Parenting: Preconception

For countless women, trying to conceive is a daily commitment that may include religiously charting their basal body temperatures, using ovulation predictor kits, taking prescription drugs or experimenting with herbal therapy.

"It is hard because for a few months I will be regular and it makes it easy, and then I go four months without a cycle and it makes it very difficult," says Laura Wedeking of Bryan, Texas, who dates her "erratic" cycle back to her teenage years. "It is really annoying when I have a cycle three months in a row and I am regular and I don't end up pregnant, and then I go for three months without one and still nothing."

"I get extremely frustrated," says Laura Pita, a Norwalk, Conn., resident whose cycles have ranged from 35 to 42 days in length. "By the time I have finally ovulated, other women are on to new cycles or have had the almighty positive test."

Pita says she never thought much of her long cycles until she and her husband began trying to conceive. "When I was a teenager, I loved the fact that my cycles were long," she says. "And I'll probably like it again once we've had a baby, but right now, I just get disheartened. We've been trying for nine months, but I just started my seventh cycle."

For women with consistently irregular cycles, achieving pregnancy can be difficult, but not impossible. "Many times, all you have to do is correct the cycle," Dr. Bayer says.

A specialist can provide the best care for these women as they try to conceive, says Dr. Kenneth Gelman, a reproductive endocrinologist with the Center for Endocrine and Diabetes Care in Hollywood, Fla. "There's very good medication for women with these problems," Dr. Gelman says, adding that irregular cycles are the most common problem he deals with every day.

Causes of Irregular Cycles
Who has irregular cycles, and why? Dr. Bayer says these women typically fall into one of three categories:

• They're athletes or have reduced body weights. Diet and exercise may alter hormones, leading to cycle irregularities.
• They're experiencing impending ovarian failure, which often signals the onset of menopause. The average age of menopause is 50, but it can occur much earlier.
• They have chronic anovulation, meaning they don't ovulate and may or may not have periods, or anovulatory bleeding. Women who are overweight, are pre-menopausal, show signs of overproduction of male hormones or who have certain medical conditions often are anovulatory.

Melissa Allen of Apache Junction, Ariz., had been trying to get pregnant for a year when she was diagnosed with polycystic ovarian syndrome. Symptoms of the syndrome, which affects an estimated 6 to 10 percent of all women and is a leading cause of infertility, include irregular periods.

"When we started trying to conceive, I really thought nothing of my irregular cycles," Allen says. "I didn't know a thing about anovulation and was sure that if you menstruated then you had to ovulate. I was devastated when I learned that wasn't the case. [The PCOS diagnosis] was the explanation for my irregular cycles but it certainly didn't give me any peace."

How Specialists Help
A reproductive endocrinologist or obstetrician specializing in infertility can assist a woman with an irregular cycle in a number of ways, depending upon her situation.

"With impending ovarian failure, the overall chances (of conception) are reduced – there's not much that can be done," Dr. Bayer says. "With the other two categories there's a very good chance of success with treatment."

Specialists check a woman's thyroid as well as follicle stimulating hormone (FSH), which drives the menstrual cycle. If her cycle needs to be regulated, Dr. Gelman says he might initially prescribe a birth control pill. Prescription drugs such as Clomid, which induces ovulation, also might be explored.

Physicians may recommend using ovulation predictor kits, which Dr. Bayer acknowledges are expensive and frustrating for women with irregular cycles.

Albany, N.Y., resident, Alisa Labunski, whose cycles are anywhere from 32 to 52 days long, tried ovulation predictor kits, but found it difficult to know when to begin using them. "They only come with five days' worth, and since my cycles vary so much, I often use them all and never see a positive," she says.

An Emotional Roller Coaster
Allen takes the prescription drug Provera to induce menstruation and Clomid to trigger ovulation. She also charts her basal body temperature "each and every morning."

"And at the end of every cycle, I feel like a failure," she says. "I guess that's the best way to sum it up. Getting pregnant, in theory, is such an easy thing to do, so why can't I?"

Christie Nielson can relate. The Utah resident and her husband, who easily conceived their son nearly eight years ago, have been trying for a second child for 18 cycles. She began experiencing irregular cycles after going off the birth control method Depo Provera, which she took for more than four years after the birth of her son. Months of taking Clomid, tracking her temperatures and using ovulation predictor tests with no success haven't been easy, she says.

"As for my emotional well-being and that of my marriage, my inability to get pregnant has really taken a toll," she says. "I have become really depressed the last several months and am getting really discouraged as all of my friends and coworkers become pregnant the first time they try."

Dr. Bayer empathizes with women like Allen and Nielson who struggle month after month. But while some couples seemingly have no problem conceiving, he points out that even in the most ideal situation – both partners are healthy and have no reproductive problems – there's only a 15 to 20 percent chance of success each cycle.

"The reproductive system is very inefficient," he says.

Nielson realizes she's not alone, which is why she and her husband created a Web site to share their story and offer support to others. "So far we have had a wonderful response and I have made many friends with other women who are in the same situation as I am," she says. "Our business has been therapeutic as well as successful."

Wedeking, who had a successful pregnancy despite irregular cycles, offers this piece of advice to women who are discouraged: "Just keep trying and keep your hopes up. It is possible and don't ever think of yourself as broken because it took me a long time to figure out I wasn't broken, and there are other women out there going through the same thing. Keep your hopes up."