Why can't I get pregnant?

I know it's taken a year to finally start writing but my plan is to pick a topic each month or so and give you some advice, and maybe a little science about these things. Some of the topics will be my "most asked questions"(how can I lose weight?), some will be an opportunity for me to vent about misconceptions out there (if I raise my arms above my head will the cord wrap around my baby's neck?) , some may even be for fun (what's the worst phone call I've received on call). I'm not going to pretend that I know everything. And while I will do some research on these topics I'm not going to present a review of the literature on each topic either. I want this to be practical and easy to understand. Something you can take away and use. So here goes....

My first topic is about trying to get pregnant. This is one of the most trying times in many couples lives. We're already going to assume that you are in agreement with your spouse about even getting pregnant. There are some many pschological complexities about conception but I'm not really going to talk about those here.

There are three things you need to get pregnant: an egg, sperm, and a happy meeting place. Let's start with the egg. If you are having regular cycles (every 25-35 days) you are probably ovulating. Ovulation should occur around 14 days from the start of your period. Some women will feel the ovulation as a pain on one side, most women will get a watery, clear discharge with ovulation. Some women will even spot a little with ovulation. If you still aren't sure, you can do a temperature chart (BBT chart) by taking your temperature every morning before you do anything else. After ovulation your temperature should rise by a 10th of a point or so. These charts can be difficult to read but if you drop one by I can look at it for you. Lastly, you can use an ovulation predictor kit that you buy over the counter. These are actually pretty good at identifying ovulation. You must have a negative reading before you have a positive reading for it to be accurate. If you test is "alway positive" you are not ovulating. Occassionally you think you are ovulating around day 14 and so you always have intercourse then, and after doing some testing you find you ovulate day 17 and you've been missing the timing all along!

So let's say you can't identify any ovulation. You're periods come every 3 months, or maybe even every 2 weeks. If you are not ovulating you will not get pregnant. Occassionally someone will only ovulate every 3 months or so. These are women who may take years to concieve and then suddenly it happens. Regardless, if you can't identify ovulation that is when you come in and talk about ovulation induction. This involved medication that will encourage your ovaries to prepare and ovulate a follicle. There are risks to this-including twins/triplets, but it tends to work fairly well. The details of ovulation induction will have to be given at another time.

Sperm. Lots of sperm. While it only takes on to fertilize an egg, it takes millions to get the one to the right spot. 40% of infertiliy is male (40% is female and 10% have both). So, if you are ovulating regularly and having timed intercourse and you are still not pregnant in 9-12 months, a semen analysis should be done. This is a simple test and fairly inexpensive. A sample is given to the lab ( I have a specific person who does them in my office) and they will look at the sperm counts, as well as seeing if there are abnormalities (sperm with two heads etc). If the counts are good you husband is off the hook. If they are low he will need to see a urologist to see if there are ways to increase it. As a man makes sperm all the time many things can temporarily influence his count. If he is an avid biker, if he wears tight pants, if he sits in hot tubs all the time, even a cold or flu can affect counts for awhile. He may also have a hydrocele or vericocele in the testicle that can influence counts. If he has borderline low counts we can often try intrauterine insemination (IUI) here. If the counts are low the only way to concieve is through a process called ICSI done along with IVF in Salt Lake.

Happy meeting place. The uterus is the meeting place and has to be of normal shape and size. There are some developmental abnormalities that may cause the uterus to have a septum or for half of the uterus to be missing and these can cause infertility or miscarriages. The tubes have to be open. Tubes can be blocked from various reasons-usually an infection but sometimes just developmentally as well. The cervix has to be accepting of the sperm. There can't be any antibodies or other things that may kill sperm as they try to swim up. There are many theories about cervical problems. Most are unproven and few have any treatment except doing IUI. Lastly, there can't be any outside influences, specifically endometriosis. Endometriosis is when the normal lining of the uterus grows outside of the uterus. We are not sure how this causes infertility but it is believed that it "poisons" the embryo in a way. It is usually symptomatic beforehand by causing crampy, painful periods, painful intercourse, bowel symptoms with your periods etc. The only way to diagnose endometriosis is through laparoscopy (surgery) but it can be suspected just by symptoms and your exam.

Remember though, only about 20% of couples concieve each month. You are not considered infertil until after 1 year of trying. If you have a clear problem, like no periods on your own, seek help earlier, otherwise try and document ovulation and do worry too much. Sometimes it happens when you least expect it. Take your prenatal vitamins or folate if you are trying to concieve. If you are on medications or have medical problems your should probably be seen before you get pregnant. Stay healthy and happy trying!