per menstrual cycle. In women under the age of 35 years old, we believe that if they have been trying to conceive with their partner for a year and have not been able to conceive, it is time to see a doctor regarding fertility. In women over 35, we shave that down to six months. During this time that the couples are trying to conceive, it is important they were in the same geographical area and are having sex regularly during a woman’s most fertile time, which is when she ovulates.
Have you been tracking your period?
This is important. The normal menstrual cycle should be between 21-35 days. Every woman should track their periods to get an idea if their cycle falls within that range. I recommend using a menstrual tracking app (I like the Clue and Flo apps), so you can get an idea of your most fertile time, which is when you’re ovulating. If you track your period and notice that your periods are more frequent or more sporadic, then you will have some valuable information to give to your gynecologist and your fertility specialist in order to narrow down some reasons why you may be having difficulty conceiving.
Do you have any medical conditions?
Underlying medical conditions like thyroid issues, diabetes, and prior history of sexually transmitted infections could affect your fertility. It is important that we know about these things. Knowing about your medical conditions and making sure that they are properly managed and treated can improve your chances of getting pregnant, but also give your gynecologist and fertility specialists valuable information to work with in order to make sure that you are in your absolute best health to carry a baby.
What medications or supplements are you taking?
It is important for your doctors to be aware of all medications and supplements you are taking to ensure there is nothing you are ingesting that could be harmful to a pregnancy. There are some medications to treat high blood pressure or seizures, for example, that are not recommended to take during pregnancy. It is good to know about these medications in advance and, if need be, change to medications that are better suited for a growing pregnancy.
In addition, I would make sure that you are taking a key supplement – a prenatal vitamin! The best time to start taking a prenatal vitamin is before you conceive because even before you know that you are pregnant, your growing baby needs all of the additional vitamins and minerals that a prenatal vitamin provides to ensure healthy organs. In that same vein, limiting your caffeine intake to less than 200mg per day and alcohol to less than 3 drinks per week will also ensure that you are at your best health for a pregnancy.
What types of things do you do to destress?
Stress is everywhere these days. Modern life brings many different stressors with work and family that can have a negative impact on your overall health. Throw the inability to conceive into the mix here, and you’re layering on a whole additional level of emotional angst which can cause your body to release a variety of hormones, like cortisol, that can make it even more challenging to get pregnant. Finding a great way to destress, like yoga, meditation, running, or dancing can really help you decrease these hormones that can have a negative impact on your fertility. These activities can also give you a great way to manage your stress when you conceive and later when taking care of your child!
With the information that I gather from this initial consultation, I will then use it to help come up with a fertility plan to help my patients. The closer my patients are to having most of these answers and health issues in order, the closer we can get to a couple’s goal of having a baby!
Heather Irobunda, MD, FACOG is an Obstetrician-Gynecologist based in Queens, New York. You can learn more about her background and get in touch with her here!