Getting Pregnant

THE BIRDS AND THE BEES

If you are planning to get pregnant, a short review of the "birds and the bees" may be helpful. If intercourse takes place around the time of ovulation and adequate numbers of sperm are delivered to the cervix, pregnancy may occur. So, the estimation of the time of ovulation to time intercourse accurately is critical.

Couple at the beach

The semen forms a gel following ejaculation that then liquefies in 20 or 30 minutes. Some of the sperm move into the cervical mucus within minutes. Uterine contractions propel the sperm up through the uterus, and sperm can be found in the tube in as little as four minutes. (This extremely rapid movement explains why douching is not an effective contraceptive method.) The female partner should not get up immediately after intercourse to maximize the chance of pregnancy.

The numbers of sperm are dramatically reduced as they ascend the genital tract. Most are lost by simply leaking out of the vagina. However, in the upper genital tract, many get eaten by scavenger cells all along the reproductive tract (a process called phagocytosis). Also, some are lost through the fallopian tube into the pelvic cavity. So the next time someone tells you that all you need is one sperm you will know what an understatement that is.

MONITORING YOURSELF

Since "timing is of the essence," it's helpful to understand how your own reproductive system is working. All of these observations are safe, fairly simple to do, and, except for one, free of cost. In fact, some of the simpler ones are utilized by the natural family-planning methods to try to prevent conception. You can put them to use in helping you get pregnant by optimizing your timing of intercourse.

Monthly cycle

date

You can calculate your most fertile time based on the history of your previous cycles, especially if your menstrual periods are regular. Ovulation usually occurs about two weeks before the next expected menstrual period. This is because the luteal phase of the cycle usually lasts 12 to 14 days. So if, for example, you have the often-quoted 28-day cycle, your ovulation probably occurs on Day 15 of the cycle. If your cycle is usually 35 days, ovulation will most likely occur on Day 22. If there is a variation of your cycle of never less than 28 or more than 35, you need to take that variation into account - you will probably ovulate between Day 15 and Day 22. It's easy to calculate, but you do need to know the variation of your cycle length. Remember, no woman is absolutely regular. Even some women who thought they were regular found they were actually irregular when cycles were closely observed.

Temperature chart

If you've had even the most preliminary infertility workup and treatment, you are probably familiar with the basal body temperature (BBT) chart. The concept is really quite simple. It was observed that one of the effects of progesterone on the woman's body is a slight temperature elevation of about a half a degree. A woman's temperature has the least variation day-to-day upon awaking, before any physical activity (basal temperature). Therefore the slight shift caused by progesterone is most noticeable at that time.

fertility chart

If you take your temperature first thing in the morning, before you get out of bed even to go to the bathroom, and chart it for one complete menstrual cycle, you should see following ovulation that the temperature rises and stays up until just before the next menstrual period. You don't even need a special thermometer. A good-quality thermometer that you are able to read to one-tenth of a degree will do. If you have difficulty reading a thermometer, one of the electronic digital thermometers is for you. You should not use the temperature chart to time intercourse. The temperature shift from the production of progesterone has a variable relationship to release of the egg and often occurs some time following ovulation, which may be too late! You can sometimes see a slight dip in the temperature before ovulation, but this is not consistent and reliable.

We feel that the BBT is a valuable way for you to understand your cycle and can be used for scheduling and interpreting infertility tests. However, it is not very good for predicting ovulation. Some physicians do not advise its use at all because they feel that it adds to the anxiety and stress already pres-ent in the couple experiencing an infertility problem. Some use it on a limited basis (for example, for only three cycles) and then, once it has served its purpose, discontinue it. You can judge its value to you for yourself.

Cervical mucus

Like those women learning natural family-planning methods, you can learn to identify the cyclic changes in your cervical mucus. At the time of ovulation, the cervical mucus becomes abundant, clear, and stretchy, with the consistency of egg white. Again, you can use this observation along with the regularity of your cycle and the results of previous months' temperature chart to determine your most fertile time of the month. You can check the mucus by observation or, if not enough is visible, you can check it by putting a finger into the vagina and sweeping it across in front of the cervix to obtain some mucus.

Monitoring the LH surge

Now we are getting more scientific. Over the past decade manufacturers have come out with home test kits for various medical conditions. One of the first and most prominent has been the home pregnancy test kit. There are now a number of these on the market; they give the consumer the opportunity of doing her own pregnancy test and obtaining the result privately.

The home testing trend now includes tests for detection of the LH surge. A variety of tests on the market detect the LH surge in the urine, but we find Ovuquick, Clearplan Easy and First Response to be the most reliable. Ovuquick usually gives a very clear-cut result. After adding three drops of urine to a Test Cassette, you match a test line, resulting from the concentration of LH, to a reference line. When the test line is darker than the reference line the test is considered positive. The results are accurate and the test takes only a few minutes. However, some women do not get a clear result as Ovuquick seems to be sensitive to increases in fluid intake. So, if the results are not clear, a more definitive result may be obtained if fluids are restricted during the testing period.

We usually recommend that the test be done in the afternoon or evening, starting a few days before anticipated ovulation. We recommend doing the test later in the day because the surge most commonly starts in the early hours of the morning and takes some time to reach levels detectable in the urine. If it is done in the morning, you could miss the surge that day and pick it up the next day, one day late. Remember, we are not detecting the beginning of the surge but detecting evidence that the surge started during the preceding 24 hours. Since ovulation usually occurs some 36 to 44 hours after the beginning of the surge and we may be detecting it up to 24 hours after the surge has started, we recommend that couples have intercourse the following day. If insemination is planned, we time it for the following morning.

Using this basic information will help maximize your chances of conceiving sooner and make every cycle potentially more productive.