Problems Getting Pregnant

A quick look at pregnancy

Problems getting pregnant can occur due to a number of factors, including those unrelated to proper function of a couple’s reproductive systems, such as frequency of intercourse, overall health, age and lifestyle of both partners.
Couples can maximize their chances of getting pregnant prior to trying medical infertility treatments by having intercourse every three days around ovulation (and more often actually doesn’t hurt, but also doesn’t seem to help according to research). They can also make lifestyle changes affecting weight and overall health.
Couples also need to consider the risks after becoming pregnant for both the mother and the developing baby.

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Understanding sex & conception

Trying to conceive shouldn’t be left entirely to luck. A good understanding of the male and female reproductive systems, particularly the female menstrual cycle, can make all the difference in a couple’s success conceiving.

In order to conceive, the woman’s ovaries must release an egg to be fertilized by the man’s sperm, which must be present at the proper time. An egg is fertilized in one of the fallopian tubes, then the resulting embryo travels to implant in the uterine lining where it develops into a fetus during pregnancy.

Eggs are released by the ovaries once each menstrual cycle; this is known as ovulation. Menstrual cycle lengths vary but generally range from 21-35 days and most are roughly every 28-30 days. Ovulation typically occurs two weeks before the start of the woman’s next period but cycles vary and are hard to predict. After leaving the ovary the female egg is only viable for 12-24 hours, while the male sperm is viable for up to five days. In theory, it’s ideal to have unprotected sex on the day of, or up to two days prior to, ovulation in what is known as the “fertile window,” though pregnancies can occur with a single act of intercourse up to five days prior to ovulation.

Natural fertility can be optimal during certain days during the menstrual cycle. But despite the popularity of ovulation tracking, it can be difficult to track exactly, and there is little proof that ovulation monitoring itself increases the chance of conceiving.

But there are a number of ways to monitor ovulation, including:

• Urine analysis kits that measure the level of luteinizing hormone (LH predictor kits)
• Smartphone apps that calculate approximate ovulation dates as a woman would on a calendar
• Tracking changes in cervical mucus
• Measuring basal body temperature that may rise after ovulation (but this will only indicate ovulation after it has already occurred).

Irregular menses, which are not uncommon for women, or a lack of menses should be evaluated medically.

Related Information: Female Fertility Testing

Starting with sex: Increasing the chances of getting pregnant

When it comes to intercourse with the intent to become pregnant, the two big questions are how often and how should it be done?

How often. There is a myth on the internet that one should have sex as many times as possible in order to conceive. However, a New England Journal of Medicine study showed that if women had sex once on the day of ovulation, one day prior or two days prior, there was no difference in the pregnancy rates. The same article showed no difference between 1, 2, 3, 4 or 5 acts of intercourse in that window for the chance of becoming pregnant. For this reason, if a couple is trying on their own, having sex every 72 hours (roughly) around the time of ovulation should maximize their chances without needing LH predictor kits, basal body temperature charting, etc. However, all of this assumes that the guy has sperm, the woman has eggs, that they can meet in the fallopian tubes, and that the uterus is healthy for sustaining a pregnancy.

How should it be done. There are a number of rumors and myths about conception but there is little evidence that doing such things as trying certain sexual positions or maintaining a prone position for a period of time after intercourse will improve the likelihood of becoming pregnant. Even though a woman’s climax might help transport sperm, there is no proof that a climax (orgasm) can improve the chances of pregnancy.

Some lubricants affect sperm survival and motility (movement) such as K-Y Jelly, and some types of Astroglide. Despite the rumor that these make sperm more slippery, helping them get where they need to be, the reality is that many lubricants are spermicidal (i.e. kill sperm). If one needs or prefers to use a lubricant, the American Society for Reproductive Medicine (ASRM) suggests mineral or canola oils or hydroxyethylcellulose-based lubricants, because they do not have the same effect on sperm.

Personal lifestyle practices for healthy fertility

Diet

A healthy, well-balanced diet is beneficial for both men and women. There is little evidence that particular diets like vegetarian, low-fat, vitamin enriched diets, or herbal remedies improve fertility in the general population. For women with polycystic ovary syndrome (PCOS), a low carbohydrate diet can improve symptoms and fertility.

Alcohol and large amounts of caffeine are best avoided when trying to conceive, as they can have a negative impact on fertility. Alcohol’s effect on female fertility is uncertain, but it is associated with birth defects, and there is an association between high levels of caffeine (four or more cups of coffee daily) and an increased risk of miscarriage.

Women attempting to conceive are also encouraged to add a folic acid supplement to their diet to reduce the risk of certain birth defects.

Exercise

Moderate exercise can help increase the chances of conceiving, and can also effectively reduce stress, which has been shown to interfere with ovulation.

However, too much strenuous exercise can impact ovulation. It’s important each person check with a physician to determine the appropriate amount and intensity of activity.

Weight

Underweight, overweight and obese women can experience decreased fertility, often due to changes in ovulation associated with weight.

Diet and exercise can help moderate the effects of weight on fertility in both women and men, whose sperm count and quality are influenced by weight.

Smoking and medications

Both partners should quit smoking tobacco products, which have a proven negative impact on fertility for both men and women. Use of other recreational drugs is also highly discouraged due to the studied prevalence of birth defects.

Before attempting to conceive, it can be useful to discuss any medications currently being taken with a doctor. Couples should also make sure that all immunizations are up to date.

Pregnancy complications

After a woman reaches the first goal of conceiving, there are still a number of possible complications that can occur. To reach the next goal of a healthy pregnancy, it’s good for women to know the signs and symptoms of pregnancy complications so they can be prepared and know when to seek help from a doctor.

• Anemia – A condition where the number of healthy blood cells is below normal, causing the person to feel tired, weak or faint. Many people have anemia, and it can also occur during pregnancy. It can be treated by taking iron and folic acid.
• Depression – Depression can be experienced by women prior to, during or after pregnancy. Marked by feelings of intense sadness, irritability, changes in appetite and thoughts of harming oneself or the baby, depression can be treated through therapy, support groups and with medication.
• Ectopic pregnancy – The fertilized egg needs to implant within the lining of the uterus for a healthy pregnancy. However, an ectopic pregnancy occurs when the fertilized egg (embryo) implants elsewhere, usually in the fallopian tube. The embryo cannot develop properly outside of the uterus and poses a great risk to the health of the mother (including putting her at risk for death). Severe abdominal pain, shoulder pain and vaginal bleeding are symptoms. An ectopic pregnancy must be ended due to the severe risks to the mother.
• Gestational diabetes – Some women experience extremely high blood-sugar levels during their pregnancy, known as gestational diabetes. Pregnancy-related diabetes can usually be controlled with a meal plan, while some women require insulin. Gestational diabetes can increase the risk of preeclampsia and early delivery.
• Preeclampsia – This condition that causes high blood pressure during pregnancy. High blood pressure, swelling of hands and face, stomach pain, dizziness and headaches are all symptoms. Medicine may be administered to prevent the mother from having seizures, but the best solution for preeclampsia is delivery.
• Hypermesis gravidarum – Hypermesis gravidarum (HG) is best described as an extreme form of morning sickness that can cause severe dehydration, fainting and fatigue. HG can cause such severe and frequent vomiting that the woman must be hospitalized.
• Miscarriage – An estimated 10-20 percent of pregnancies end in miscarriage, which is defined as a loss before 20 weeks. In most cases miscarriage occurs naturally and cannot be prevented. Vaginal spotting or bleeding is not uncommon during a health pregnancy but can also be a symptom of miscarriage.
• Infections – Viral infections such as the flu, or bacterial infections such as a urinary tract infection can be harmful to pregnancy and to a developing baby. Hand washing, safe sex, avoiding certain foods and cooking approved foods thoroughly can help prevent illness. It’s helpful to discuss diet and food restrictions with your doctor. Prior to becoming pregnant it is important to get tested for sexually transmitted infections, as they can cause preterm labor, stillbirth and low birth weight.

Next steps: Consult Positive Steps Fertility about getting pregnant

If you have struggled to conceive, it may be time to seek out a specialist. Fertility experts recommend seeking a specialist after a year of unprotected intercourse without pregnancy (six months for women 35 and older). Twelve months of uncertainty is difficult, so frustration and personal distress before a year can also be reasons to schedule a fertility consultation.

At Positive Steps Fertility, we treat you like family as we help you build yours. Call us or contact us online to get the help you need.