This is the first article in a series about fertility, for women and men. I will include things to do to improve your fertility, whether it’s natural, or assisted with holistic approaches or reproductive technology. Read the related post Prepare for Fertility and Conception with Functional Medicine.
Interesting (in)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 causes are due to female issues, 1/3 are due to male issues, and 1/3 are unexplained.
• One in eight couples have 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 jump to thinking that something is wrong with you. Our culture places heavy emphasis on fertility being your responsibility. In my experience I see women seeking help for fertility far more often and sooner than men do.
It may be a surprise to learn that infertility is a male issue just as frequently as it is a female issue. And since 1/3 of the time it’s an unexplained issue, you simply cannot assume infertility is due to a female factor.
Given that 2/3 of the time there is not a known female factor, do not jump to the conclusion that your body isn’t working right. Also, if there is a known female factor, it doesn’t mean you are any less of a woman, it’s simply a biological issue that once identified, can be dealt with.
Trying to conceive (TTC)
The definition of TTC is having unprotected intercourse. However, there is no part of this definition that describes how often couples should have intercourse when they are TTC, or when the right time is to have intercourse in order to conceive.
If you are think you are infertile, the first thing I do is go beyond the classic definition with some investigation. I ask you:
• Do you track your fertile window?
• What methods do you use to track?
• Do you get signs of ovulation, and what are they?
• Do you time sex according to your fertile window?
You may be self-educated, aware of your cycle, and track your 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.
My definition of infertility is 12 months of TTC while tracking ovulation correctly.”
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 (temperature while fully at rest), and how to track your fertile cervical mucus. Temperature and cervical mucus are two easy and practically 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!
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 letting it through. If you were to put some of your fertile cervical mucus on a slide and view it through a microscope, you’d see a fascinating “ferned” pattern.
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 to, 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. There is no way this will be accurate.
These apps assume that you are typical, and make assumptions about when you ovulate based on the number of days in your cycle.
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.
So many 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!
The bottom line is if you use an app that just counts your cycle days without tracking your temperature, cervical fluid, or LH surge, it is highly possible that it’s inaccurate. The same is true if you simply count your cycle days on your own, without tracking your fertile signs.
Just a little bit of an emotional issue…
Fertility is by far the most emotional issue that I tackle in my work with women.
We 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. There is a trend now towards women choosing to be child-free, and being comfortable with it. However, it’s not the norm (yet) to be raised that way.
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!
These questions are highly useful to explore, for women and couples who are TTC:
• If you don’t get pregnant naturally, would you seek help?
• Are both partners willing to be examined for issues?
• Do you want to start with holistic help? If so, how long would you 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?
Fertility care is intimate and personal work. I usually include these questions when I work with women. If a woman can’t discuss these questions with anyone, or cannot even think about them, I become concerned about her emotional state. 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.
Please stay tuned for the next post on male factor causes! You may also want to read the related post Prepare for Fertility and Conception with Functional Medicine.