Frequently Asked Questions About Conception
Maybe we all learned our lessons a little too well back in junior high’s sex ed class when we were told how easy it is to get pregnant. The fact of the matter is, getting pregnant is often more difficult than we realize, especially as we age. So, to set the record straight and hopefully avoid a few surprises and minimize the potential for disappointment, here are a few reminders on how to get pregnant.
Does taking birth control affect fertility?
In general, birth control pills do not affect fertility. Within 1 to 2 months of stopping pills, a woman's menstrual cycle returns to what’s considered normal for her.
Birth control pills will "cover over " a woman's natural and possibly irregular cycle giving her a predictable monthly cycle. When she stops pills, her cycle returns to her normal and possibly irregular cycle and hence the pill gets the blame.
What should I expect if I’m coming off birth control and trying to conceive?
Within one to two cycles, all women who have a naturally strong ovulatory and regular cycle should be ovulating. You can use an ovulation predictor kit to help time intercourse with ovulation.
What are the chances of conception each month?
The rate of conception is highly dependent on the quality and quantity of the woman’s egg. According to the American Society for Reproductive Medicine, a woman’s best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20 percent chance of getting pregnant. That means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again. By age 40, a woman’s chance is less than 5 percent per cycle, so fewer than five out of every 100 women are expected to be successful each month.
Why does egg quality decrease with age?
The concept of a woman’s egg quality has everything to do with the probability that an embryo will implant and is strongly related to the age of the woman’s egg and her ovarian reserve. We cannot determine egg quality by looking at an egg or measuring how receptive it will be to sperm, or even how well the embryo cells appear to be initially dividing.
We can test egg supply with ovarian reserve testing, but we do not currently have a test for egg quality; instead, the most reliable test for egg quality is female age.
Much of the problem with egg quality as women age has to do with an increased likelihood for chromosomal abnormalities to affect the eggs. Chromosomal abnormalities may affect the number of chromosomes, as in the case of Down syndrome or Turner syndrome, or the structure of chromosomes, which may show as chromosome translocation, duplication, or deletion. The bottom line, egg quality decreases and the rate of chromosomal abnormality increases as a woman ages.
While we weren’t using birth control for a few years, we’ve only been actively “trying” for 6 months with no success. Should we be concerned?
Often when couples aren’t on birth control they will avoid pregnancy by having the male partner withdraw prior to ejaculation. Withdrawing the penis before ejaculation is not an effective method of contraception. Something else is going on that you have not yet become pregnant.
Is there a best time to have intercourse?
The best time to have intercourse that will result in conception is during a woman's luteinizing hormone (LH) surge. In an ideal 28 day cycle, this typically happens around day 14. The body releases the egg 24 hours after the peak of the LH surge. The egg only lives for 1 day after ovulation. If conception has not occurred, the egg dies and there will not be a pregnancy that month.
Ejaculated sperm can live in the reproductive track for 4 days, but optimal timing is with the LH surge so that sperm will be waiting in the Fallopian tube when the egg arrives. It is reasonable to try from days 12 to 16. Some people may choose to extend this from days 10 to 18. If there was only 1 day per month that a couple could engage in intercourse, then they should have sex at the time of the LH surge. Intercourse too early in the cycle or later in the month maybe important in a relationship, but it is recreational not procreative.
How do I know if I'm ovulating?
If you have regular and predicable cycle, then you are ovulating. Many women have an awareness of the changes in their body across their menstrual cycle. Some women note changes in the cervical mucus, others say they can actually feel the ovulation event. Once ovulation occurs and the egg is released, you may feel the effects of progesterone such as breast tenderness. However, if you don't feel these things, you can certainly still be ovulating especially if you have a regular cycle.
Do you recommend a cycle tracking app?
Shady Grove Fertility recommends the Glow app to track your menstrual cycle and activity around trying to conceive. It even has the option to track lifestyle habits for men. The Glow app also offers infertility testing and treatment tracking should the need arise. Just remember, all apps are better at prediction when data is entered consistently. Ovulation and attempts at pregnancy are no exception.
Should I use an ovulation predictor kit?
One way to be sure ovulation is occurring is to use an ovulation predictor kit. There are many brands. Our patients have had good luck with the Clear Blue Easy kit, as it is very easy to interpret—a circle for negative, a smiley face for positive. Begin testing around day 12. It is good to have a couple of negative days, so that when you get a positive, you are sure it is positive.
Are there kits you don’t recommend?
We do not recommend the digital kit, which provides information on high fertility (by measuring estrogen, and then a flashing smiley face that measures LH). It is expensive and does not provide additional useful information.
How often should we have sex?
People should do what feels natural. Getting pregnant can be stressful. Sex should not be stressful. Often couples (read: men) have trouble performing on demand. Attempting conception after several months of negative results can put a strain on couples and impedes the romance in a relationship. Our physicians typically say that having sexual intercourse every other day during the week of ovulation (days 12 to 18) is reasonable. If every day feels right for you, then go for it. Some couples are concerned that daily sex will deplete the amount of sperm the male has available. This is a myth.
Is one position better to conceive?
No. They all work.
Do I need to lay with my legs up after intercourse?
This is not necessary. If it makes you feel more at ease, you can wait 5 to 10 minutes before getting up, although this is not necessary.
A lot of ejaculate spills out after withdrawal. Is this a problem?
No. More than enough sperm stay inside the vagina.