Infertility

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Infertility

18 Pointers to Aid Conception

You've decided to become parents. In a celebratory mood several months ago, you destroyed your last few condoms in a water balloon fight, dumped your spermicide stash into the trash, and retired the old diaphragm. Ever since, you've been having glorious, unprotected sex.

Small problem, though. Your lovemaking isn't making any babies. And that's beginning to worry you. Just how long does this conception business take? What can you do to help nature along?

FOR COUPLES

Here is what experts advise couples who are beginning to worry about their lack of success at conception.

Give it a year. If you're under 28, your sex life is wonderful, and there's nothing in your medical history that points to a possible reproductive problem, our experts say keep trying for a year.

"About 60 percent of couples conceive within six months and 90 percent within the year," says Mitchell Levine, M.D., an obstetrician/gynecologist with Woman-Care in Cambridge, Massachusetts. "When you get older, naturally, fertility decreases a bit."

Even women in their twenties don't ovulate every month, adds Joseph H. Bellina, M.D., Ph.D., director of Omega International Institute, a fertility clinic in New Orleans, Louisiana. In the thirties, the likelihood of monthly ovulation begins to lessen. That's why the older you are, the sooner you'll want to consult a specialist.

MEDICAL ALERT When the Stork Needs More Than a Nudge You'd like to have a child. But your body isn't cooperating. Should you give it a little longer? Or is it time to consult a fertility specialist? According to our experts, seek medical counsel if: Your menstrual periods are scant or irregular, and your cervical mucus doesn't change. You may not be ovulating. You've used an over-the-counter ovulation kit for three cycles now, but it's never given you any indication you're ovulating. You are under 35 and have been unable to conceive despite a year of unprotected intercourse, or over 35 and have been unable to conceive after six months. You're producing milk, or you have male-pattern hair growth on your breasts, upper lip, or chin. You may have a hormonal imbalance. You or your partner have suffered from chlamydia, a sexually transmitted disease that can destroy the fallopian tubes in women and inflame and scar the ductal system in men. Your medical history includes pelvic infections, endometriosis, polycystic ovary disease, abdominal or urinary tract surgery, injuries to the perineum, excessively high fevers, or the mumps or measles. You've used an intrauterine device (IUD). You or your mate suspect exposure to some substance like lead that is known to impair fertility.

Talk it out. Are you both sure you want that baby, or is one of you ambivalent? Our experts have had plenty of stories about couples who try half-heartedly for years but don't conceive until after one partner's uncertainty is resolved.

"I had a couple where the man was older, he had children from another marriage, and he wasn't sure he wanted to be a father at this point in his life," says Dr. Levine. "After a couple of sessions of really talking it out, he got really excited about becoming a father again. And that's when they conceived."

"It's eerie," adds Marilyn Milkman, M.D., a San Francisco obstetrician/gynecologist and clinic faculty member at the University of California, San Francisco. "I've had four patients come in for fertility evaluations, walk out the door, and become pregnant within the month."

Let the passion take you. Forget about ovulatory charts, mucus charts, and scheduled sex until you absolutely have to worry about them. If you've got time, "let the passion take you," says Dr. Milkman. "Often that does better."

The Alternate Route Goodbye K-Y Jelly, Hello Egg White Heads turned when Emory University fertility specialist Andrew Toledo, M.D., an assistant professor in the Department of Gynecology and Obstetrics, suggested that couples use egg white as a vaginal lubricant to induce conception. "This is not some magic bullet," cautions Dr. Toledo. "It's only useful as a lubricant for those couples who find dryness a problem." He advises couples to use egg white only during the few days each month when a woman is fertile. The rest of the month they should use whatever lubricant they prefer. Why egg white? Dr. Toledo says he was intrigued by the results of a study in Canada that found egg white had the least effect on sperm motility and survival. It makes sense, he says. Egg white is pure protein. And the vast amount of sperm is pure protein in nature. "Sperm does not do well in a carrier different from its structure." "For the six, seven, or eight couples who told me they needed to use some kind of lubricant, this helped." Several couples who tried this did conceive. But don't use egg white if you're allergic to it, he cautions. Take the egg out of the refrigerator ahead of time, so that it's not cold, and separate the white from the yolk. It makes no difference whether you apply the substance to the glans of the penis or the vagina.

Ease up on your work schedule. Workaholism and constant pressure can put the squeeze on fertility, says Dr. Levine. "I see a lot of career people and I say to them 'take a look at what message you're giving to your body.' " For Dr. Levine, it makes sense from an evolutionary standpoint. Your body knows that a period of extreme stress is not an ideal time to get pregnant.

Use the standard missionary position on days when you suspect the woman is fertile. The man-on-top style of intercourse is best for conception, says Dr. Bellina. The woman should remain lying down for 20 minutes after her partner ejaculates.

"I advise couples to have intercourse on those nights and then fall asleep," he says.

Stop smoking. Cigarettes can impair fertility in men and women. Studies of men have shown that smokers are more likely than nonsmokers to have sperm counts below the normal range, and to have less sperm motility. An English study of 17,032 women showed that the more cigarettes a woman smoked per day, the less fertile she was likely to be. Researchers suspect that smoking may alter hormone levels in a woman's body.

FOR WOMEN ONLY

Here are some helpful measures that women can take to help increase the chances of pregnancy.

Make sure you're ovulating. Are you having regular periods? If not, you may not ovulate.

"One key to ovulation is noticeable changes in cervical mucus midway through the cycle," says Dr. Milkman. "The mucus will be thin, watery, and clear." Other signs include premenstrual breast tenderness, cramps, and what the Germans call mittelschmerz—ovulation pain, she says.

Another way to test ovulation is with a kit you buy at the drugstore. The kit, which reads levels of the ovulation release hormone in your urine, is only about 50 percent effective when you use it morning and night, says Dr. Bellina. Kits available only through your doctor's office tend to be more accurate. The best time to test is between 10:00 a.m. and noon.

If you get a positive result the first month you use it, great. If three cycles pass without giving you a positive result, it could mean that either the kit isn't sensitive enough for you or you're not ovulating. Either way, consult your doctor.

If you want to be a fertility goddess, try to look like one. Some women can induce ovulation by putting on a few pounds or taking off a few. In general, the closer your actual weight is to the ideal weight listed in the Metropolitan Life statistical tables, the better. You want to be within 95 percent of that ideal but below 120 percent.

Researchers have found that body fat can actually produce and store estrogen, a hormone that primes the body for pregnancy. When total body estrogen is too high or too low, the system can be thrown off balance. The more fat, the more estrogen produced.

In one study by reproductive endocrinologist G. William Bates, M.D., a professor of obstetrics and gynecology and dean of the Medical University of South Carolina College of Medicine, 29 slim and nonovulatory women attained ovulation when they gained enough weight to put them within 95 percent of the ideal. Within three years of entering the program, 24 of the 29 became pregnant. In another study by Bates, 11 of 13 overweight and nonovulatory women regained ovulation after they lost weight: 10 conceived.

Go easy on the exercise. There are two reasons for this. If exercise causes you to lose too much body fat, you can stop ovulating. But even if you maintain normal body weight, you may still put yourself at risk if you spend more than an hour a day working hard at activities like running, cross-country skiing, or swimming.

In a study of 346 women with ovulatory dysfunction, Beverly Green, M.D., a maternal and infant health specialist in Silverdale, Washington, found some evidence that women who had never been pregnant and who exercised vigorously for more than an hour a day increased their risk of infertility. The study found that exercise exerted its effect on fertility through a means independent of its ability to promote weight loss.

What's going on here? Dr. Green is not sure. Dr. Bellina suspects the endorphins, brain chemicals released during vigorous exercise, may, like morphine, affect a woman's prolactin levels. Elevated prolactin levels may interfere with ovulation.

At any rate, Dr. Green, a marathon runner who had no difficulty bearing children, cautions against overinterpreting her study. Her advice to dedicated athletes? "Try to cut back and see if it makes a difference."

Time it just right. If ovulation is occurring normally, maybe you're just not making love when you're fertile. It could be that simple, says Dr. Levine.

"Sometimes you've got two career people, they're having intercourse maybe once or twice a week, and they're just not hitting it," he says.

How do you remedy this? Try to predict ovulation. If you don't want to fuss much, you can predict the date of your next period and count back 14 days. Then make love every night from day 11 through day 16. Or you can buy an over-the-counter ovulation test kit, which will give you about 24 to 36 hours advance warning of ovulation. When the test indicates ovulation, make love that night and the night after, advises Dr. Bellina.

Thou shalt not douche. Anything that interferes with the pH level of the vagina can make life unfriendly for sperm. That includes douches, lubrication agents, and jellies.

"I tell people never to douche," says Dr. Milkman. "If you leave the vagina alone, it will do just fine at cleaning itself."

Go easy on caffeine. More than a cup of coffee a day can hurt your chances of becoming pregnant. The same holds true if you ingest the equivalent amount of caffeine from chocolate, soft drinks, or other caffeinated beverages.

In a study of 104 women who were attempting to become pregnant, researchers at the National Institute of Environmental Health Sciences found that those who drank more than the caffeine equivalent of a cup of coffee a day were half as likely to conceive as those who consumed less.

FOR MEN ONLY

And on the male side of the equation, there is more advice.

Give your sperm time to bounce back. Any viral illness associated with fever can depress sperm count for up to three months, says Neil Baum, M.D., director of the Male Infertility Clinic in New Orleans, Louisiana, and a clinical assistant professor of urology at Tulane University School of Medicine. Bad colds can have the same effect.

Why is the effect so long-lasting? According to Dr. Baum, the normal cycle to produce a sperm is 78 days. It takes another 12 days for the sperm to mature. Healthy semen, by the way, contains in excess of 20 million sperm per teaspoon. If you looked at the sample under a microscope, more than 60 percent would appear to be swimming forward.

If your sperm count is healthy, a cold or flu probably won't knock it out of the fertility range. But if it's borderline, an illness may.

Say no to steroids. Anabolic steroids can shut off the pituitary gland and alter the body's natural hormone balance, says Dr. Baum. "It's not uncommon for athletes to have infertility problems," he adds. "Long-time use of steroids can permanently damage the testicles."

Be wary of drugs and alcohol. Various over-the-counter and prescription drugs can depress sperm count. If you're not sure about the medications you use, consult your pharmacists or doctor. Tagamet, an ulcer medication, is one to watch out for. Others include chemotherapeutic agents and certain antibiotics. And various studies over the years show that chronic drinking and habitual marijuana use can be at fault, too.

Keep 'em cool. Nature's way of keeping your testicles a half-degree cooler than your core body temperature is to house them outside the body. But if you heat the core temperature too much, or heat the testes themselves, you can affect sperm production.

Dr. Baum advises you to be careful about excessive physical activity, temperature extremes, hot tubs, and close-fitting underwear if you want to father a child.

Remember that abstinence makes the sperm grow stronger. If a baby is what you're after, daily intercourse can be too much of a good thing because it can decrease your sperm count.

"For the average couple, this doesn't matter," says Dr. Levine. "But in a borderline case, this may do it." Most experts recommend you abstain for two days prior to the woman's fertile period to let the sperm build up, then make love every other day.

PANEL OF ADVISERS

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G. William Bates, M.D., is a reproductive endocrinologist, professor of obstetrics and gynecology, and dean of the College of Medicine at the Medical University of South Carolina in Charleston.

Neil Baum, M.D., is director of the New Orleans Male Infertility Clinic, a clinical assistant professor of urology at Tulane University School of Medicine, and a staff urologist with Touro Infirmary in New Orleans, Louisiana.

Joseph H. Bellina, M.D., Ph.D., directs the New Orleans-based Omega International Institute, a fertility clinic in Louisiana. He is a national adviser of the Child and Human Development Council of the National Institutes of Health.

Beverly Green, M.D., works in infant preventive health and family medicine with Group Health Cooperative of Puget Sound in Silverdale, Washington. She specializes in maternal and infant health.

Mitchell Levine, M.D., is an obstetrician/gynecologist with Women-Care in Cambridge, Massachusetts.

Marilyn Milkman, M.D., practices obstetrics and gynecology in San Francisco, California. She is on the clinic faculty of the University of California, San Francisco.

Andrew Toledo, M.D., is a reproductive endocrinologist and an assistant professor in the Department of Gynecology and Obstetrics at Emory University in Atlanta, Georgia.