Ask the Expert Series with Dr. Don Aptekar
Finding out that you have ‘unexplained infertility’ may simultaneously be a relief and unbelievably frustrating. You may find relief in the silver lining of hope that you and your partner may not have anything wrong. On the other hand, it may be terribly frustrating to not know why you aren’t getting pregnant. Not knowing what the future holds can leave you feeling that you have no control over something that is very important to you. Whatever you are feeling, seasoned expert in fertility, Dr. Don Aptekar, understands and has helped thousands of women through this confusing time. Read the Q&A below to get the scoop on the most common questions asked by women diagnosed with unexplained infertility when they go to see Dr. Aptekar.
Q: My partner and I have been trying for years now, how is it possible to have unexplained infertility and still not be pregnant?
A: If you have been told that you have ‘unexplained infertility’ statistically that doesn’t mean it won’t happen for you. ‘Unexplained infertility’ may simply mean that your doctor hasn’t yet figured out if there is a problem or not. The only real proof that nothing is wrong, is pregnancy.
Please know that there is a mysterious side to pregnancy. I’ve had patients believe that after 3 years of trying, that they are infertile and then became pregnant. Just the other day I had a 43 year old patient who had been trying for several years find out she was pregnant with out any interventions.
On the other hand, if you are ready to take the next step and start treatments recommended by a fertility specialists, go ahead and make your appointment. While waiting to get into the clinic, which is typically a 3 month wait, make sure your timing is correct and try each month. I’ve had numerous patients get pregnant while on the waiting list.
Q: I have tried everything, timing my ovulation, LH sticks, relaxing, losing weight and I’m still not pregnant. Is there anything else I can do?
A: The answer to this question depends on your age. If you are young, take a break. The next step that will be sold to you is IVF.
If you are over the age of 38 and you’ve used ovulation prediction methods for at least 3 months, IVF is the next step.
For any age, other things you can try: it is recommended that if you have high (or low) BMI, that you work to achieve a normal BMI, reduce caffeine intake to no more than 2 cups of coffee per day (or 250 mg daily) as well as reduce alcohol intake to no more than 4 drinks per week (source).
Q: I’d like to know my options outside of a clinic that is trying to convince me to try IVF.
Try to figure out not only when you ovulate, but the 3 days before you ovulate. This is called your fertile window and is the time of the month you are most likely to get pregnant. I mentioned earlier that I had a 43 year old patient that just got pregnant. She didn’t want to use IVF and said she had been ‘trying’ for years. I talked to her in more detail about what she meant by ‘trying’ and it turned out she needed to focus more on having intercourse during her fertile window. It still took her time and patience but now she is pregnant.
If you are older, remember that you may get fewer tries each year to get pregnant. It may take you a couple of years because you may have only 3-4 good eggs in a year, rather than 12.
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Q: If they can’t find anything wrong, what could be preventing me from getting pregnant?
As I mentioned in the first question, it could be something that we haven’t figured out yet. Just keep trying or go do IVF to see what happens when fertilized. You may appear to be ovulating during the ultrasound but something else may be unexplained on the nuclear level. Sometimes it takes going through IVF to find out if there is a problem and the egg can’t get fertilized.
Make sure of the following:
- Both you and your husband are engaged in the process. It’s not the woman's problem, but a problem as a couple.
- If your husband has not been evaluated yet, make sure gets checked out and that he is fertile. With infertility, there is a 35% chance it is the male, there is a 35% it is the female and 20% chance there is an issue with the couple (and 10% unknown).
- Have you ever had an infection? If you have, make sure your doctor knows about it. Some unexplained fertility may be due to endometriosis, so confirm if you have endometriosis or not. Endometriosis will cause infertility in an insidious way.
- Egg quality may be poor. The number of quality of eggs are affected as you age. This then becomes a number game. It may take a year to two years to get that good egg.
- Timing may be off. To get pregnant, timing is everything.
Q: Why me? Why does my sister get pregnant and I don’t?
I get this question a lot and I usually answer by starting with that fact that we don't’ know the answers to many problems. For example, why do some people get diseases and other people don’t?
What I’d like you to think about is whether you have the goal of parenting or the goal of pregnancy. If you aren’t getting pregnant, there are many ways to be a parent and there are many ways to get pregnant. Sort out which one is really important to you. Or you can choose to be childfree.
If parenting is your goal and you want your own child, there are many children that need homes. Adoption may be expensive, it’s not easy, but neither is your own pregnancy. On the other hand, some people will go to the end of the earth to get pregnant. You can try an egg or sperm donor or buy an embryo. If having a biological child is what is essential to you, you can try surrogacy. No choice is a bad or good one - just try not to make yourself crazy during the process.
What is Ask the Expert with Priya? Once a month we will interview experts in fertility to get the scoop on key questions about trying to conceive.