IT TAKES 2 TO TANGO

Infertility. It’s something way too many couples are familiar with. In fact, 8-12% of couples experience infertility. Infertility is defined as not just difficulty with getting pregnant, but staying pregnant. As we’ll discuss in this post, while medical intervention may be necessary at some point, there are a myriad of things you can do to prepare for conception, increase your chances of successfully conceiving, and reduce your risk of infertility. And, even if you ultimately find yourself choosing to pursue more intense medical interventions like IVF, the strategies discussed in this series can improve your chance of a successful outcome!

Infertility by the Numbers

While every month without a positive pregnancy test can feel like an absolute eternity, true infertility is clinically defined as more than 12 months of active trying without a successful pregnancy. If the woman is 35 or over, 6+ months of trying without success is considered infertility. And, if you’ve been on birth control, especially long-term, this can make it take even longer for conception to occur and fertility to return. Now, this doesn’t mean you should wait to “do” something until it’s been over a year! You can start right now, today. And if you read the first post of this series about when to start, you know that the sooner you do, the better!

15-20% of pregnancies end in miscarriages; 75% of which occur in the first trimester. These numbers may actually be higher, as many women experience what’s known as a chemical pregnancy, where the pregnancy is lost so early on that they didn’t even know they were pregnant yet! Secondary infertility, or infertility after you’ve already had a successful pregnancy, affects around 30% of couples. So in your circle of 5 friends, at least one is likely to have a miscarriage, while 2 of them are likely to experience secondary infertility. I say this not to be alarmist, but to point out how common this is, yet how little we discuss it. The focus tends to be on the babies we meet instead of the ones we don’t, but as a momma who has several angel babies, I’m all too aware of how precious those little unmet babies are.

If you know someone who’s experienced infertility or if you’ve experienced it yourself, I’d be willing to bet that the focus was on what the woman was doing (or not doing) that was the “problem”. Research has focused almost exclusively on the female contribution to pregnancy, to the detriment of advancing the field, in my opinion. What we are currently beginning to recognize is how significantly men contribute to this issue! In fact, recent research suggests 40-50% of cases of infertility actually stem from MALE factors. That’s right, it takes two to tango, and men are JUST as likely to be the issue in cases of infertility (and miscarriage) as women.

Keep those Swimmers Happy

Sperm. They are delicate little buggers! While men often like to think of themselves as macho and “manly”, their sperm are, well, anything but. Temperature changes, weather/season, alcohol, diet, excess weight, and a sedentary lifestyle can all affect sperm quality and quantity. And, since the most common cause of miscarriage in the first trimester is genetic issues (i.e. baby wasn’t likely to be healthy), this matters! Poor, unhappy sperm = increased risk of miscarriage. Sperm provide HALF the genetic material for baby! If half the genetic material isn’t good, outcomes are unlikely to be either! In fact, recurrent miscarriage may actually be from unhappy sperm. Beyond that, it appears that the MALE genetic contribution is responsible for the placenta. In other words, an unhealthy placenta may be from unhealthy sperm. This could influence pre-eclampsia, baby’s in utero growth, and more. Research has already shown that there is an increased risk of pre-eclampsia in the mother if her male partner was born to a mother who had pre-eclampsia. In other words, it appears this risk can pass down the male line, suggesting a genetic component. With all of that, why WOULDN’T we want to study sperm extensively? And why do most cases of infertility focus on the woman?

It Starts with the Egg

Yes, sperm definitely plays a much larger role in a healthy pregnancy than we currently give it credit for, but a healthy egg is also essential to a healthy pregnancy. First, an egg must be released. No egg, no pregnancy, no baby. This is why having a regular, healthy cycle is key to fertility. Not only do we need an egg to be released, but we also need a long enough luteal phase for the egg to have a chance to get settled in the uterus if fertilized. And, we need healthy cervical mucus to support the sperm getting to the egg in the first place! Just like the sperm, the egg also should ideally be healthy. The egg provides the other half of the genetic material. If the egg isn’t happy, it’s much more likely conception won’t occur or it will end in miscarriage. Like sperm, the egg is also quite sensitive to oxidative stress (inflammation). 

Timing

Remember, step one to getting pregnant is getting regular. No cycle = no egg = no baby. You want to make sure you have a regular cycle and you’ve recovered from any sort of birth control depletion you might have. I’ve said it before, but it can’t be overstated – an abnormal cycle suggests hormone imbalance, which is not ideal for conception OR a healthy pregnancy. As I mentioned above, birth control use can extend the time it takes to get pregnant. Ideally, you want to get off of birth control and start preparing for baby a good 6 months before you hope to conceive (3 months if you weren’t on birth control! Remember, it take 90 days for the egg to fully mature). In women that hadn’t been on birth control, or got off of it and prepared before trying to conceive, the average time to conception was about 4 months, versus EIGHT months if they were on birth control prior to trying to conceive!

So, if your cycle is regular, when should you be trying to “tango”? Recall that ovulation only occurs once a month, and you are only fertile for 5, MAYBE 7 days each cycle. The most obvious sign of ovulation is a change in cervical mucus. When you start to see an uptick in cervical mucus, you’re in your fertile window. You should see a day or two of peak mucus (egg white, stretchy) right before ovulation. When the mucus stops, so does your window for trying for the month. LH strips (luteinizing hormone) can help predict ovulation, but can’t confirm it. A rise in LH signals the follicle is getting ready to release the matured egg. A positive LH suggests the egg will be released within the next 24-36 hours (it might NOT be, but if there’s an egg that’s going to be released, that’ll be the window!). Temping can only CONFIRM ovulation, not predict it. So if you’re charting your temps for a few cycle prior to trying to conceive, you can at least get a sense of when during your cycle you typically ovulate. Finally, cervical position and firmness can also indicate your fertility. A high, soft, open cervix = fertile; a low, firm, closed cervix = not fertile. 

With healthy cervical mucus, the sperm is able to live for up to about 5 days inside the woman’s body. And the sperm MUST be there, ready to meet the egg when it is released (so if you wait UNTIL you ovulate, you’re likely to miss the egg as the sperm is working its way towards it!). Once ovulation occurs, the egg only lives for about 12-24 hours before it begins to breakdown. So if you want to get pregnant, ensuring the sperm is there before ovulation is crucial. In general, when you see fertile cervical mucus, it’s go-time! Studies have not found much of a difference between every other day or every day intercourse and conception success during the fertile window. If you’re using LH strips, the day you get a positive is definitely a good day to tango!

Forget what healthy ovulation looks like? Check out this post!