This American Fertility Association’s new quarterly publication, Getting Started, is for all of us in the throes of attempting to get pregnant.

Now, we know that you’re all at different points in the journey. Some of you are taking the first “Yahoo, we’re gonna have a baby” steps. Others have been walking the walk for quite some time without the longed-for pregnancy. Maybe you’re among those contemplating the possibility of reproductive problems.

This newsletter is for all of you who may be within that first year of trying and for those of you who are just starting to see a doctor. You’re in that place of wanting to know more, wondering if something’s wrong and needing.

While the focus is on non-medical and low-tech conception, Getting Started will tackle the issues common to everyone in the process.  We’ll talk about the nitty-gritty of conception – from physiology and common misconceptions (pardon the pun) to techniques for improving success. Look for articles about fertility-enhancing diets,

The American Fertility Association wishes to gratefully acknowledge Ferring Pharmaceuticals for generously underwriting Getting Started, underscoring Ferring's commitment to advancing patient care through education.

exercise and lifestyle; maintaining and boosting the intimacy, connection and tolerance between partners; coping with family and friends; dealing with work; and the biggie, managing stress.

Believe me, these are the things you’re going to want to read about because I’ve been through it all. I can still remember the first time my husband and I made love without birth control. After seven years of diligently avoiding conception, we went after it with wild abandon. It was a whole new level of marital bliss. I was totally convinced I’d get pregnant right off the bat.

Well, uh-uh and uh-oh.  After three months of crazy unfettered love, nada. Frustration set in. I reluctantly dipped my big toe in the TTC online community. I bought fertility predictor kits, followed the instructions and peed on the paper. I put pillows under my bottom and stayed stock still after intercourse. I took my basal body temperature each day. I read every book and online article that was available.

So I can pretty well guess that if you found The AFA online, more than likely you’ve been trying to have a baby for a little while and your own giddyup sex is starting to feel a little fraught. Your period may now carry a load of disappointment rather than the relief you felt for most of your life if you thought about it at all. Sometimes it’s hard not to see menstruation as of a signal of failure, loss and betrayal by your own body when all you want is what it seems everyone else has – a baby.

There are lots of things you can do to help yourself and each other during this period. Getting Started is a sure-fire way to get a grip on the situation. Remember you’re not alone. You’ve got lots of company and support. You’ve got The AFA.

See you soon,

Pamela Madsen

More and more, gynecologists serve on the front lines of primary health care for women. In a relationship that important, how is it possible that the most basic conversation about childbearing doesn’t often come up? Well, that’s about to change because it should.

A 20 or 30-something woman should expect her Ob-GYN to have an age appropriate birds-and-bees discussion with her.

If she’s trying to get pregnant, the doctor should not only do the routine exams (including breast and pelvic and Pap smear) and blood tests, but should take a detailed reproductive history. He or she should establish if there are fertility risk factors such as endometriosis, fibroids, a history of sexually transmitted diseases such as Chlamydia, recurrent miscarriages or a family legacy of early natural menopause. Regardless of the patient’s age or circumstance the responsible doctor should tackle the issue of starting a family. Women have the right to be informed.  Physicians have the obligation to impart that knowledge.

If the woman is under the age of 35 and the couple has been having unprotected sex for a year, it may be time to do a series of fertility tests to determine if there are any medical or physiological obstacles to conception. This might include a hysterosalpingogram to determine if the tubes are open and timed blood tests to check ovarian reserve. Let’s not forget the men in this equation.

Couples must also be made aware of the role of the male factor in fertility problems (about 40%) and miscarriage. That makes testing the man every bit as important as testing the woman. The gynecologist should ask about his cigarette smoking, medication usage and the state of his general health all of which have an impact on the state of his sperm. Then, in addition to the traditional counts and cultures, sperm is increasingly tested for quality -- a big shift from a few yeas ago when only egg quality was an issue. This involves sending a sperm specimen to a special laboratory to measure the amount of fragmentation of the nuclear material [DNA] in the head of the sperm.

The second aspect involves the slightly older woman who goes for a routine gynecologic checkup but who is NOT trying to get pregnant regardless of her marital status. Besides the routine questions and exams, the Ob-GYN must raise the topic of childbearing because with advancing  maternal age, as new research confirms, paternal age, comes diminishing fertility. Despite widespread media coverage of the topics, most people don’t understand that critical correlation. It’s all too common that women in their mid-thirties, unaware that they’re jeopardizing their chances of having children, delay having a babies until they require assisted reproductive medicine or it is too late to have a biogenetic child.

Gynecologists should educate women about their options such as donor sperm and embryo and egg freezing to preserve the opportunity to have a child. There’s no guaranteed outcome but these always improving techniques offer real possibilities.

A woman in her mid-30s may not be in the position to have a child or may not  want one, but she has the right to know the stakes. So does he. A trusted gynecologist may just be the best person to give women—and their partners—the straight skinny.

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So you’ve come down with I-want-a-baby syndrome and you’ve got it bad. You find yourself with a gooey smile every time you see a toddler waddling along. The Baby Gap window is positively magnetic – you can’t tear yourself away. You no longer think it is silly to spend prodigious sums on the Rolls Royce of strollers. You’re so ready to be new parents you can’t believe it’s not happening with wham-bam speed. Waddup?

Maybe nothing much. The path to parenthood is unpredictable. For some people, conception happens in a couple of steamy nights. For others it’ll take months and may require serious planning. And some people will need medical treatments to make a baby. All of it is well within the scope of “normal.” It’s just harder for some than others, the way everything in life tends to be.

But you can exert some control over your reproductive destiny. No, it doesn’t involve feng shui, crystals or gravity boots.  It’s much more prosaic than that. It has do with understanding the pretty intricate choreography of conception so you can dance in time, fine-tuning your bodies to be baby-ready, and, of course, putting the reins on stress.  Here are a few tips to get you on the path of making babies.

Baby-Making Basics
Statistically speaking, it will take a 30-year-old couple six months to conceive a child. Nine months for those 35 and older. At age 37, about half of all couples will not conceive within a year. And by age 42, approximately 90% of couples will not have conceived.  Conventional wisdom has it that under 35 couples should hightail it to a doctor if they’re unable to conceive after one year of unprotected sex, and for the over-35 crowd, make it six months.

It may be that there’s a reproductive obstacle that needs medical attention. Compromised fertility does affect more than 6 million U.S. couples and the numbers are going up.

On the other hand your problems may be relatively simple to resolve. If you know what you’re doing.  Do you?

Timing is Everything
There are only 12 to 24 hours each month when an egg can be fertilized. The AFA’s data reveals that up to 20% of couples having trouble conceiving are miscalculating the best time for intercourse.

To make sure you’re  having sex at the right time, figure it this way: Women are most fertile a few days before the middle of their menstrual cycle. To calculate your best window of opportunity, subtract 17 days from the average length of your cycle. That’s your prime time for conception sex.

You can chart your course by monitoring your body basal temperature. Or you

might consider using an over-the-counter fertility kit, which if used properly, eliminates the guesswork.

Have intercourse every other day during your most fertile period, at least four separate times. But don’t go overboard. More than one sexual encounter a day can lower your partner’s sperm count. After intercourse, just lie there in post-coital bliss. That’ll help keep the sperm inside, swimming in the right direction.

Max Out Your Pregnancy Potential – Clean Living
It is a fact of reproductive life that what you eat, how much you weigh, the exercise you do, the colas and coffee you slug and the cigarettes you light up—just to name a few things—can profoundly affect your procreative ability.

Start with a candid assessment of the way you live day-to-day, your physical and psychological self. Then be prepared to make some changes because nobody’s perfect.

Balancing The Scales:
You can be too thin. Or too fat. It’s one of nature’s crueler quirks that weight affects a woman’s reproductive capacity more than a man’s. The female body is at its reproductive best when it’s within 15% of the ideal weight. Ideal, in this context, is not about looking like “America’s Next Top Model.” Ideal is the weight at which your body and its hormonal systems run as smoothly as a well-oiled Mercedes. Many women begin experiencing problems when they’re less than 95% or more than 125% of that weight.
 
Should you find yourself at either weight extreme, consult your doctor and a nutritionist. (We’ll have more on the surprising role of food in the next issue of Getting Started,) do not try crash or fad diets to gain or lose girth if achieving and sustaining a healthy pregnancy is your goal.

Feast for Fertility
It’s simple. Eat all the things you know you should but probably don’t. Lots of fruits, vegetables and low-fat protein. Have at least three nutrient-laden meals daily and treat yourself to snacks of the cottage-and-fruit variety (sorry, but ix-nay on the Haagen Azs-Day). Don’t skip meals. If weight loss is on your to-do list, limit portion size and savor flavorful foods.

Despite your best efforts, it just may not be possible to get all the vitamins and minerals you need from food. So, men and women, go for a good supplement that doesn’t tout megadoses, especially of fat-soluble vitamins such A and D that can build up and become toxic. Avoid herbal supplements unless they’re cleared by your doctor. They’re often potent, untested and unregulated.

Limit caffeine and alcohol intake. One cup of coffee a day should suffice. A glass of wine might not hurt, but moderate to heavy drinking takes its toll on male (sperm shape and motility) and femalvulatory dysfunction) fertility and has a deleterious effect on embryos and fetuses. 

Get Exercised
Bend, stretch, run, lift weights, take yoga and maybe a bit of Pilates for good measure. Keep it moderate because you can overdo it.  Exercise junkies and serious athletes risk plummeting fertility.

Among women who log more than 30 or 40 miles a week running, the risks are high for amenorrhea (no periods). Men, though less vulnerable to the side effects of uber-workouts, are not immune—with lowered sex drives, drops in testosterone levels and sperm health on the line.

Haz-Mat Suits, Anyone?
Let your lawn go au natural. Let the deck paint peel. Pesticides, weedkillers, paint thinners and the like can have a deleterious effect on male sexual function and sperm production. Women working with chemical solvents—nitrous oxide, vinyl chloride, for instance—may be at risk for early miscarriage. Wear protective gear when working with these substances, particularly if there’s regular exposure at your workplace.

Smoking Out The Danger
Smoking will stunt your capacity to reproduce. Period. It poisons gonads and increases susceptibility to sexually transmitted diseases in both men and women. It ups the likelihood of tubal pregnancies, cervical cancer and pelvic infections. Need any more be said?

Keep Your Head
You’ve been playing by all the reproductive rules. So far, all you’ve got to show for it is a growing sense of panic.  With both of you focused on the baby goal, the relationship between partners can start to feel fraught. Don’t suffer. Do something.

Couple care
Communication between you is critical. Talk about what’s going on. Remember that you want a baby because you love each other. And while sex may now feel like one more chore, make room for other intimacies: hugs, kisses and perhaps physical contact that doesn’t always lead to intercourse.

Self-love
Pay attention to yourself. Take yoga. Meditate. Take a scented bath. Read. Listen to music. Whatever. Just do it. If it deflates the internal tension, it’s good.  

Public disclosure
Both of you should decide whether or not to tell. Of course you’re excited about the possibility of becoming parents and there’s a desire to share the news with your parents, your siblings and your friends. If you do, be prepared for unsolicited advice and, inevitably, pressure. Stay cool. Keep a sense of humor and lean on each other for support.

Check our future issues of Getting Started for more about managing relationship stress.

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