Whether you're just considering starting a family or you've been trying for a while, our complete guide to conception can help.
If you're reading this article, chances are you're not pregnant yet but would like to be soon. For approximately 85 percent of American couples, conception happens fairly easily, and we hope you're among them. During the times in your life when you're trying not to have a baby, you know that having unprotected sex just once can result in pregnancy. But the truth is, conception doesn't happen quite as quickly as you may think, particularly when you're 35 or older.
Even if you're younger and you time intercourse perfectly, "you have only a 20 percent chance of getting pregnant each month," says Bryan D. Cowan, M.D., a reproductive endocrinologist and chairman of the department of obstetrics and gynecology at the University of Mississippi Medical Center in Jackson. In the following pages, you'll learn how to improve your chances of getting pregnant "naturally," and find expert information on what to do if you don't.
Before you start trying
Cut out caffeine, alcohol and cigarettes Caffeine may increase the risk of endometriosis, a known cause of infertility. (It also can damage sperm.) Having as few as five alcoholic drinks a week can impair conception, according to Resolve, an infertility association. And smoking can speed the loss of eggs, affect sperm quality and may even accelerate menopause by several years.
Stop Overexercising Women who regularly do vigorous aerobic exercise may stop ovulating. While most doctors believe moderate exercise is fine, some disagree. "For certain women, even moderate levels of exertion may contribute to infertility," says Alice D. Domar, Ph.D., director of the Mind/Body Center for Women's Health at Boston IVF. She recommends that women who are not conceiving take a three-month break from any exercise that raises the heart rate to more than 110 beats per minute.
Achieve your ideal weight Having too much or too little body fat can cause irregular or infrequent ovulation. "Women whose body mass index [BMI] is between 24 and 30 are most fertile," Domar says.
Reduce stress and depression There's evidence that negative emotional states can make it harder for a woman to conceive, Domar says.
What to do first
See your OB-GYN Your doctor will test for infections, including fertility-harming sexually transmitted diseases; monitor any chronic health problems; give you a prescription for prenatal vitamins containing folic acid; and review any medications you take.
Discontinue using birth control pills Stop taking them at least one full cycle before you start trying to conceive, advises Marian Damewood, M.D., chairwoman of the department of OB-GYN at York Hospital in York, Pa., and president of the American Society for Reproductive Medicine.
Determine when you're ovulating "When used correctly, [all three of the following methods] are relatively reliable in telling time of ovulation, but none is perfect," says Lee C. Kao, M.D., co-director of the Center for Reproductive Medicine at Cedars-Sinai Medical Center in Los Angeles.
Body temperature Take your temperature first thing every morning before you stir; it drops about a half-degree when you ovulate. Be aware that false readings are common, and the method can't predict ovulation, only tell you that it's happened, Damewood says.
Cervical mucus When you ovulate, cervical mucus increases in volume and becomes thinner and "stretchier." Some women may notice the change.
Ovulation-predictor kits Over-the-counter urine tests such as First Response (about $28) and Answer (about $18) monitor levels of luteinizing hormone (LH), which surges 24 to 36 hours before ovulation. "I consider this method most reliable, based on clinical studies," Kao says.
Time intercourse Have sex every other day beginning a few days before ovulation until a few days after. In a 28-day cycle, this would be from day 10 to day 18 (the day your period starts is day 1). Having sex more often may cause sperm levels to fall too low in a man with an already low count.
If it's not happening
If you are under 35, seek medical advice if you're not pregnant after a year of unprotected sex. If something in your medical history may impact your fertility, such as a sexually transmitted disease or pelvic surgery, see a doctor after six months of trying. Same if you're over 35; egg quality declines quickly then. "Age has a dramatic effect on ability to conceive," says Gilbert Haas, M.D., of the Center for Reproductive Health in Oklahoma City. If you're 35 or older, the longer you wait to seek help, the less likely it is that a doctor will be able to help you conceive.
Have your partner get an infertility exam
The most common causes of male infertility are varicocele (dilated veins in the scrotum) and obstruction of sperm pathways; both usually can be corrected with outpatient surgery. While no medications can improve sperm count or motility (movement), procedures such as intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI) may help bypass the problem. Home tests such as Babystart and SpermConfirm measure sperm count and/or motility. However, a normal result doesn't necessarily mean that a man's sperm is not the issue, because these tests don't check for all the factors that can contribute to problems. Unfortunately, for more than 20 percent of infertile men, the cause is unexplained, according to Peter N. Kolettis, M.D., an associate professor of urology at the University of Alabama at Birmingham.
See a doctor yourself
The older you are and the more complicated your medical history, the better it is to see a doctor with extensive training and experience in infertility. The good news is doctors can correct many problems with surgery, hormones and other medications. The diagnostic procedures you may undergo involve blood tests (including a check of your thyroid and progesterone levels), a biopsy of the uterine lining, a hystero-salpingogram (dye is injected to see if your uterus and tubes are normal) and a laparoscopy, which looks for endometriosis and adhesions in the tubes.
Investigate infertility centers and costs
The Centers for Disease Control and Prevention tracks infertility clinics' success rates at http://www.cdc.gov/reproductivehealth/index.html. For a list of the 15 states that mandate insurance coverage for infertility treatment, go to www.resolve.org. If you're not covered, you may be drawn to the "package deals" some clinics offer. For example, some promise to provide a certain number of assisted reproductive technology cycles for a fixed fee or to refund money if treatment fails. Although some of these are legitimate, you should investigate them closely before agreeing to a package deal.
"Non-Western" practices to enhance fertility are best used in concert with traditional medicine, says Mark Bush, M.D., of Conceptions Women's Health and Fertility Specialists in Boulder, Colo. "If a woman has blocked [fallopian] tubes, she can take all the herbs in the world and they won't get her pregnant," he says. Once you and your partner have been checked out, here are some approaches you may want to investigate.
A study published in Fertility and Sterility in 2000 found that about half of the women in either a support group or a cognitive-behavioral group became pregnant, compared with only 20 percent in a control group. (Cognitive-behavioral therapy involves learning to "reframe" negative thoughts like I will never have a baby to I am doing everything I can to try to get pregnant.) "Women with fertility issues have a high degree of depression, anxiety and isolation," says Elizabeth Grill, Psy.D., a clinical psychologist at the Center for Reproductive Medicine and Infertility at Cornell Medical School in New York City. Grill offers women a "toolbox" of coping methods, including deep abdominal breathing, meditation, self-care, visualization and cognitive therapy.
"Acupuncture increases blood flow to the uterus and decreases stress hormones, both of which help pregnancy attempts," says Ann Cotter, M.D., medical director of the Atlantic Mind Body Center in Morristown, N.J. Several good studies report high success rates when acupuncture and in vitro
fertilization are combined.
Preliminary research has yielded good results with a nutritional supplement that includes chasteberry and green-tea extracts. However, experts say it's best not to self-prescribe, so seek a qualified herbalist. The American Herbalist Guild sets standards; look for "A.H.G" after a practitioner's name. Licensed acupuncturists (L.Ac.'s) and naturopathic physicians (N.D.'s) from an accredited four-year school also can prescribe herbs. —Mary Jane Horton
Is it him or you?
The most common causes of infertility are problems with eggs and ovulation, the fallopian tubes and sperm. According to Resolve, 40 percent of infertility is due to a female factor, 40 percent to a male factor and 10 percent to a combination of male and female factors; 10 percent is unexplained.
Infertility's Toll On A Marriage
Infertility is one of the most stressful things to befall a marriage, says Kristen Magnacca, author of Love and Infertility (LifeLine Press, 2004). It can trigger arguments, mood swings and feelings of isolation. What's more, it can take all of the fun out of your sex life. "You're making a baby, not making love," Magnacca says. She recommends scheduling enjoyable, non-baby-making sex in the early part of your menstrual cycle and seeking counseling if needed. She also encourages having a written "fertility game plan." "This ensures that both parties are on the same page," Magnacca says.
Going the high-tech route
The following commonly performed fertility treatments are roughly listed from least to most invasive (and expensive). Costs depend largely on location, and success rates are very approximate because they vary greatly based on several factors, including a woman's age, her and her partner's diagnoses or health history and where the procedure is performed.
Approximate cost (per cycle)
Approximate success rate (% per cycle)
Intrauterine insemination (IUI) with "washed" sperm
A large number of sperm are concentrated into a small volume of fluid and inserted into the uterus.
A donor's sperm is inserted into the uterus.
Ovulation-enhancing drugs such as clomiphine citrate (Clomid, Serophene)
These pills induce ovulation, normalize irregular cycles and increase egg production.
Follicle-stimulating hormones (Follistim, Gonal F) plus IUI
These injected drugs stimulate egg production.
In vitro fertilization (IVF)
An egg or (usually) eggs are retrieved from the woman and fertilized outside of her body. The embryos are then transferred to the uterus.
$5,000–$12,000, plus $2,000–$6,000 for drugs (much less if using frozen embryos)
A woman undergoes IVF using a donated egg.
A surrogate conceives using her, your or a donor's egg and your partner's or a donor's sperm.
The American Society for Reproductive Medicine provides referrals to reproductive endocrinologists; 205-978-5000, www.asrm.org.
Resolve is a national infertility association that provides education, advocacy and support; 888-623-0744, www.resolve.org.
Serono Inc., a manufacturer of fertility drugs, offers a free Fertility LifeLines program. Call 866-538-7879 for information about treatment, support groups and specialist referrals.
The Society for Assisted Reproductive Technology can help you locate a fertility clinic; 205-978-5000, www.sart.org.