When Getting Pregnant Isn't as Easy as You Think

My high school insistence on the pill was likely a result of a health education in which preventing pregnancy was the sole focus of conversation surrounding sex. It's certainly important to learn about safer sex (and, let's face it, not every student gets that) and the risk of pregnancy and STDs as a young person. But the focus on preventing pregnancy can follow us into adulthood, when our OB-GYNs are often advising on birth control rather than future family planning. So when are we supposed to learn how to get pregnant, if that's something we so desire?

Turns out, a lot of people are misinformed about baby-making.

"No one really teaches us how to conceive when we're ready to do so," said Cary Dicken, M.D., a board-certified reproductive endocrinologist at RMA Long Island IVF. "I think the majority of my patients are very surprised to learn, especially as we get older, it's not that easy to get pregnant every month."

Understanding when to have sex to conceive is the first hurdle, and Irvine, California-based fertility coach Elizabeth King said she works with plenty of people who are not getting pregnant, simply because they're trying at the wrong time.

If you turn to Google for this information, you might think day 14 of your cycle is the best time for trying to conceive (TTC). This average day of ovulation is based on a 28-day cycle. But most women do not experience the "average" cycle. Even month to month, there can be discrepancies in the timing of when you ovulate.

King said all kinds of environmental and situational factors can impact when you ovulate each month. "Sometimes it's stress-related. Even travel can throw your cycle off."

While women hear plenty about "biological clocks"—and there shouldn't be added pressure to have kids ever or by a certain age—there is a distinct lack of education on how to conceive when/if you want to do so. And it's hurting many who are eventually trying and struggling.

Another common misconception is that if a couple is not getting pregnant, there must be something wrong with the woman. But 40 percent to 50 percent of all infertility cases between a man and a woman are due to a male factor. If a couple is struggling to get pregnant, both partners should see their doctor about fertility health assessments.

The standard protocol is for OB-GYNs to refer you to a fertility specialist after one year of TTC if you're under 35 and six months if you're 35 or older. (The discrepancy is based on the fact that fertility tends to drop faster for women after 35, so you want to identify any problems ASAP.)

But that pattern seems to be shifting, likely as a result of improving access to fertility health education and at-home hormone testing. "I'm definitely seeing more people coming in who are younger," Dicken said.

Fertility experts are increasingly encouraging a more proactive approach to fertility health, which might mean testing as soon as you're trying to get pregnant, or even before. While the argument against testing early is that it can cause undue stress and there is no definitive test to identify fertility issues, having information on potential issues and overall health can help shed light on the possibilities. Information about your fertility health can be a helpful tool in your conversations and decisions about future family planning, no matter where you're at in that process.

A standard fertility assessment is the first step, whether you're struggling to conceive or simply want to gather all of the information right away.

At Kindbody, a clinic specializing in fertility health access for people at all stages of life and TTC, a fertility assessment for women includes three parts: a blood test, an ultrasound, and a consultation to review health and family history, and to discuss the results. The blood test measures Anti-Müllerian Hormone (AMH), the hormone considered most reflective of your ovarian reserve. The ultrasound, conducted vaginally with a camera on a wand (it kind of resembles a dildo), allows the doctor to count egg-producing follicles, which indicates the number of eggs available to potentially be released during ovulation in a given month.

The consultation allows doctors to help you assess the results and how they relate to how many kids you want to have and when. So, for instance, if your AMH levels are very low and you're hoping to have three kids, it might be wise to start trying soon or consider freezing your eggs, as low AMH can indicate a higher rate of ovarian aging.

Other fertility assessments may look at levels of luteinizing hormone (LH), progesterone and your thyroid. These tests can be done at a fertility clinic, but you may also choose to take an at-home fertility test, which are becoming increasingly popular

Some women will also be referred to a specialist for a hysterosalpingogram (HSG). In this procedure, a thin tube is inserted through your vagina into your uterus to release a fluid that can be viewed by X-ray. The fluid runs through your uterus and your fallopian tubes, allowing the doctor to view any blockages. If one tube is blocked, then you're likely only ovulating every other month, when the unblocked tube releases an egg. If both tubes are blocked, then sperm is unable to reach an egg and the blockage must be remedied in order for you to become pregnant.

This test has actually been shown to increase your odds of getting pregnant in the two cycles following the procedure, simply by having it done. It's thought that the dye running through your tubes can clear the way for an easier passage for sperm and egg to meet.

As we mentioned, women aren't the only ones who need to get tested. Men whose partners are not getting pregnant should have a semen analysis done to look at signs of infection, semen volume, and sperm concentration and motility (how well they are swimming). A visit to the doctor will also include a review of your health history, lifestyle, any medication and a variety of personal details that may impact fertility.

The first time Breanna Hughes got pregnant, it was a complete surprise. She and her partner hadn't been trying. Sadly, that pregnancy ended in miscarriage. But their ability to get pregnant without trying gave the couple confidence that it wouldn't be difficult to do so again. Five years and four more miscarriages would happen before Breanna and her partner finally had a successful pregnancy. She's due to give birth any day now.

After the first two miscarriages, they decided to visit a fertility specialist.

"We thought we'd just go to the clinic and get treatment right away," Hughes said. Then they learned there was a six-month wait to even be seen for an initial assessment. "The rule of thumb I tell people now is that if you feel ready to see a fertility specialist, you're too late."

It's a good argument for making the appointment as soon as you're trying to get pregnant, or at least calling to find out what kind of wait you might be looking at, if and when you need it. But also, some doctors may be able to test certain aspects of fertility health before you're referred to a specialist, which can give you a better idea of whether or not it will be necessary.

In the months they waited to see a specialist, Hughes tried all sorts of things to get pregnant. She wore a bracelet to track ovulation and started weekly acupuncture treatments. She used ovulation predictor kits. Through online research, she cobbled together what she now calls a random assortment of supplements and prenatal vitamins. The lack of comprehensive information on what kind of supplements to take inspired Hughes to start her company, Bird & Be, which offers customized supplement regimens for people who are TTC.

Depending on who you ask and what type of doctor you see, advice on how to address fertility issues runs the gamut. My fertility specialist put me on some supplements following bloodwork and recommended acupuncture, which is thought to improve ovarian and follicular function.

Every journey to parenthood is going to look different. And if you find yourself seeking answers to infertility, the ones you come to will be based on your own beliefs, preferences, and the advice of your doctors and other care providers. It's a journey that can be fast and exciting or long and heartbreaking, and any number of in-betweens. But if you do find yourself struggling to conceive, Hughes said to remember this journey can be a long one, and it's so important to find celebratory milestones along the way.

"If you look at the end goal of having a baby, some days that goal will seem so distant—it's crippling and impossible." Hughes would mark other milestones to celebrate little wins along the way, like taking her prenatal supplements every day.

"I know nobody wants to come see me," Dicken said, who works with people through all types of fertility treatments. "It's a roller-coaster ride."

But Dicken said there are also options and solutions for most people, everything from thyroid medication to IVF to surrogacy or adoption. First thing's first: Understanding your fertility health and where you're at in that journey will prepare you for the many directions it might take.