This is the first post in a series about fertility, for women and men. Learn how to improve your fertility, whether you’re using the old-fashioned natural approach or getting some help from reproductive technology. Read the related post Prepare for Fertility and Conception with Functional Medicine.
Interesting fertility facts
- The definition of infertility for a couple is failure to conceive after 12 consecutive months of trying to conceive (TTC) when the woman is 35 years old and younger. For women age 36 and older, it is failure to conceive after six months of trying.
- 1/3 of infertility cases are due to female issues, 1/3 are due to male issues, and 1/3 are unexplained.
- One in eight couples has trouble getting pregnant or sustaining a pregnancy.
- Nearly 40% of semen analyses show abnormal sperm.
Not just a woman’s issue
As a woman trying to get pregnant unsuccessfully, you may feel that something is wrong with you. Our culture emphasizes that fertility is your responsibility – and infertility is your fault.
It may be a surprise to learn that infertility factors (causes) are a 50-50 split between men and women. Sometimes it’s a combined factor. And about one-third of the time the cause is unexplained in conventional medicine.
Fortunately, female and male factors are often due to biological causes that we can identify and improve. When we take a functional medicine approach, we can also identify and treat many of the “unexplained” infertility causes that slip through the cracks with a solely conventional approach.
Trying to conceive (TTC)
Here I use an expanded definition of the term TTC that includes all the ways of intentionally trying to conceive – through intercourse, insemination, or in vitro fertilization.
If you are TTC naturally without success, basic starter questions to explore include:
- Women, do you track your fertile window, what are your methods, and are you sure you understand them? Do you get signs of ovulation, and what are they?
- Men, Have you done a semen analysis? It’s important to know if your swimmers are abundant and mobile. Do you use weed? It can make your swimmer sleepy.
- Couples, do you time sex according to her fertile window?
Gals, you may be self-educated, aware of your cycle, and track ovulation. There’s oodles of information online these days, and fancy apps and software to track cycle details. Yet at least 50% or more of the women I see either do not track their ovulation or do it incorrectly. So, step one is to get cycle tracking down. Let’s get down to business about what this means.
Methods to track your cycle and ovulation
Taking Charge of Your Fertility is a classic and useful book to start with. It teaches you how to track your cycle with basal body temperature, and how to track your fertile cervical mucus. Temperature and cervical mucus are two easy and free ways to track. The third method is an ovulation predictor kit (OPK), which uses disposable sticks that you pee on. All three methods are excellent, and the key is to find which ones work for you.
If you like tracking and making charts, temperature tracking could work well. There are fancy apps and software you can use that make clear charts for you. I recommend Ovagraph or Fertility Friend. For some women, it’s annoying to do this, because it requires doing something every single day, and you may prefer days free from thinking about it! Also, you have to do it before you get out of bed in the morning.
Tracking cervical mucus is fairly easy, it’s something you can do when you pee. Here is a great lesson on how to do it. When you are fertile, cervical mucus has what we call “egg white” consistency. This means if you put your thumb and finger together and pull them apart slowly, it should be slippery and stringy like an egg white. Estrogen production is high during this part of your cycle, and that’s what causes your cervical mucus to become slippery.
Slippery fertile mucus is perfect for both catching sperm and also helping it move through your vagina and past your cervix. If you were to put some of your fertile cervical mucus on a slide and view it through a microscope, you’d see the fascinating “ferned” pattern pictured above.
Ovulation predictor kits (OPKs)
These measure luteinizing hormone (LH). When there’s a surge of LH, it signals the release of an egg from one of your ovaries. This is your LH surge. It’s important to know that your fertile window is before and during your LH surge.
When you release an egg, ideally you want sperm to be waiting in your fallopian tube ready to fertilize it! This means sex right before ovulation is ideal. After you ovulate your temperature should spike, due to the progesterone released from your empty egg sac. Your cervical mucus gets thicker and drier to form a plug to keep sperm inside your uterus. Your OPK should be negative for LH.
Lastly, some women can tell when they are fertile by their sexual desire. Biologically, you can have an increased sex drive during your fertile window. This makes perfect sense. As mammals, it’s similar to being “in heat” which is when female mammals want (or will allow) intercourse. Human females are “in heat” once per month if we ovulate regularly.
Methods NOT to use for tracking
Don’t use an app that just counts your cycle days without measuring any of the above biological signs of your body. These apps assume that you are typical, and make assumptions about when you ovulate that may not be accurate.
The typical or textbook cycle is 28 days, with ovulation on day 14. However, many women vary from typical! You can ovulate way outside of this window. This is not a way to predict your fertile window or your ovulation.
Countless times women have seen me who use apps like this, think they are infertile, and then it turns out they are timing intercourse according to the app and not their own bodies. The app might say your fertile window is day 12-13, and in reality, it might be wildly different, such as day 20-21!
an emotional issue!
Women have a great deal of societal pressure to reproduce, mixed up with our biological urges if we have them. Typically we are raised to think that our lives are not complete if we don’t have children.
Sometimes we think we can plan it out or control it, like other things in our lives. However, this is one area in which we have no control, over if or when it happens at all. It takes letting go of control, and for women who are planners, it can be difficult when fertility doesn’t go as planned. The emotions that come up over the lack of control can be all-encompassing.
If you ovulate regularly, you only have about 12 chances per year to conceive. Women can become obsessed with each chance, to the point of losing perspective on the rest of their lives. It can be an emotional roller coaster every cycle. I highly recommend talking about your feelings with your partner and other safe supportive people!
Planning questions before TTC
I’m a big fan of conscious conception, which means developing an awareness of what TTC means to you. These are useful questions to explore:
- If you don’t get pregnant naturally, would you seek help?
- Are both of you willing to be examined for issues?
- Do you want to start with holistic help? If so, how much time do you have to give to holistic approaches?
- Would you seek assisted reproductive technology (ART) such as medications, insemination, or IVF? If so, how far are you willing to go
- What is your plan B if you do not get pregnant? Would you adopt? Foster a child? Stop trying and let life take its course?
If women and men can’t discuss these questions with anyone, or cannot even think about them, I become concerned about their communication and emotions. I may recommend a therapist, or a support group such as Resolve.
Additional useful questions include:
- Why do you, and your partner, want to get pregnant?
- What are your expected parenting styles or philosophies? How will you share the work of parenting?
- What happens if you have a child with a disability? Or a child completely different from your expectations?
I include this last set of questions because, for each one of them, I can think of at least one woman whom I wish had explored it before starting her process of TTC.
Continue to the next post on male factor causes. You may also want to read the related post Prepare for Fertility and Conception with Functional Medicine.