Parenting: Preconception

When you're having trouble getting pregnant, there's that dreaded word that looms closer and closer each month you're unsuccessful: infertility. At what point are you infertile? Most doctors will tell you that for the average couple, after a year of trying to conceive with no contraception, you're placed in that category, or at least you're at the point where you should consider you might need help to make your dreams come true.

So once that infamous month rolls by, what's a couple to do?

The Time Frame
The first thing you should know is that "one year" is not the magic number for all couples. In fact, according to Dr. Larry Barmat, director of endometrial lab and donor egg co-culture at Abington Reproductive Medicine in Abington, Penn., the most important factor in determining when to seek help is age. "One year is really an outdated definition for infertility," he says. "It all depends on the couple's age," particularly the female's age.

For example, women in their mid-30s might seek the help of a doctor after six months, and women age 39 and up might only wait three months, says Dr. Barmat. In fact, Dr. William Keye, director of reproductive endocrinology and in vitro fertilization for Beaumont Hospital in Royal Oak, Mich., suggests that women age 40 and up seek the help of a reproductive endocrinologist as soon as they decide to conceive.

Also, couples with prior medical problems that may affect fertility – such as irregular or no periods in the female, prior urologic surgery in the male or current or prior sexually transmitted diseases in either – seeing a doctor sooner rather than later may be appropriate.

Jackie Meyers-Thompson, co-author of Fertility for Dummies (For Dummies, April 2003) and three-year infertility patient, sought medical help at age 36 after six months of trying to conceive. By the year mark, she and her husband had already completed an intrauterine insemination (IUI).

First Things First
When you've passed that key mark and things are not going swimmingly, there are many things to consider.

First, are you timing intercourse appropriately? Contrary to popular belief, a woman does not always ovulate on day 14 of her menstrual cycle. To be more accurate, you might check out the book Taking Charge of Your Fertility (Quill, November 2001) by Toni Weschler to learn how to monitor your basal body temperature and gauge your cervical fluid for indicators of ovulation and fertility. "Properly timed intercourse can cure a fair number of patients of infertility," says Dr. Keye.

Those methods are not an exact science, so some women turn to ovulation predictors for a more precise time frame. Ovulation predictors, both saliva based and urine based, help you determine when you are about to ovulate and give you a two- to three-day window of optimum fertility.

However, Dr. Barmat does not recommend these products, citing the fact that there is no evidence that they do anything to enhance a woman's fertility. In fact, he says using such products may even increase the couple's stress level, and they are expensive. "It's cheaper to buy a bottle of wine than a urine LH kit and have a romantic evening," says Dr. Barmat.

Couples should also run down the list of problems that can prevent a healthy pregnancy such as smoking, drinking, being over- or underweight, not taking folic acid, etc., and get these items in check, says Dr. Peter Horvath, a reproductive endocrinologist at Albany IVF in Albany, N.Y.

Choosing Your Path
Before you decide to seek help, Dr. Keye recommends you and your partner have a discussion, if you haven't already, about whether you'd be willing to consider adoption. After all, he points out, if you're going to pay the high cost of infertility, which does not guarantee that you'll end up with a baby, you might consider adoption where the money you invest definitely results in a child.

Also, for couples who are young (30 and below), have no obvious medical problems and are not in a hurry, you might consider trying for six months to a year more. A study by researchers at the National Institute of Environmental Health Sciences in North Carolina found that – unless the male was over 40 – only one in 10 couples failed to conceive in the second year of trying. On the flip side, however, according to Dr. Barmat, studies have shown that after three years of trying without success, the chances are very low that the couple will ever conceive.

Melanie Morrissey Clark, co-author of The Fertility Handbook (Addicus Books, April 2002) and mother to triplets conceived via in vitro fertilization, cautions couples not to waste time. "Get help as soon as you suspect a problem, because the woman's age is the No. 1 factor in the couple's success in conceiving and carrying a pregnancy to term," she says. "Time is your best ally if you use it wisely." She was 31 when her babies were born.

Mandy Parton, 29, of Dallas, Texas, who has been trying to conceive for two years, waited a little longer before seeking help. "We sought fertility help right after we hit the one-year mark," she says. "We saw one specialist and didn't get such a good vibe from him. We investigated adoption for a while after that, and then we returned to the 'world of infertility'..."

Other options for couples not yet ready to dive full force into infertility treatments include alternative routes, such as acupuncture. Dr. Barmat, Dr. Horvath and Dr. Keye all say if a couple expresses interest, they may refer them on to a certified acupuncturist in their area, though usually just as a complimentary treatment. In fact, a 2002 study in Germany appearing in the journal, Fertility and Sterility, found that performing acupuncture on IVF patients greatly enhanced their chances of becoming pregnant.

Meyers-Thompson says she received acupuncture treatments periodically during the three years she was trying to conceive and had a treatment during the cycle that she finally became pregnant. She found the main benefit was that it helped her relax. "It really seemed to help my disposition and helped my anxiety go down," she says.

Couples might also incorporate an activity that they find relaxing, such as yoga, visualization or meditation, into their regular routine to help them de-stress. Some studies have shown stress causes a reduced chance of pregnancy, according to Dr. Barmat.

"There's no question that there's a mind-body connection, and that certain alternative therapies can be helpful," says Dr. Horvath. He suggests that often the best benefits can be derived at the intersection of Eastern and Western medicine. But, cautions Dr. Keye, "Don't hang your hat on just [alternative treatments] and delay getting appropriate medical therapy."