If you’ve been trying and hoping to get pregnant for awhile, you may be wondering if you’re missing something. Do you really have to go and see–well–someone like me? In fact, when is it time to see a fertility specialist?
1. How long have you been trying? If you’ve been having fairly regular sex without using any birth control for less than one year, these ideas may benefit you. However if you’ve been trying for more than a year (more than 6 months if you have irregular periods or are older than forty), then you are better off to stop fooling around and make an appointment with a board-certified reproductive endocrinologist.
2. How are you timing intercourse? Basal body temperature charts are old-school but can still be helpful in timing intercourse and determining if your cycles are normal. Smartphone apps and websites abound for doing this and you use a digital thermometer. The good part about the BBTC is that it creates a record of your cycle that can be helpful in diagnosing your fertility issues. Does the charting go up and down? Is the rise a single peak that goes down again or does the temperature remain elevated for 10-14 days like it should? These can be signs that you have problems with your ovulation and you should see a doctor to sort it out. The bad part of temperature charting is that once the temperature rises, you have already ovulated and you need to get busy PRONTO. It’s also a pain in the neck to do. It’s a very fussy test where a lot can interfere with the reading including talking, timing, eating, drinking and moving.
A better option is the ovulation predicition kit. These vary in quality. The best I’ve found to date is the ClearBlue digital kit, which is easy to read and to use and is accurate. You start testing about the 10th day of your cycle if your cycles are between 25 and32 days and continue testing once a day until you see a smiley face. This cheerful little icon tells you it’s time to try for a baby and is much easier to interpret than the darkness of the blue line. Once you get the smile, stop testing. Save the test strips for another month if you need them.
There is a test available for checking the estrogen in saliva. This is a tiny microscope to help you see estrogen crystals in your saliva. As the saliva dries on a slide, it creates crystals that look like fern fronds under the microscope. High estrogen levels are an indicator that ovulation is approaching and can suggest that the next few days to a week are a good time to try to get pregnant.
Another test of estrogen levels is the cervical mucus. There are a lot of complicated protocols available for this but basically if you have a sticky egg-white like discharge when you wipe, you’ve got good mucus. This doesn’t predict the actual day of ovulation, but like the fern test it lets you know that your levels of estrogen are high, which goes along with a ripe, ready-to-ovulate egg.
3. How healthy are you? Planning to conceive is the perfect time to optimize your health. Smoking, drinking and drugs are all bad for you. They are bad for your partner too. Shocker! They are also all bad for getting pregnant, and bad for your baby once you conceive. I’ve have many patients tell me they plan to quit smoking as soon as they get pregnant. They are missing the point that the smoking is one of the things keeping them from getting pregnant. Women who smoke have eggs that act older, decreased fertility, higher miscarriage rates and sicker babies. You need to normalize your weight too. A normal weight is a body mass index between 19 and 25. Overweight is a BMI between 25 and 30. If you are a 5’4″ woman, this is a weight range between 115-175 lbs. Your fertility is decreased outside of this range. If you need help with this, start with your primary care doctor.
If you are doing all these things and still not pregnant after one year, don’t wait any longer. You really should have conceived by then and need additional evaluation. Your OB/GYN can begin the process and help you to find a good fertility specialist in your area.