Before you start trying

During the times in your life when you are 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 might think, particularly when you are 35 or older. Even if you are younger and you time intercourse perfectly, you only have a 20 per cent chance of getting pregnant each month. 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.

• Cut out caffeine, alcohol and cigarettes
  Caffeine may increase the risk of endometriosis, a known cause of infertility. It can also damage sperm. Having as few as five alcoholic drinks a week can impair conception. Smoking can speed the loss of eggs, affect sperm quality and may even accelerate menopause for several years.


• Stop over-exercising
  Women who regularly do vigorous aerobic exercise may stop ovulating. While most doctors believe moderate exercise is fine, some disagree. According to US fertility expert Dr Alice Domar, “For certain women, even moderate levels of exertion may contribute to infertility.” 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,” Dr Domar says.


• Reduce stress and depression
  It’s not clearly understood why but evidence suggests that negative emotional states can make it harder for a woman to conceive, says Dr Domar.

Handy techniques

If you're serious about getting it right sooner rather than later, follow these tips:

• Body temperature
  Take your temperature first thing every morning before your get out of bed; following ovulation, your body temperature can increase by 0.5 ºC. You won’t be able to feel the shift but by using a basal body temperature thermometer, you should be able to detect it. The temperature spike indicates that you have ovulated; you are most fertile in the two to three days before ovulation takes place.



• Cervical mucus
  When you ovulate, cervical mucus increases in volume and becomes thinner and “stretchier”, like uncooked egg white.



• Ovulation-predictor kits
  Over-the-counter urine tests monitor levels of luteinizing hormone (LH), which surges 24 to 36 hours before ovulation. Based on clinical studies, this is considered one of the best methods for testing for ovulation.



• Saliva-test kits
  When a woman is about to ovulate, her saliva begins to form a distinct fern-like pattern due to an increase in the level of salt and oestrogen. This visible ferning pattern begins to appear around three to four days prior to ovulation and can be seen using an over-the-counter kit.



• 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 one). 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 one year of protected sex. If something in your medical history may have an impact on your fertility, such as a sexually transmitted disease or pelvic surgery, see a doctor after six months of trying.

The same applies if you are over 35; egg quality declines quickly then.

"Age has a dramatic effect on the ability to conceive," says fertility specialist Dr Gilbert Haas. "If you are over 35, the longer you wait to seek help, the less likely it is that a doctor will be able to help you conceive."

Get your partner to have an examination
The most common causes of male infertility are varicocele (dilated veins in the scrotum) and obstruction of sperm pathways. Both can usually be corrected. 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. A normal result on a sperm test does not necessarily mean 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 per cent of infertile men, the cause is unexplained.

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 hysterosalpingogram (dye is injected to see if your uterus and tubes are normal) and a laparoscopy, which looks for endometriosis and adhesions in the tubes.

Infertility's toll on a marriage
Infertility is one of the most stressful things to happen to a marriage, says Kristen Magnacca, author of Love and Infertility. 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,” says Magnacca. She recommends scheduling enjoyable, non-baby-making sex in the early part of your menstrual cycle and seeking counselling if needed. She also encourages having a written “fertility game plan”. “This ensures that both parties are on the same page,” Magnacca says.

Alternative approaches

Non-traditional approaches to enhancing fertility are best used in conjunction with traditional medicine, says fertility specialist Dr Mark Bush. "If a woman has blocked [Fallopian] tubes, she can take all the herbs in the world and they won’t get her pregnant," he warns.

Once you and your partner have been checked out, here are some approaches you may want to investigate.

Mind/body techniques
A study published in 2000 found that about half of the women in either a support group or a cognitive-behavioural group became pregnant, compared with only 20 per cent in a control group. Cognitive-behavioural 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 Dr Elizabeth Grill, a clinical psychologist. Dr Grill suggests a toolbox of coping methods, including deep abdominal breathing, meditation, self-care, visualisation and cognitive therapy.

Acupuncture
"Acupuncture increases blood flow to the uterus and decreases stress hormones, both of which help pregnancy attempts," says Dr Ann Cotter. Some studies suggest a high success rate when acupuncture and IVF are combined.

Is it you or him?
The most common causes of infertility are problems with eggs and ovulation, the Fallopian tubes and sperm. Data suggests that 40 per cent of infertility is due to a female factor, 40 per cent to a male factor and 10 per cent to a combination of male and female factors and 10 per cent is unexplained.