If you’ve have been trying to conceive for 3 months…
Then you know how mentally difficult it is to get a period. You mark your phone app appropriately and count the days until next ovulation. Next, you
harass ask your partner to have sex frequently and you eat just right. Eventually, you read 3-4 blogs on fertility and talk only to your closest friends. But after months of this, you still haven’t seen those infamous two pink lines.
After 6 months, you’re still not pregnant…
Start to talk to your medical provider. Typically women meet with their regular doctor and they’re met with blank stares. They encourage women to just keep trying. They say, “take your prenatal vitamins and worry less.” So, you try so hard to worry less, but that is much easier said than done. It’s common to wonder if your worrying is slowing down your potential to fertilize an egg every month. You’ve even wondered if something is wrong with your partner.
Finally, you wonder if you’ve waited too long. You blame yourself, your weight, your period, your food and your lifestyle. Thinking about this every day at work, you wish you could devote more time to “trying”. When will your day come? When will you have good news give? Fantasies about telling your partner to ensue.
I hear you, nothing is wrong with you for thinking these things and no, you haven’t gone crazy over this. This is just so important to you.
But occasionally some women just have difficulties.
If you have been having unprotected intercourse for 1 year without becoming pregnant and you are under the age of 35, you should seek the help of a medical professional. If you are over 35, you should seek help sooner at about 6 months. Your chance of becoming pregnant is roughly 87% during the course of 1 year between 27 – 35 years old.¹ This only slightly diminishes to 82% after 35 years old, but it incrementally decreases as the years’ progress. ¹
Before you seek help
Keep track of your ovulatory cycles by plugging in the days of your period into a nifty fertility tracker (there are plenty, go for the one you like and is free). Next, buy ovulation predictor kits and use them every day once your period ends, particularly in the morning. Write down your findings. Also, check your cervical mucus for color and consistency. When your cervical mucus is clear and sticky like egg whites, you are most likely ovulating.
Does your predicted ovulation day (from your app) match your cervical mucus and ovulation predictor kit findings? If so, please have sex. However, it is most advantageous to have unprotected intercourse every day the six days prior to and including your anticipated ovulation day. This comprises your fertile window. After 6 months to a year of attempting, if you are not pregnant, please make a fertility appointment with your practitioner.
So what does “help” really look like?
When women come to me to be worked up for infertility. They are stressed and concerned and want everything tested. Unfortunately, we don’t have a good measure of fertility, but there are some hormones we can evaluate.
- Thyroid Stimulating Hormone (TSH)
The thyroid determines the metabolism and circadian rhythm of our bodies. Your period can be directly affected by an abnormal TSH level. This is incredibly easy to treat if it is found that you have a slow thyroid (hypothyroidism), elevated TSH level or subclinical hypothyroidism. Frequently, a low dose of synthetic T4 is given even in those that have a relatively normal TSH level.
Prolactin is a hormone produced in great quantity when producing milk or during lactation. When you are lactating, you usually will not have a period. This is amenorrhea. Prolactin levels can be falsely elevated and cause amenorrhea if you have abnormal secretions from your nipples or if you have a pituitary tumor (causing more of this hormone to be created). This is easy to test for but, it is best done when there has been no nipple stimulation or heavy protein meal for at least 24 hours.
- Follicle Stimulating Hormone (FSH)
This hormone comes from the pituitary gland in the brain and is sent to the ovaries to encourage them to produce estrogen. This may be very high if the ovaries are not producing enough estrogen. If you are nearing menopause, FSH will be high and estrogen will be low.
Tested to help determine if premature ovarian failure is at fault.
- Anti-Mullerian Hormone (AMH)
This is most likely the most popular test to have done and is consistently being requested in women concerned about fertility. AMH levels give us an idea about your ovarian reserve. Depending on age, your number may be higher or lower, but typically we are looking for anything above 1 and lower than 8 based on age.
Testosterone levels should be low in a female, however in women with polycystic ovarian syndrome (PCOS), levels may be abnormally high.
- Hysterosalpingogram (HSG)
This is fluoroscopy (x-ray) done with contrast dye that is pushed through the cervix into the uterus. This dye will be seen spilling out of the follicular tubes and will aid in the determination if the uterus and the tubes are patent. You want patent (open) tubes because this means that an egg and sperm can freely float through the tubes to meet each other. The fallopian tubes can become occluded from endometriosis, chlamydia, ectopic pregnancies or pelvic inflammatory disease.
- Sonohysterogram (SHG)
This test is similar to the HSG but it uses saline to visualize the interior of the uterus for polyps and fibroids. These findings can impede the implantation of an embryo and will make it difficult to achieve or maintain pregnancy.
- Ultrasound (US)
Done vaginally to visualize the uterus and the ovaries. This is an imaging test to rule out fibroids, adenomyosis, ovarian cysts and a more-than-normal number of follicles.
- Semen Analysis
This test involves a man to wait to ejaculate for 3-5 days. Later, he will be instructed to ejaculate into a specimen cup either at home or in the office. Keep it warm and get it tested as quickly as possible for factors like speed, motility, sperm count, shape and function.
More things to Note
Obviously, these tests take some time to have done. Your medical provider may do some of these tests or additional tests. For accuracy’s sake, many tests need to be done at specific times. Timing is important not to disrupt a natural pregnancy. Some of these tests can be uncomfortable and painful. Occasionally these tests may be normal, in which case, the diagnosis of unexplained infertility may be given.
It’s okay to be scared to have these tests done or to be diagnosed with infertility. However, time is of the essence. If you suspect that you may have infertility, it is best to contact your medical provider so that testing may begin as soon as possible.
I wish you the best and many fertile years ahead. Got a fertility question? Ask below!
¹Dunson, D. B., Baird, D. D., & Colombo, B. (2004). Increased Infertility With Age in Men and Women. Obstetrics & Gynecology,103(1), 51-56. doi:10.1097/01.aog.0000100153.24061.45
This is not intended to be personal medical advice, but instead, general education. Please contact your medical provider for all of your medical care.