If you're having trouble conceiving, you're not alone – chances are someone you know is having trouble too. Fertility problems are on the rise in the United States. As of the CDC's 2010 National Health Statistic Report, 1 in 6 American couples have trouble getting pregnant or sustaining a pregnancy compared to 1 in 10 couples in 1990. Most women spend decades of their lives trying to avoid pregnancy. When they decide to conceive, many women are surprised and frustrated to learn that it’s not so easy for them to get pregnant after all.“Many of us conflate our self-worth with our ability to reproduce, so we perceive failure to conceive as a central failure to our personal identities as men, women, husbands, and wives.”A couple is generally diagnosed as "infertile" after twelve months of unprotected intercourse without conception. "Infertile" is more than just a label – this diagnosis can have a powerful impact on individuals' personal identities and self-worth. Virtually everyone who experiences fertility problems perceives them as stressful, and research has found that couples suffering from infertility experience greater interpersonal conflict. Common themes recur in psychological research about infertility: many of us conflate our self-worth with our ability to reproduce, so we perceive failure to conceive as a central failure to our personal identities as men, women, husbands, and wives.
About 30 percent of infertility cases are due to female problems such as ovulatory failure, tubal damage, and endometriosis, and another 30 percent are due to male problems such as low sperm count. The most common cause of infertility, however, is simply "unexplained," meaning doctors can’t find any specific medical problem impeding conception.
A large number of couples with unexplained infertility may not actually be infertile at all; they may simply be mistiming intercourse for the woman’s most fertile phase. A growing body of evidence suggests that fertility problems may be exacerbated due to poor recommendations from doctors and a widespread ignorance of female fertility.
Mistake #1: Use Calendar Methods
Doctors most commonly recommend calendar methods as a first-line treatment for couples having trouble conceiving. Calendar methods involve timing intercourse based on the statistical average day of ovulation. This usually means assuming ovulation will occur on day 14 of the menstrual cycle.
In reality, only a minority of women ovulate exactly on day 14. Telling couples to time intercourse for day 14 may actually do more harm than good for a large portion of women. Women's cycles vary, so while some women may ovulate on day 14, others may ovulate as early as day 8, late as day 22, or even later. Timing intercourse for the statistical average ovulation day rather than the woman’s actual ovulation day may cause couples to systematically mistime intercourse. For these couples, a narrow focus on day 14 may decrease odds of conception dramatically or even make conception impossible.
Mistake #2: Rely On Ovulation Predictor Kits
Ovulation Predictor Kits (OPKs) detect the surge of the luteinizing hormone (LH) that is present in urine associated with ovulation. Many couples use OPKs to help identify when the woman may be most fertile. However, OPKs may actually be misleading for a variety of reasons.
On average, the LH surge the OPKs detect occurs about 24 hours before ovulation, but the timing of the surge may vary from about 16 to up to 48 hours. Because the most fertile days of a woman's cycle are actually a day or two before ovulation, timing intercourse according to the results of an OPK may actually cause couples to miss the most fertile days of the cycle. For many women, the time of highest probability of conception may have already passed by the time the LH surge is detected.
There are a host of other reasons why OPK results may be unreliable as well: some women's LH levels may peak below the threshold that the kits test for, while others (particularly women who are approaching menopause) may have high enough levels of the hormone to cause false positives. Many women also experience false peaks of the LH hormone days before ovulation actually occurs, which may also result in false positives. Relying solely on OPKs is not the most reliable way to increase your odds of getting pregnant.
Mistake #3: Over-prescription of Clomid
Clomid (clomiphene citrate) is one of the most commonly prescribed fertility drugs. Clomid works by stimulating egg development in the ovaries to encourage ovulation. However, the drug also has an unwanted side effect that can drastically reduce a woman's likelihood of getting pregnant – it can dry up the cervical fluid necessary for sperm to reach the egg.
“Women are often prescribed Clomid before they know whether they're ovulating or not, meaning that women who are already ovulating are being treated for a problem they don’t have.”Women are often prescribed Clomid before they know whether they're ovulating or not, meaning that women who are already ovulating are being treated for a problem they don’t have. Not only is this a needless expense and hassle, the drug may actually harm these women’s chances of conceiving while using it. Clomid should be an informed decision rather than a routine first-line treatment for infertility.
A Solution That Works
Infertility can take a hefty emotional and financial toll on couples, and the longer it takes to conceive, the bigger the impact. The most efficient and cost-effective way to overcome infertility is to rule out the possibility that simple mistimed intercourse is standing in the way of conception.
Fertility Awareness is a simple and inexpensive daily practice that involves monitoring your fertility signs to detect when ovulation is approaching. These fertility signs include basal body temperature, which is your waking temperature throughout your cycle, and cervical fluid, the slippery fluid your cervix secretes as ovulation approaches.
“Fertile couples using cervical fluid monitoring to achieve pregnancy have a 90% chance of conceiving after three months, while couples who do not use fertility awareness to conceive have only a 54.5% chance of conception by three months.”Simply having sex while your body is producing fertile cervical fluid doubles your chance of conceiving that cycle. Fertile couples using cervical fluid monitoring to achieve pregnancy have a 90% chance of conceiving after three months, while couples who do not use fertility awareness to conceive have only a 54.5% chance of conception by three months.
Fertility awareness may also allow couples to identify simple and early hints at cycle irregularities that may impede conception, such as a short luteal phase or anovulation. Diagnosing these issues allows couples to have more informed conversations with their doctors and make educated decisions about treatment options.