Pregnancy: Trying to Conceive
How do you figure out when you're fertile and when
you're not? Wondering if you or your partner is infertile? Read on to boost your
chances of conception and get help for fertility problems.
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Ten Infertility Questions to Ask Your Doctor
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
 Be sure to take along the records of any diagnostic
studies and/or fertility
treatments you may have had in the past if you are visiting a new fertility
specialist. If you have been keeping records of the dates of your menstrual cycles
and/or basal body temperature charts, take these along too. Also, print
this and take it with you to your doctor visit.
- What is my diagnosis, and how does this condition
specifically interfere
with fertility? Does my partner have a condition that interferes with
fertility? Will these conditions worsen over time, improve, or remain
constant?
- If the reason for my infertility is unclear, what diagnostic tests do
you recommend? What is the likelihood that each of these tests will
establish a diagnosis? Are there any risks associated with the testing? Does
my partner need additional testing?
- What type of treatment would you recommend trying
first? Does this treatment involve surgery, medications, or both? What are the risks of
treatment?
- In your practice, how often does this treatment
result in pregnancy? (Be sure to determine whether your doctor is talking
about pregnancy rates or
live-birth rates when discussing specific treatments so you can make
adequate comparisons. For example, a treatment may have a 30% pregnancy rate
per cycle but only a 25% live-birth rate due to early miscarriages.)
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Fertility Awareness
The Menstrual Cycle
Being aware of your menstrual cycle and the changes
in your body that happen during this time can be key to helping you plan a
pregnancy, or avoid pregnancy.
During the menstrual cycle (a total average of 28 days), there are two parts:
before ovulation and after ovulation.
- Day 1 starts with the first day of your period.
- Usually by Day 7, a woman's eggs start to prepare to be fertilized by
sperm.
- Between Day 7 and 11, the lining of the
uterus (womb) starts to
thicken, waiting for a fertilized egg to implant there.
- Around Day 14 (in a 28-day cycle), hormones cause the egg that is most ripe
to be released, a process called ovulation. The egg travels down the fallopian
tube towards the uterus. If a sperm unites with the egg here, the egg will
attach to the lining of the uterus, and pregnancy occurs.
- If the egg is not fertilized, it will break apart.
- Around Day 25 when hormone levels drop, it will be shed from the body with
the lining of the uterus as a menstrual period.
The first part of the menstrual cycle is different in
every woman, and even can be different from month-to-month in the same woman,
varying from 13 to 20 days long. This is the most important part of the cycle to
learn about, since this is when ovulation and pregnancy can occur. After
ovulation, every woman (unless she has a health problem that affects her periods) will have a period
within 14 to 16 days.
Charting Your Fertility Pattern
Knowing when you're most fertile will help
you plan or prevent pregnancy. There are three ways you can keep track of your
fertile times. They are:
- Basal body temperature method - Basal body temperature
is your temperature at rest as soon as you awake in the morning. A woman's basal body temperature rises
slightly with ovulation. So by recording this temperature daily for several
months you'll be able to predict your most fertile days.
Basal body temperature differs slightly from woman to woman. Anywhere from 96
to 98 degrees orally is average before ovulation. After ovulation most women
have an oral temperature between 97 and 99 degrees. The rise in temperature can
be a sudden jump or a gradual climb over a few days.
Usually a woman's basal body temperature rises by only
0.4 to 0.8 degrees Fahrenheit. To detect this tiny change, women must use a
basal body thermometer.
These thermometers are very sensitive. Most pharmacies sell them for around $10.
You then record your temperature on a special chart.
The rise in temperature doesn't show exactly when the egg is released. But
almost all women have ovulated within three days after their temperatures spike.
Body temperature stays at the higher level until your period starts.
You are most fertile and most likely to get pregnant:
- two to three days before your temperature hits the highest point (ovulation),
and
- 12 to 24 hours after ovulation.
A man's sperm can live for up to three days in a woman's body. The sperm can
fertilize an egg at any point during that time. So if you have unprotected sex a
few days before ovulation there is a chance of becoming pregnant.
Many things can affect basal body temperature. To get the most useful chart
you should take your temperature every morning at about the same time. Things
that can alter your temperature include:
- drinking alcohol the night before
- smoking cigarettes the
night before
- getting a poor night's
sleep
- having a fever
- doing anything in the morning before you
take your temperature -- including going to the bathroom and talking on the
phone
- Calendar method - This involves keeping a written record of each menstrual
cycle on a calendar. The first day of your period is Day 1. Circle Day 1 on the
calendar. Do this for eight to 12 months so you know how many days are in your
cycle. The length of your cycle may vary from month to month. So write down the
total number of days it lasts each time. To find out the first day when you are
most fertile, check your list for the cycle with the fewest days. Then subtract
18 from that number. Take this new number and count ahead that many days on the
calendar. Draw an X through this date. The X marks the first day you're likely
to be fertile. To find out the last day when you are fertile, subtract 11 days
from your longest cycle and draw an X through this date. This method always
should be used with other fertility awareness methods, especially if your cycles
are not always the same lengths.
- Cervical mucus method (also known as the ovulation
method) - This involves being aware of the changes in your cervical mucus
throughout the month. The hormones that control the menstrual cycle also change the kind and amount of
mucus you have before and during ovulation. Right after your period, there are
usually few days when there is no mucus present or "dry days." As the egg starts
to mature, mucus increases in the vagina, appears at the
vaginal opening, and is
white or yellow and cloudy and sticky. The greatest amount of mucus appears just
before ovulation. During these "wet days" it becomes clear and slippery, like
raw egg whites. Sometimes it can be stretched apart. This is when you are most
fertile. About four days after the wet days begin the mucus changes again. There
will be much less and it becomes sticky and cloudy. You might have a few more
dry days before your period returns. Describe changes in your mucus on a
calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the
first sign of wetness after your period or a day or two before wetness begins.
This method is less reliable for some women. Women who are
breastfeeding, taking
hormonal contraceptives
(like the pill) using feminine hygiene products, have
vaginitis or
sexually transmitted diseases (STDs), or have had surgery on the
cervix should not rely on this method.
To most accurately track your fertility, use a
combination of all three methods. This is called the symptothermal method.
Next: Infertility »
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