What can I do to get pregnant before we decide it's time to see a fertility specialist?

When friends or acquaintances are having troubles getting pregnant they often ask me, "What can I do to get pregnant before we decide it's time to see a fertility specialist?" The official definition of infertility is "The inability to conceive a pregnancy after 1 year of unprotected intercourse for women under 35, and six months for women over 35."

I tell my friends that there are several steps you can take with your OBGYN prior to visiting a fertility specialist. If you already know that you have an infertility factor, then visiting a fertility specialist sooner may improve your chances of having a family. Time is important when it comes to fertility, as a woman's age increases her fertility decreases. Women are most fertile between the ages of 20-28 and fertility really begins to decline after 35.

I always mention that if you do go to a fertility or IVF (In Vitro Fertilization) clinic, it doesn't mean you'll automatically be doing IVF. The majority of fertility specialists want to try lower tech and lower cost measures first before they recommend IVF. These other treatments may include clomid, diet and exercise, diagnostic testing and possibly surgery.

Each month a fertile couple (maternal age under 35) has about a 20-30% chance of conceiving, most couples believe that once the birth control goes out the window it should be closer to 70-80%! This is important to remember if you and your partner have tried for a couple of months without a positive pregnancy test.

This is the game plan I suggest to my friends if they have been trying for several months without luck.

1. Start charting your cycle. If you have been on hormone controlled birth control for a while, then your natural cycle may be very different from your 'medicated' cycle. Get to know what your natural cycle is like because it can be useful information if you end up at a fertility specialist. Plus it's important for women to know the handful of days each month when they are ovulating and can conceive. There are many websites that you can log onto, and even apps you can download to chart your cycle and tell your when your most fertile days should be. I used Pink Pad lite for my iphone, which was free and helped me to monitor my menstrual cycle when I first stopped taking birth control pills. Some women ovulate earlier than suggested and others later.

2. Using ovulation predictor kits can be helpful for some women to discover when/if they are ovulating in their cycle. Don't panic if you don't surge, I tried an ovulation predictor kit during the same cycle that I got pregnant with my daughter and it never surged for me. While there may be some value in using them they are not 100% accurate.

3.  If it's been several months without success and you're charting a normal cycle and surging from the ovulation predictor kits then I advise that the male partner have a semen analysis done. It's a painless and relatively inexpensive test (average around $175-250) that will let you know if his sperm is up to standards.

4. Try acupuncture - this IS even for the needle phobic, which I was, until I tried acupuncture. They shouldn't call them needles because they don't hurt, and they are hair thin. If you do get pregnant you're going to have your blood drawn a lot, and acupuncture needles are nothing in comparison. I found the experience to be very relaxing and have had it done many times. The best way to track down an acupuncturist that has fertility experience is to call your local fertility specialist and see who they recommend. Many fertility centers work with acupuncturists to help improve their patient's experience and potentially their pregnancy rates. I love acupuncture because it is holistic and covered under some insurance plans, if not, you can use your flex spending account money toward acupuncture.

5. Talk to your OBGYN and find out how much experience they have with fertility diagnosis and treatment. Not all OBGYN's are equal when it comes to how knowledgeable they are at diagnosing and initially treating infertility. I would call your local fertility center and ask if there is an OBGYN they would recommend. Often times fertility centers will know which local physicians send them the best initial fertility work ups and those are the OBGYN's you would want to start with.

6. Your OBGYN may put you on clomid which is a pill that induces egg production and ovulation. It is important to not do too many clomid cycles because there have been studies that suggest that women who are on clomid for many cycles (12+) could have an increased risk of ovarian cancer. Additionally, if you're on clomid for close to a year it's likely that you should try a different approach including IVF. Many fertility specialists do a maximum of six cycles of clomid before moving on to the next treatment course.

7. Talk to your OB/GYN about having an AMH (Anti-Mullerian Hormone test) done, which is a test that can help to give you a better idea of the size of your remaining egg supply. This test doesn't give you the quality of your eggs, but rather an idea of the quantity of eggs that you have remaining. Result from this test may suggest that you need to see a specialist sooner rather than later.

8. Have your OB/GYN do a Hysterosalpingogram (HSG). This is a test that injects dye into your uterus and out through your fallopian tubes. This will let the physician know if you have any issues with your uterus or blocks in your fallopian tubes that could be causing problems. There have been studies that suggest a slight increase in fertility potential following this procedure.

These are just a few suggestions of what you can do prior to deciding it's time to move on to a fertility specialist. Educating yourself about your cycle and reading about fertility from reputable sources can help to alleviate some of the stress you may be feeling about going to a fertility specialist. Below are a few resources I feel are helpful to educate and empower and offer support.

http://www.asrm.org/patient_resources/
http://cnyfertility.com/
http://resolve.org/

Leave your kids at home - it makes you a better mom

Who were you before you were a mommy? I remember going out when it was dark more often, and lots more time with friends, but mostly I remember the feeling that I could go anywhere, do anything and not feel an OUNCE of guilt as I enjoyed myself -"100% Pure Freedom Lareina".

Join me present day. Once 7:45 hits I'm starting to prepare our toddler overlord that bed time is quickly approaching. This is never met with acceptance, but instead with shock, horror, and tears as she wriggles on the floor. Yes Sidonie - bed time happens EVERY night. Every night. Eventually her fate is accepted. A few minutes pass and we head upstairs with promises of extra books for good behavior as we brush teeth, go potty and get PJ's on. Once the books are read, we've done our family cuddle, and baby massage and extra cuddles from mommy are complete I drag my exhausted butt to our bedroom. Clock it - 8:30 and I'm just steps behind her getting my PJ's on and teeth brushed anticipating the full body relief as my head hits that inviting pillow. This is pretty much the status quo. That is, unless it's mommy's night out.

My ex-husband has our daughter every Thursday night and every other Friday and Saturday night. At first her absence was devastating to me since I had been the only one caring for her every night for the first year and a half of her life as I was a single mommy, but when we moved closer to my ex-husband the schedule changed. I decided that instead of staying at home, moping about missing my little one I would re-introduce myself to "100% Pure Freedom Lareina". I gotta say, she's a pretty 'rockin chick. :) Those nights I'm free to be the old me again, to go and flip through mindless magazines uninterrupted at Barnes & Noble, to meet friends out for dinner and drinks, get a massage, go to a yoga class, or to just see where the night takes me. Divorce and sharing custody have literally no perks, other than not being married to a jerk anymore, and being forced to be away from your child really isn't one of them - but sometimes you just have to change the thought process and make yourself believe it's a perk.

The perk I have translated the situation into, is that when I do 'carpe diem' on my nights away from Sidonie,  I'm able to return home feeling rejuvenated, less stressed and like I just treated myself to something special.  Spending some time in my old shoes is good for me, and ultimately good for Sidonie. I think it's so easy to lose yourself 365 days a year to being a mommy, since it's a role that never ends.  Mommies are always putting kids, husbands, work, extended family - you name it at the top of their priority list leaving themselves at the bottom. That can only translate into exhaustion, frustration and a little bit of resentment.

Most moms liked themselves before they had kids. Don't forget that YOU are still YOU, and have YOU-needs and YOU-wants and that the best thing you can do for your child (and probably your husband too!) is to spend some time away from them and with YOU. Many moms seem to get stuck in the guilt cycle of "I can't leave my child home - they need me 24/7!" or "Oh my husband works so hard I feel guilty leaving him with the kids after a long day" or my favorite "Oh Jimmy doesn't seem to be feeling very good, I should probably just stay home". If your husband can't handle them for one or two evenings a month then he needs to go to daddy camp. I know it's hard to give up some of the control and responsibility when you are a stay at home mom, because essentially your kids are your job. But like any job - you NEED to take some vacation time so you can be a better employee - er..mommy.

So be a good mommy. Leave your kids at home. Make a date with your girlfriends (or with yourself) mark it on the calendar, text/email, and verbally confirm it with your husband so he knows your are taking some YOU time. Leave the mommy guilt at the door (daddy CAN handle it - even if he does it differently than you) and re-introduce yourself to "100% Pure Freedom Woman". YOU will be glad you did (I hear she's a 'rockin chick).

How I've spent my 20's and 30's - Baby Making.

While I didn't actually become a mom until I was 30, my entire 20's and 30's was been devoted to making babies. I'm an embryologist at a fertility center, which in layman's terms means I make babies for couples who are undergoing IVF (In vitro Fertilization) treatment.

I'm lucky to have found a career that I enjoy, and a life that has reached a point of pure bliss - but it has been one heck of a path to get there. Since I got into IVF I've lived in four states, have moved well over a dozen times, have been married three times and divorced twice and have an amazing three year old daughter and a little boy due in July of 2012. My life has been anything but steady and slow-moving. But through it all there has been one steadfast constant - making babies. When things in my world seemed tumultuous or too much to handle, going to work to help couples conceive their dreams was my calm and peace. The look in a couple's eyes when they learn they are pregnant after fighting their own battle with infertility is something that is only comparable to the joy that I felt when I first looked into my daughter's eyes.

My life has given me many opportunities to experience things that I never thought I would, both good and bad. I feel like I have many stories and experiences to share about making babies, raising babies and how I've survived and (mostly!) enjoyed it all. Thanks for reading.

Lareina