For many of us, we thought getting pregnant would be as easy as 1-2-3. I mean, why would we work so hard not to get pregnant if it was hard to get pregnant in the first place? There also is the fact that we live in a day and age where we are used to being in control of our lives. So it can be quite surprising and frustrating when we are ready to get pregnant and, well, it doesn’t happen in the time frame we envisioned. The older we get, the longer it can take to get pregnant. With many couples waiting longer to start their families, and with the ‘biological clock’ ticking loudly in our heads, it can be super stressful when the months pass by with out a positive pregnancy test.
We met with Dr. Don Aptekar (who started his 40th year of his Denver practice as an OB/GYN in 2016!) to find out which questions he receives the most frequently when couples are trying to conceive.
Q: What is the most commonly asked question you get from women trying to conceive?
A: That one hasn’t changed at all over the past 40 years: It’s when do I ovulate or when can I get pregnant. Which is understandable, a recent study in 2017 just concluded, "Many women, including those who had monitored their ovulation, had poor fertility knowledge and failed to identify the fertile window" (source).
My patients always try and eliminate possible reasons for why they aren’t getting pregnant. They will say something like “I’m taking cough medicine and I do this and do that…” They might want to know if they are allergic to sperm or if their cervical mucus is too thick. It’s a completely natural thing to ask, but the reality is that for the majority of my patients it all comes back to the timing of intercourse.
Q: What are the most important things I need to keep in mind?
A: Time your fertile window correctly, take prenatal vitamins and don’t drink alcohol. Most of all, try to enjoy the process.
Q: When am I most fertile?
A: You are most fertile 2-3 days before ovulation and the day of ovulation. To maximize your chance of getting pregnant, have intercourse every day or every other day 3 days before ovulation and the day of ovulation.
Q: Speaking of ovulation, when do I ovulate?
A: The biggest misunderstanding is what day my patient thinks she ovulates and how to predict her fertile window. Many women believe they ovulate on day 14 of their cycle. Day 14 is based on an average from a group of women and an estimate for a 28-day cycle. However, women have been found to ovulate on any day between day 8-20 of their cycle. Long story short, unless you have intercourse every other day (which I don’t recommend unless you and your partner are up for it), you need to use your own biological cues to figure out when you ovulate and so that you can predict your fertile window.
Q: If it is taking a long time to get pregnant, is it mainly an issue with the woman?
A: A major misunderstanding is that it is generally the woman’s fault if pregnancy is not happening, or that it because of her age. It can equally be the man's issue as it is the woman's. If you haven't gotten pregnant in 6-12 months, don't forget to get your man's sperm count checked out.
Q: Do I have a fertility problem?
A: This obviously isn’t an easy question to answer. Once a month I see someone who believes she has a fertility problem based on something she read online. And then the next month they are pregnant. Timing the fertile window, and not giving it enough time, are typically the two biggest problems.
Of course, you should always ask your doctor any time you have concerns, even if it hasn’t been the ‘recommended’ amount of time yet to get checked for fertility issues.
For women under the age of 35, the recommended amount of time you should try to get pregnant before seeking fertility treatment is 12 months, and for women over the age of 35, it is recommended to seek fertility testing once you have tried for 6 months. Please note, however, the older you are, the longer it will statistically take to have a successful pregnancy.
That said, if you suspect a problem or if you have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner.
Q: How can I know when my fertile window is?
A: Historically it hasn't been easy for women to pinpoint when they ovulate. Some of my patients track their oral temperatures on a routine basis, but I’ve found that it causes too much stress. Ovulation kits don’t work for everyone, but may work for you. I’m looking forward to when Priya launches its product to give women a stress free option for predicting their fertile window.
Click below for more information on how to find when you ovulate
Q: What medicines can I take when I’m trying to get pregnant?
A: The hardest thing for many of my patients is to make decisions about what medicines they should avoid when trying to become pregnant. I tell them no medication is approved during pregnancy and the typical next question is, “so then what should I take for my allergies?” I explain that if you really don’t need it to manage your medical condition, than don’t take it.
For example, if you get a headache, try rest and hydration. If your headache is so bad that you feel that you need to go to the ER, then you should probably take your medication. But I’m telling you, no medication has been approved to be taken during pregnancy.
If you are trying to get pregnant, and there is a chance you may be pregnant, before you take a medication ask yourself, “is this something I really need?” If it is, then talk to your doctor about your options.
Q: What about drinking alcohol while trying to conceive?
Alcohol is always a big one I get asked about. Alcohol is not recommended during pregnancy - ever. But the truth is the majority of women I see drink early in the pregnancy because they didn't know they were pregnant. Drink a little bit of alcohol and the risk is minuscule, but I’m not going to tell someone it’s ok.
My advice to you is that from time of ovulation to onset of the next period, you shouldn’t drink alcohol. That way you don’t have a big concern. We don’t understand all the risks, so it’s best not to drink.
Q: If I do need fertility testing, what tests should my doctor perform?
A: That partly depends on your situation; however, you doctor will want to know if you are ovulating, if your partner has viable sperm, and if the two can get together. To figure this out your doctor should do the following:
- Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), anti-mullerian hormone (AMH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
- Complete semen analysis for the male partner
- Hysterosalpingogram (HSG), an x-ray or a Saline Infusion Ultrasound (also called a Sonohysterogram or SHG) to evaluate if the your fallopian tubes are open
- Ultrasound to confirm the normal appearance of the uterus and ovaries
Q: What can I do to increase my chances of conceiving?
There are things you and your partner can do to help make yourself more fertile. Getting in shape will help to increase your fertility, but will also help your pregnancy and the health of your baby. Even if you do end up needing IVF or medical intervention, being healthy not only helps to increase the chances of the medical intervention working, but also can help make you feel better and less stressed.
To start with, adopt healthy behaviors. In other words, eat plenty of vegetables and fruit and stay away from eating too much sugar and processed foods. If you and/or your partner are smoking, that needs to be eliminated. That’s hard to do on your own, so I recommended asking your doctor about programs that help with that. This applies to your partner as well.
Exercise regularly but don’t go out and start training for a marathon.
Weight has a major impact on fertility for both partners, either being too skinny or overweight can impact hormone levels that effect ovulation and sperm production. Talk to your doctor about your weight to make sure you are in the ‘fertility zone’.
Also, get quality sleep and stay away from known toxins. Do things that make you feel happy and healthy to reduce stress. If your doctor agrees, you should also start taking daily 400mcg (0.4mg) dose of folic acid.
Q: What about if I have a miscarriage(s)
Check out this blog where we interviewed Dr. Aptekar on "FAQs about having a miscarriage when trying to conceive"