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Getting Pregnant Can Be Tough

A lot leads up to the decision to get pregnant: thinking, fretting, saving, planning, and best of all-practicing! But when the moment arrives that you and your partner decide it's finally time for your egg to meet his fleet of tiny Michael Phelpsian fertilizers, you want it to happen pronto. That desire for instant pregnancy-test gratification is what prompts some women to start browsing the fertility websites when that telltale double pink line eludes them during the first few months of trying. And in cyberspace, successful conception seems rarer than a backyard UFO sighting. The offline facts: Female fertility starts to decline at the tender age of 27; by 35, a woman is considered to be "of advanced maternal age," a senior citizen in the maternity ward. Even more troubling: More than 6.1 million people of childbearing age in the United States experience infertility-about 10 percent of the reproductive-age population, according to the Centers for Disease Control and Prevention. And anytime even a fertile couple tries to get pregnant, the chances of success are a mere 20 percent per cycle. Hearing these stats, it's easy to bug out, but the news isn't really so dire. "It's not as if there's an epidemic of infertility out there," says Victoria Jennings, Ph. D., director of Georgetown University's Institute for Reproductive Health. "Apart from more women trying to get pregnant later in life, there are no data to suggest that the rate of infertility has increased." And even for women in their late thirties and early forties who are having problems, each day brings treatment breakthroughs and an increased understanding of how pregnancy happens. We know-you're still worried. That's why we've talked to top fertility specialists to get the answers to women's most common questions. Consider this your CliffsNotes on getting knocked up. When is a woman's most fertile time? You have only about a six-day window each month to conceive-your most fertile period actually begins five days before ovulation and ends about one day afterward. This is because the sperm (which can survive for more than 100 hours) need to be in the upper part of your fallopian tubes when the egg comes out of the ovary. And conception is more likely to happen when intercourse is before ovulation, not after. The best strategy is to have sex at least every other day during that fertile window. But here's the rub: It can be hard to know exactly when you ovulate. Even if your menstrual cycle is, say, precisely 27 days every month, ovulation doesn't necessarily take place at the same time each cycle. An OTC ovulation test kit can tell you when you're about to ovulate, but by then you've missed several fertile days. At Georgetown's institute, this baby-making method is recommended for women whose menstrual cycles are usually 26 to 32 days: Have sex every other day from days 8 through 19 of their cycle (day 1 is the first day of your period). Does having sex in certain positions up the chances of making a baby? You don't need to switch from reverse cowgirl to missionary: Doctors say sexual position has no effect on fertility. Nor do you have to invert yourself into a headstand once the deed is done. The truth is, sperm have just a few minutes to swim into your cervical mucus, where they hang out and are released into the uterus over the next several days. Elevating your hips on a stack of pillows or hanging upside down at the time of ejaculation will not enhance the chances of that happening. Are there any symptoms that could indicate getting pregnant will be tough? Unfortunately, no. "Most of the time, there are no symptoms, and fertility-sapping conditions like ovarian cysts, fibroids, chlamydia, and polycystic ovary syndrome often go undiagnosed until a woman tries to become pregnant," says Louis Weckstein, M.D., medical director of the Reproductive Science Center of the San Francisco Bay Area. "The exception is endometriosis, which can result in significant pain during intercourse or menstruation." If you haven't yet had a checkup with your general physician or ob-gyn to make sure you're healthy and free of STDs, do it now. Why is a woman's age so freakin' important? It's the number-one determining factor for fertility. Sure, we hear about 50-year-olds miraculously giving birth after having fertility treatments, but the truth is, even with in vitro fertilization (IVF), the chances of having a child at age 45 are a mere 1 to 2 percent. The reasons: As women get older, their number of healthy eggs dwindles. And around age 35, the system inside the body that causes eggs to be released starts to break down, making ovulation more difficult and less frequent. (Home ovulation
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tests can tell you if you're rolling out an egg every month.) So while you may have hundreds of thousands of eggs-in-waiting, only a select few will ever mature enough to be pushed out by your ovaries. Still, today's baby-making technology means that significant numbers of women are conceiving well into their forties. (That 1 to 2 percent figure cited above translates into a decent number of rug rats.) According to the National Center for Health Statistics, between 1990 and 2005, the number of infants born to women ages 35 to 39 rose 52 percent, and the number born to women ages 40 to 44 has doubled since 1981. Do guys have eternal fertility? "Women's fertility starts to decline in their early thirties and then drops even faster in their late thirties and forties. Men's fertility does the same thing, but less rapidly," says Harry Fisch, M.D., director of the male reproductive center at NewYork-Presbyterian Hospital in New York City. Testosterone levels decline about 1 percent per year in men after age 30, and as a result of that, their sperm counts can start falling. There are a few signs that a guy's sperm may need a tune-up, says Fisch. "Is he overweight? Testosterone is broken down in the fat cells, especially those in the belly, so the more fat the man has, the lower his testosterone levels tend to be. Does he have small (less than one and a half inches in diameter) or low-hanging testicles? That can be a sign of varicose veins in the area, which can cause low sperm counts and low testosterone." Early interventions can treat these problems, and fertility treatments can boost your partner's chances as well as your own. For men who have defective sperm or a low sperm count, "we have basically solved male infertility in 99 percent of cases, thanks to procedures that can isolate the best sperm from the rest," says John Jain, M.D., a reproductive endocrinologist in Santa Monica, California. Could taking antidepressants (or any other meds) get in the way of making a baby? Antidepressants are one of the most common drugs American women take long-term, and in general, these meds don't affect the menstrual cycle or fertility (unlike certain drugs for bipolar disorder, which can have an impact on fertility). Doctors discourage patients from quitting cold turkey because the risk of relapse of depression would be very high, and the idea is that a happy, healthy woman is more likely to have a healthy pregnancy. No antidepressants are "approved" for use in pregnancy or breast-feeding, but they may still be taken if the benefits outweigh the possible risks. While there have been concerns that drugs such as Prozac (fluoxetine), Celexa (citalopram), and Zoloft (sertraline) might increase the risk of birth defects, the majority of studies have not found this to be the case. But other drugs can interfere with your fertility. For instance, some (not all) experts say that antibiotics can change your cervical mucus patterns, making it difficult to tell when you're ovulating, and cold medicine with antihistamines can thicken or dry up cervical mucus, so it's harder for his sperm to connect with your egg. If you're taking any medication regularly-including herbal ones-run your pregnancy plans by your pharmacist or prescribing doctor to discuss whether the risks of quitting outweigh the benefits. Same goes for your partner. Can fretting about getting pregnant prevent it from happening? Try to chill, but mainly for your peace of mind. According to a survey for Resolve, the National Infertility Association, 64 percent of women mistakenly think stress, which isn't a medical condition, is what makes conception difficult. In fact, many doctors also believe there's a link between stress and fertility, but no scientific study proves that being frazzled hurts your chances of getting pregnant. "Clearly, women all over the world are under severe life-threatening stress and they still get pregnant," says Shari Lusskin, M.D., director of reproductive psychiatry at New York University Langone Medical Center. "So why can't some highly stressed career women? We really don't know if stress is a cause." One theory: "Too much emotional or physical stress-think constant worrying or training for a marathon-can lower your progesterone levels, which could interfere with ovulation," says Sami David, M.D., assistant clinical professor of ob-gyn at Mount Sinai Hospital in New York City and coauthor of Making Babies: A Proven 3-Month Program for Maximum Fertility. "But we don't know enough to draw easy conclusions about a link." So for now, the best advice is to relax and try not to let the ticking of your biological clock drown out everything else in your life. And remember: The odds of getting pregnant are in your favor.

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