Fertility Mistakes You (And Your Doctor) Could Be Making

(Don’t let these fixable errors get in the way of trying to get pregnant) Nobody’s perfect, and when it comes to making a baby, there are some common mistakes that couples make, and even some common mistakes that doctors make. Don’t let these fixable errors get in the way of trying to get pregnant.

When Elizabeth Potts Weinstein, a financial adviser and author in San Jose, California, got married in 2004, she assumed she and her husband would conceive in no time. “After all, my sister and friends all got pregnant in just a month or two of trying, and I was just 29 at the time,” she says. So she was stunned when things didn’t go according to plan.

Weinstein picked up a book on charting her body’s fertility signs, and quickly homed in on the problem: She was ovulating at a different time every cycle. Because the couple had focused their lovemaking around the middle of a prototypical 28-day cycle—Day 14—they were missing Elizabeth’s fertile window every month. Armed with the new information, the Weinsteins conceived their daughter, Grace, about six months later.

“I knew that my periods fluctuated all over the place, but it didn’t occur to me that it meant my ovulation fluctuated,” Weinstein, now 34, muses. “Obvious when you think about it, but it didn’t occur to me. Who knew you could ovulate on Day 20?!”

Fertility specialists say that thousands of couples may be sabotaging their best efforts at conception with simple errors like this, and some doctors may unwittingly play a role in the mistakes, too. Luckily, many of these goofs are not only fixable but don’t require a high-tech or pricey solution. Here are the most common blunders specialists see.

Mistakes Couples Make
Using a lubricant

There’s little less spontaneous than having sex for the purpose of making a baby. So many couples reach for a lubricant to facilitate intercourse. Yet, “People are rarely told that almost all lubricants—even saliva—can impede sperm,” says Toni Weschler, M.P.H. And using oils can increase the chance of getting a vaginal infection, she adds. The exceptions: New “sperm-friendly” lubricants, such as Pre-Seed and Conceive Plus, specially developed not to impede the sperm’s journey. Visit preseed.com or conceiveplus.com for more information.

Waiting too long to see a specialist

Used to be, patients were referred to a fertility specialist, such as a reproductive endocrinologist, if they were unable to conceive within a year. This still makes sense for people under 35, but if there are hidden fertility issues (even obvious issues like previous surgery), waiting a full year can set you back unnecessarily, heightening your anxiety and squandering precious time.

If you’re over 35, see a specialist after six months of trying to conceive. And if you’re over 40, “There’s nothing wrong with checking in immediately,” says John D. Gordon, M.D.

Women who have had a prior pregnancy are particularly likely to wait longer than they should. “They assume if they were fertile in the past, they don’t have fertility problems,” says Alice Domar, Ph.D. “But we see a lot of secondary infertility—the inability to conceive or bear a subsequent child. Remember, you’re older now than when you had the first pregnancy—and your eggs are older, too.”

Assuming that regular periods equal fertility

Just because you have a period does not mean you are ovulating or that the eggs you release are of a high enough quality to ensure pregnancy. “This myth is often held among women of older reproductive age,” says Hugh S. Taylor, M.D., chief of reproductive endocrinology and infertility at Yale School of Medicine. “Women think they must be fertile if they’re cycling. But women can go on having periods as much as a decade after they’ve stopped producing good, healthy eggs.”

Women of any age can experience so-called “anovulatory” cycles, during which no egg is released, meaning pregnancy can’t occur. Such cycles can produce some bleeding, which results from a buildup of the uterine lining.

To be sure your periods are the real thing, confirm you are ovulating from the get-go. You can use an ovulation prediction kit, which includes urine test strips to track rises in luteinizing hormone (LH), signaling impending ovulation. Or try fertility awareness techniques: charting your basal body temperature (your temperature upon waking in the morning) and checking the consistency of your cervical fluid day to day, suggests Weschler, who outlines the specifics in Taking Charge of Your Fertility (Collins Living, 10th anniversary edition 2006).

Not ovulating can be a result of several underlying health problems, including a thyroid disorder or polycystic ovary syndrome. Any failure to ovulate warrants further investigation and treatment.

Believing that good health habits will extend your pregnancy prospects

Fertility declines with age: A healthy 25-year-old engaging in unprotected sex has about a 20 to 25 percent change of conceiving in any given month; a 30-year-old’s chances are 10 to 15 percent; by age 40 it’s down to 4 to 8 percent; and over age 43 it’s less than 2 percent. Yet many women believe that their healthy ways will help them beat their declining odds regardless of age. “I’ve had patients in their late 30s or early 40s come in and say they’ve taken care of themselves, never smoked, and eat well. They’ve just gotten married and are shocked that they can’t accomplish their goal of starting a family,” says Dr. Gordon, co-director of Dominion Fertility in Arlington, Virginia, and co-author of 100 Questions and Answers About Infertility (Jones and Bartlett, 2007). Taking care of yourself is important for optimizing your fertility, but “it won’t make your eggs younger or guarantee a pregnancy at age 42,” says Domar, executive director of the Domar Center for Mind/Body Health at Boston IVF in Waltham, Massachusetts.

Missing a woman’s “fertile window”

Many couples may not be conceiving because they’re missing their prime baby-making opportunities. “Either a couple thinks every woman ovulates on Day 14 of the cycle or they have no idea when the woman is most fertile,” Domar says. According to one study presented at the World Congress on Fertility and Sterility, 20 percent of couples seeking help for infertility do so unnecessarily—they just have the timing wrong.

Truth is, not all women ovulate exactly on Day 14, as many women—and even some doctors—believe. Ovulation times vary from woman to woman and also in the same woman from cycle to cycle.

Normal cycles can range from 21 to 35 days, and “normal healthy women ovulate about 14 days before they get their period,” says Domar. Do the math: If you have a 22-day cycle, you probably ovulate around Day 8; if you have a 34-day cycle you probably ovulate on Day 20. Use ovulation prediction kits or fertility awareness methods to pinpoint the event, then let nature take its course.

Even when couples can pinpoint ovulation, however, they may not be taking full advantage of woman’s fertile window. “Some women think they are most fertile after they ovulate,” says Domar. Not so. Women’s fertile period lasts six days—the five days before ovulation and the day of ovulation itself.

Seeking out a fertility clinic just because it helped a friend get pregnant

“Patients will sometimes pick a facility because it helped a friend or a sister get pregnant,” says Domar. “But you have no idea if your problems are comparable. Since many folks who use donor eggs or sperm don’t tell anyone, for instance, a friend getting pregnant at 45 might well have used donor eggs, meaning that her physician is not a magician.”

Domar also cautions against choosing a facility based solely on published success rates. “A clinic which basically allows everyone who walks in the door to cycle, or attempt IVF, is going to have a far lower success rate than one which is highly selective about who gets to cycle,” she says.

Your best bet is to seek out a board-certified reproductive endocrinologist. “Choose clinics whose physicians belong to national and local organizations related to fertility, such as the American Society for Reproductive Medicine, and clinics that align with patient advocacy groups such as RESOLVE,” recommends Ronald C. Strickler, M.D., M.B.A., director of education and research, division of reproductive medicine, Henry Ford Medical Group, Troy, Michigan. And, he advises, go with a provider that is associated with a respected health institution in your area and offers a full spectrum of services.

Mistakes Doctors Make

Prescribing Clomid for no good reason

Some ob/gyns and general practitioners turn to medications that stimulate the ovaries to promote ovulation, such as clomiphene citrate (Clomid, Serophene), when their patients don’t get pregnant promptly. But experts now say there’s nothing to be gained from taking these medications unless you have been specifically diagnosed with an ovulatory disorder. “Clomid does not make you super-fertile. It’s meant to treat a defect in ovulation,” says Dr. Taylor. “People don’t realize there are downsides.”

In fact, taking Clomid inappropriately could make it harder, not easier, for you to conceive. The drug is known to dry up cervical fluid, which is needed for sperm to travel up the reproductive tract. And the medication makes the endometrium thinner, making it more difficult for a fertilized embryo to implant in a woman’s uterus.

What’s more, if your doctor puts you on a trial of Clomid, you may be wasting time that could be spent identifying and treating an actual fertility problem. Says Dr. Taylor, “In older reproductive-age women, that time can make the difference in their ability to conceive or not.”

Failing to perform basic fertility tests

If you’re concerned about your ability to conceive, or you face a long wait to see a reproductive specialist (there are only about 1,050 reproductive endocrinologists nationwide, for instance), your ob/gyn or family doctor can still orchestrate several basic fertility tests to rule out some conception issues. Yet some doctors are slow to order these tests and may even prescribe treatments before doing them. Before you proceed to any sort of fertility fix, you should have the following tests:
•    A transvaginal ultrasound examination to check for abnormalities in the uterus (fibroids or polyps) or on the ovaries (cysts). The ultrasound can also indicate how many follicles are present, which helps predict IVF responsiveness.
•    A hysterosalpingogram, an X-ray assessment of the fallopian tubes when they’re filled with dye. A laparoscopy (an examination through a lighted tube) can also check the tubes and be performed instead of a hysterosalpingogram.
•    Blood tests to check various hormone levels.
•    A hormone test of ovarian reserve, which assesses the number of egg follicles and the health of the eggs within them.

Abnormal results in any of these tests should help point your doctor in the right direction for treatment, or prompt him to refer you to the right specialist immediately.

Forgetting the other half

About half of infertility can be attributed to the male partner, yet it’s still common for doctors to discount his contribution to the roadblock. “We often have couples referred to us where the woman may have gone through multiple cycles of infertility treatment or even surgery, but there’s never been a semen analysis,” says Dr. Taylor. Although men sometimes resist being tested, doctors are also guilty of this omission. Ob/gyns, for instance, are accustomed to treating women, not men.

Luann Udell, a jeweler and sculptor in Keene, New Hampshire, figured that out when, at age 38, she and her husband experienced a delay in conceiving their second child. After 18 months, which included treatment with an ovulation drug, she finally sought a second opinion from another doctor. “He checked our medical records and found that my husband had never had a sperm count,” she says. “Turns out he had a low-grade prostate infection. He was treated with antibiotics, and within a month I was pregnant!”

As soon as a woman gets a fertility workup, experts say, the man should have a semen analysis. In addition to knowing his sperm count, your partner should learn his sperm motility (the percentage of sperm moving normally) and morphology (the percentage that are shaped normally). Dr. Gordon says that for best results, the sample should be evaluated by a specialty lab. And make sure your partner is tested more than once, since sperm can be affected by many factors, including unusual stress or even the common cold.

Using IUI when fertility is unexplained

Like clomiphene citrate, another fertility treatment that may be used to boost conception when a fertility problem hasn’t been diagnosed is intrauterine insemination (IUI). In this technique, sperm that have been separated from semen are injected into the uterus through a flexible catheter. But new research from the University of Aberdeen in Scotland shows that couples with unexplained infertility are no more likely to deliver a baby with either IUI or clomiphene citrate than couples who don’t use it.

Performing outdated tests and techniques

While some doctors fail to perform needed and beneficial tests, others are still ordering once-standard tests that are no longer considered useful and are at the very least a waste