Judging from the questions I'm getting, the greatest fear still for many of you is that month after month is being wasted waiting for pregnancy when in reality, it's just not going to happen naturally for some reason. Most average couples can expect a normal 20% chance each month to get pregnant. If you are in this group, it is smart for you to just be patient, because pregnancy will happen without any special action on your part, usually within six months. Even if you are subfertile and only have a 10% chance each month, you still can expect to eventually conceive on your own. It just might take a year or so. But if you only have a 0-1% each month, then all you're doing by putting off getting help is just wasting time as your reproductive potential is gradually depleted.
The moment you make your decision that you would like to get pregnant, there are three questions to ask yourselves right away.
1. Am I not releasing an egg each month?
2. Is there adequate sperm?
3. Is there any physical barrier to the sperm and egg meeting properly?
The answer to the first question is one you can easily figure out yourself in many cases. If you are not getting your period at least ten times per year (no less frequent than every 35 days), then you are not ovulating as often as you should and therefore, time is being wasted during your reproductive years. It's wise to get help sooner rather than later.
The second question can only be answered by doing a semen analysis. There is no way to know the truth about a man's sperm just by looking at him nor by analyzing his general health. Granted, if he has fathered several pregnancies in the past, and nothing drastic has happened to his health since then, most likely, he does not have any severe sperm problem. A semen analysis can be done fairly easily for under $150 and is a very basic test to start with.
The third question can best be answered with a test called a HysteroSalpingoGram or HSG. This is a test where a special liquid is gently introduced into the uterus and images are taken to see where the liquid flows. This can detect if you have a polyp or fibroid tumor in the uterus that is blocking your implantation. It can also show if your Fallopian tubes are blocked or not. You should be suspicious that you might have these problems if you have had previous gynecological surgery, previous pelvic infections, very painful periods or especially heavy ones. Compared with a semen analysis, this test is more costly and more inconvenient to do, but can be obtained usually for under $800.
So how do you avoid wasting time?
Here is one good approach:
1. Begin by understanding the stages that couples go through in their desire to have a baby and figure out where you are.
2. Stop all contraception and maintain a patter of having sex every 1-3 days (preferably every 1-2).
3. If you have regular periods and are under 40 years old and do not suspect a physical barrier to pregnancy, then set yourself a deadline of 4 months, 8 months or 12 months depending on your age and personal sense of urgency.
4. If your deadline arrives and you're still not pregnant, make a decision regarding which you would rather do: semen analysis, HSG or consult a fertility specialist. At the very least, do a semen analysis. It's cheap and fairly convenient (the sample can be produced at home and does NOT have to be produced in the lab or doctor's office). If the testing is normal, set a new shorter deadline of 4 more months.
5. If still not pregnant by then, choose another action that you did not choose before. Most people would choose the semen analysis the first time and then the HSG the second time. Both these tests can be ordered by your primary care physician or by your OB/Gyn.
6. If both these tests are normal, but you are still not getting pregnant another four months later, it's time to see a reproductive endocrinologist.
By following these simple steps, you can avoid unnecessarily wasting time. Best of luck!
You are welcome to email me with comments or questions.