Tuesday, January 20, 2015
Baby got back(ordered)!
Much respect to Sir Mixalot, but the buns I am going to be talking about today are the kind that go in the oven.
Does it ever feel like pregnancy has become airborne and your uterus is the only one that didn't get the memo?
You are young, healthy, stay in shape, don't smoke, don't drink, avoid processed food, carbs and fats ( read: everything worth eating), take your daily vitamins and heck, even volunteer at the local soup kitchen!
Why haven't you gotten pregnant!??!?!
Well, as bitter sweet as it will sound, it is probably nothing. Majority of couples that don't conceive in their first year of trying, have nothing wrong with them. Its a numbers game, and more often than not, you will get pregnant, you just have to wait out the back order.
But while you are in cue, here are a few questions to ask yourself:
1. How long have you been off your birth control?
" I have infertility, I came off my pill last month and I still am not pregnant" ( True patient statement).
In a culture where becoming pregnant seems to be ubiquitous ( courtesy of all the ultrasound picture Facebook posts out there) and unanticipated pregnancy is considered inevitable if the proper precautions are not taken, it is natural to think like my patient probably did above; as soon as you discontinue birth control, you should become pregnant. The reality is, out of every 10 healthy couples trying to conceive every month, only 2 will actually be successful! 20%!! And that's in your prime fertility age bracket ( 18-30) my friends. Furthermore, some forms of birth control actually inhibit regular ovulation for up to 6 cycles after discontinuation. So don't let those Facebook posts fool you, the reality is more people are trying than actually are pregnant; they just wouldn't get as many likes for that. Patience and optimism is key.
2. Do you have regular menstrual ( i.e ovulatory) cycles?
A woman's "period" is actually just the aftermath of an unsuccessful fertilization. If you have regular periods, you probably are ovulating regularly. Given that most women only ovulate 1 egg per month, its pretty important to know when that happens. If you aren't having regular menstrual cycles ( every 28-35 days counting from the first day you bleed) you should consult your local ObGynKanobi to figure out why. Reasons include being over/under weight, your thyroid levels being off, PCOS and others. Don't forget, it could also be because you are already pregnant!
3. How often do you have intercourse?
" Oh, we have PLENTY of sex….like almost every day! sometimes twice in a day!!"
Bravo, but any efforts undertaken outside the ovulatory window is just plain recreational. There is a reason why natural planning works! ( Fellow OB/GYNS: I know, I can't believe I admitted that either) A woman is actually only able to become pregnant 3-4 days in a month. Approximately 3 days before she ovulates and up to 1 day after. So even if you are going at it like rabbits that think they are the last two pandas on earth, it won't do much if it isn't during the right time. Further more, every time a man ejaculates, the concentration of sperm in his semen declines. So after a few goes, he is essentially shooting blanks ( not to be taken literally, repetitive ejaculation is not a contraceptive method!).
4. How do you know when you are ovulating?
Some patients will use the smart phone apps to keep track. Those are great, except they simply use a mathematical prediction of when the average woman is ovulating. Typically this is anywhere from the 10th day after your period starts ( not ends!) to the 20th day. Some women can actually feel ovulatory symptoms such as a sharp sudden pain on one side. Others will use the consistency of their (cervical) discharge, which can be watery and clear while ovulating. Basal body temperature is another ( imprecise) method to narrow down the otherwise elusive fertility window. If you have the cash, you can consider buying ovulation predictor kits ( OPK's) and using them to determine when you will be ovulating as well.
I usually tell my couples that they should narrow down their window over 1-3 months using any combination of the above methods. Then perform " Timed intercourse" - no don't break out the stop watch and have at it, I mean having intercourse specifically during the right ovulatory window. Abstain from masturbation and recreational sex during the days leading up to the ovulatory window and then have intercourse daily or every other day during that time frame. More than once is not advisable. If you both are healthy, have not had any prominent history of medical problems, hereditary infertility, or genital trauma/infection, chances are, 6-12 months of timed intercourse efforts should yield a positive pee stick. If the stork still hasn't figured out your address after that, it may be time to get in touch with your doctor for more in-depth testing.
All the best and as always, be happy! be healthy!