Trying to Conceive: 5 Questions to Ask
There is a lot to learn about your body when you’re trying to conceive a baby.
Understanding the normal operation of your reproductive system can alert you to possible risk factors so that you can get the help you need sooner and have the best start at a healthy pregnancy. Preconception counseling with your doctor is a chance to evaluate your ovulation cycle, hormones, the medical histories of you and your partner and for an overall check up to prepare you for the journey ahead.
Here, we will dive into how your reproductive system works and some topics that may come up during counseling.
Am I ovulating normally?
The female body has a monthly cycle that sets the stage for the release of an egg, fertilization of the egg, growth of the fertilized egg into an embryo and its implantation into the uterus. During preconception counseling, your doctor will want to find out if your monthly cycles are normal and if you are releasing eggs at the right time each month.
When you’re trying to conceive, you might have been advised to monitor your basal body temperature (BBT) over several menstrual cycles to determine whether your ovaries release eggs (ovulate) regularly and to time intercourse to optimize your chances of pregnancy. This method is unreliable for several reasons: Many factors can interfere with BBT monitoring, including irregular sleep-wake patterns, caffeine or exercise schedules. Also, by the time you note a rise in BBT, ovulation has already occurred, and the optimal window for fertilization has passed. A rise in BBT only helps to confirm that you ovulated, but cannot help you predict ovulation and cannot alert you to the best time to try to conceive.
A better option is an ovulation prediction kit (OPK), which measures the level of luteinizing hormone (LH) in your urine. These kits can be purchased over the counter and are better at predicting ovulation when used properly. Prices range from $9 for a single test to $30 for a box of 10 tests.
Using ovulation prediction kits for two months and timing intercourse with ovulation may be all you need to become pregnant. Sometimes ovulation prediction kits can identify a problem with ovulation, or you may already know that your cycle lengths vary more than is considered normal. Although we are taught that the human menstrual cycle is 28 days, normal cycles can range from 21 to 45 days. Other features of the cycle including days of flow and heaviness of flow are also considered when defining the ideal time to conceive a baby.
Are my hormones in order?
If you have hormonal imbalances, these may contribute to problems with ovulation and the length of your cycle. If you're concerned, a preconception infertility evaluation can help diagnose and optimize your system for reproductive success. Your doctor may order blood tests for levels of hormones such as progesterone, prolactin and thyroid, to diagnose factors contributing to the lack of monthly ovulation. If your doctor thinks your irregular periods may be due to ovarian aging, he/she may order lab tests such as Day 3 FSH and AMH for indication of diminished ovarian reserve.
FSH, the follicle-stimulating hormone, is produced by the pituitary gland attached to your brain and drives the production of eggs during each menstrual cycle. Normally, the FSH level is low on day 3 of the menstrual cycle and then ramps up over the next couple of weeks, as follicles in your ovaries grow and the eggs mature. A high level of FSH earlier, on day 3, may point to a diminished ovarian reserve.
The anti-mullerian hormone, or AMH, is a hormone produced by the ovarian follicles. AMH blood tests can indicate the quantity of eggs remaining in the body, but they can’t be used to determine their quality, which also declines as ovaries age.
Are my fallopian tubes free and clear?
Tubal disease, in which your fallopian tubes are damaged or blocked, can be caused by sexually transmitted diseases, including a pelvic infection. It is not uncommon for a woman to be unaware of an infection because there were no obvious symptoms.
Blocked fallopian tubes can cause infertility by preventing eggs from traveling through to the uterus and puts you at risk for an ectopic pregnancy¹, where the embryo implants outside of the uterus. This condition can be very dangerous, even fatal, to the mother if not diagnosed and treated early. Knowing the health of your tubes and getting the appropriate treatment early can save time, money and minimize the risk of having an ectopic pregnancy.
If your fallopian tubes are blocked, your doctor may recommend surgery to open them. Sometimes, tests that force fluid into the fallopian tubes to check if they are open may also do the trick. In cases that cannot be easily fixed by surgery or to avoid such a procedure, your doctor may recommend trying IVF.
IVF is a medical procedure in which eggs and sperm are fertilized in the laboratory, bypassing the fallopian tubes where fertilization and early embryo growth normally occur. Fertilized eggs grow a few days in the lab until the embryos are ready for transfer into the uterus. Then, your doctor places one (or two) embryos in the uterus with the hope that the embryos will implant and start a pregnancy.
What are some diagnostic imaging tests my doctor might use?
If your doctor suspects that you may have blocked fallopian tubes or structural problems in your uterus, he or she may use diagnostic imaging tests to evaluate whether treatment is needed. These tests include:
► A transvaginal ultrasound to look at your ovaries to rule out ovarian cysts or polycystic ovarian syndrome (PCOS), one possible cause of infertility.
► A hysterosalpingography (HSG) to confirm that fallopian tubes are open for sperm and egg to meet for fertilization. In this test, your doctor injects fluid containing dye through the tubes and looks at the path via x-ray.
► A sonohysterography checks for tubal patency and any unusual growths or abnormal structures in the uterus that can interfere with fertility. For this exam, your doctor injects fluid into your cervix to see whether it follows on a normal path through your uterus and out your fallopian tubes.
► A hysteroscopy is another imaging test that can be used to examine the inside of the uterus for polyps, fibroids and other structural abnormalities.
Is my partner’s sperm normal?
A semen analysis can identify problems that might make fertilization through intercourse difficult or unlikely. But you and your partner can overcome some of these issues with procedures like intrauterine insemination (IUI) or IVF.
If there is a history of damage to the testicles or if your partner was born with undescended testes, he should have an evaluation by a urologist. While severe problems with sperm count or sperm function can compromise your chances of natural conception, most of them are easily overcome by treatment.
When trying to conceive, don’t be discouraged if you encounter challenges. If you suspect that your fertility may be affected by any of these or other medical conditions, you should see a fertility specialist sooner rather than later.
1: The American College of Obstetricians and Gynecologists. Ectopic pregnancy. www.acog.org/Patients/FAQs/Ectopic-Pregnancy
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