[beginning fertility issues]

Information for TTC Couples...

Written by TTC Couples.


Low-Tech Ways to Help You Conceive - Chapter 3

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Low-Tech Ways to
Help You Conceive


RAH - Sec. 2.1 above asked the question "what's the single-best thing a couple can do to increase their odds of conceiving?" This section is devoted to answer the same question, but focusing on overall/combination methods the woman in particular can use. As above, I think it's risky to point out any one thing to do that's MOST effective; if pressed, though, I would recommend either charting Basal Body Temperature or monitoring cervical fluid -- and preferably both. This will allow her to determine her time of ovulation in a "typical" cycle (BBT) and when ovulation is approaching in a particular cycle. - RAH

The post suggesting Taking Charge of Your Fertility by Toni Weschler is a great place to start. Self education about all of this is vital in order to have a productive relationship with your OB/GYN or RE (Reproductive Endocrinologist, i.e. infertility specialist.) You'll want to start charting your BBT (basal body temperature) and she explains in detail how this is done. It also explains other fertility indicators to watch for including cervical [fluid] and the postion of your cervix. In addition you'll want to try OPK (Ovulation Predictor Kit) to find out when you are ovulating. They are pretty simple to use. One of the things you'll look for in your chart is the length of your luteal phase (the 2nd half of your cycle from ovulation to the day before you get your period.) It should be at least [10] days, regardless of the length of the first half of your cycle. If it is shorter than this, you have LPD (luteal phase defect) which means your body is not producing enough progesterone. This is treated with progesterone supplements and/or clomid (an ovulation stimulator.)

[RAH - According to TCoYF, the luteal phase should be at least 10 days long, in order to allow the fertilized egg (or zygote) time to travel from tube to uterus and implant in the uterine wall. Other authorities recommend a luteal phase of at least 12-13 days long; this is a bit over-cautious, according to Toni Weschler. See Sec. 9.4 for more details. - RAH] It is never too early to start the basic fertility work up. This includes various blood tests to check for hormone levels and infections, a post-coital test to make sure the sperm is surviving in your [cervical fluid], a sperm analysis for your husband (the easiest and least invasive test of all). Additional tests include HSG (hysterosalpingogram) to make sure your tubes are open, endometrial biopsy to check hormone balance and autoimmune testing. The book I mentioned explains all of this and much more. Good luck and welcome to the world of words and abbreviations whose meanings you wish you didn't have to know. Don't take "just relax" for an answer.

I do drink a lot of soda. Would what I'm experiencing (leaking sperm) be caused by an acidic vagina? If so, how can I change the environment? Any advice would be appreciated.

Try elevating your hips during/after sex. Some people use the yoga position "The Plow" with feet straight up and hip off the mattress. Umm, after sex, of course. If you try this, hold it only for a minute or so then put your hips down on a pillow. It's tough on the neck.

I'm not aware of soda having any effect on fertility. Any of you medical types know? Nutritionally, though, if that's representative of your diet I'd start eating healthier.

I've spent a few years struggling with infertility, so my opinion is strongly colored by that, and the sort of experiences others have had and talked about on the infertility newsgroup. That disclaimer done with: 1) It is much harder to conceive over 40 ... for most women, fertility starts taking a downturn after age 35. OK, we all know stories of women who had children easily over 45, even over 50. They are true. But statistically, a hefty fraction of women over 35, and an even heftier fraction over 40 will have trouble conceiving and/or carrying a pregnancy to term. For example, of women who do become pregnant at age 45, 1/2 will lose the pregnancy in that difficult 1st trimester. 2) I would advise your friend to cut down on or eliminate caffeine and alcohol; they are known inhibitors of fertility ... and stay away from most over-the-counter drugs (tylenol and robitussin are the only safe ones I know of). If she is very over or underweight, working on changing that is also important. 3) Fat? Oil? The infertile community in which I move has a small number of people who claim success with natural (food, herbal medicine) techniques ... But the majority have found their success not with any dietary change or supplement, but with standard medical interventions. So ... 4) If your [older-than-35] friend is unsuccessful conceiving naturally in 3 cycles, she should run, not walk, to a specialist. And NOT just any OB, but either an OB that specializes in fertility, or a "Reproductive Endocrinologist" [RE], which is the medical profession's name for an infertility specialist.

Both BBT and cervical [fluid] were necessary [for me to determine ovulation]. Only cervical [fluid] showed when ovulation is emminent or occuring, and BBT confirmed it (but BBT only shows that it has happened, not exactly when on the days before). Many women don't show a dip in the BBT with the LH surge (I didn't).

I think if you had to do one, the cervical [fluid] would be the most useful. But I liked the added benefit of confirmation that the BBT provided. And a BBT chart will confirm pregnancy. A third tier of high temps will usually show for most women around the time of implantation. I used a digital thermometer with a memory, and recorded the stored temps in the evening when I was more awake. Most digital thermometers will store the last reading; mine was just a B-D brand, about $10.

Now the most important thing: my resource was Toni Weschler's "Taking Charge of Your Fertility", c. 1995. This book shows color photos of [cervical fluid] on a woman's finger (hey, just like at home!). This book provides total guidance for BBT and cervical [fluid] charting. The author also recommends charting cervical position, but I didn't find this to be very useful, although interesting (try it out, what the heck).

One thing that can help is to understand your body better. Get the book called, "Taking Charge of Your Fertility" by Toni Weschler, MPH (ISBN: 0-06-095053-6). I had to order it from my local bookstore. It is great at explaining how to read your body's messages about what is happening during each cycle. It explains BBT's, and other very helpful, and supprizingly accurate signals.

About the BCP's [birth control pills]. I took Tri-Levlen for about 9 years. I went off it 3 months prior to my wedding, because my DH (Dear Husband or Designated Hitter) and I wanted kids right away. We've been married over a year, this Feb. and now I'm here [alt.infertility]. My cycles went gonzo after I went off the pill. I thought I might be pregnant, just before the wedding, because my cycle was so long. I was freeking out, and got it the day I arrived in Michigan (we went to where all our relatives were). I was so relieved, plus, I had to prove I wasn't pregnant to my sister, whom I was staying with. (She was 4.5 months pg when she married) Needless to say, I've had many cycles that have been really bizarre. I had one where I bleed for over 3 weeks. Sometimes, according to what I've read, your cycles can take over 1 year to get normal.

There is a section in the book, "The Fertility Sourcebook" by M. Sara Rosenthal (ISBN:1-56565-455-2), that discusses something called "Post-oral contraceptive syndrome (a.k.a. post-pill syndrome) (see pg 115-116). They sometimes suggest fertility drugs in this case. The irregular cycles you may have had before, will come back. Also, some people have hyperprolactinemia. Get tested!

: Of course, I agree that for someone already under an RE's care, BBT charting : is usually superfluous. However, my understanding is that BBT is the only : low-tech, at-home method a woman can use to tell whether or not she's : actually ovulating -- so it IS useful info for those just starting down the : (hopefully short) fertility/infertility road, isn't it?

My understanding has always been that charting cervical [fluid] was far more reliable a low-tech method than BBT, and unlike BBT could be used to determine when the fertile days were starting.

I think you're right in one sense -- for those who do ovulate, and who can use [cervical fluid] as a signal, it's a much better *advance* predictor of when ovulation will occur during a given cycle. But there's one big advantage to BBT over [cervical fluid] (or OPKs) -- BBT can nearly always confirm that you are actually ovulating. [cervical fluid] can only tell you that your estrogen level is rising, which doesn't necessarily mean the follicle is growing or that it's releasing an egg.

I'd suggest using BBT to establish that ovulation is taking place, and to learn what the typical pattern is in terms of regularity -- then use cervical [fluid] and the position of the cervix to determine when maximum fertility kicks in during any particular cycle.

This month I would like to try anything remotely linked with helping me get pregnant. So far this is what I have on my list: 1. Absolutely no caffeine in any form. 2. Limit my milk intake (I typically drink a gallon a week). Or should I eliminate it entirely from my diet??? 3. Take Robitusson...anyone know which days? I usually ovulate on day 15. 4. Drink lots of water and Orange Juice...anyone know how much daily? 5. I take 1 prenatal vitamin a day and 1 baby aspirin a day (have been for quite some time now). 6. Think positive thoughts only (yes I know this can set me up for a big disappointment...but I'm going to be disappointed either way if it doesn't work.) 7. Visualize the conception and the baby implanting and growing inside me.

I have always believed prayer makes a difference.

What seemed to help for us this time was me having an orgasm after the sex. Also we did missionary position and I stayed lying down with a pillow under my butt for about 20 minutes or so. I don't know which one exactly did the trick, but I have the feeling that the orgasm might have helped. I got this tip from misc.kids.pregnancy BTW :-)

Actually, my doctor told me that they would do nothing for us until after a full year of trying. I stopped taking the pill in December and we have be trying ever since. Also, they told me there was no problem with being over thirty - that is nothing to worry about. For this month - it's every other day and I'm putting my feet up on the headboard!! The biggest thing is not to get too worked up about the matter. My doctor suggested a few drinks - wouldn't hurt and it might loosen us up!

We've been trying for 7 months, with no luck. I am ovulating (OPK and BBT tell me so), my [cervical fluid] is "ferning" (oh boy!), the post-coital says that I'm not killing off the little swimmers. We haven't had the sperm analysis done, because I somehow got the impression that it was redundant if the post-coital showed lots of swimmers moving normally. If we have no success this month, I guess we'll try that next. The doctor also recommended a hysterosalpingogram (putting dye into the tubes and doing an x-ray to check if the tubes are blocked) -- I might do that before the end of the year (since I've already made my insurance deductable!). I've heard that that just having the procedure often blows the gunk out of the tubes. (Isn't it great what we'll talk about to perfect strangers?)

Anyway, the emotional aspect is the hardest. I was ready 7 months ago, and every month that I get my period is a major disappointment. I try not to wish that we'd started sooner, because I know that if we'd gotten lucky, it would have been too soon. But I can't help thinking it, anyway. I am obsessed with getting pregnant, and with babies. I spend way too much time reading about it (good thing I don't pay for net access!). It is affecting my work, and my relationship with my husband. I've become very dull company. If I'm this obsessive now, what kind of Mom am I going to be? Two of my co-workers started trying around the same time I did, and they're already pregnant. I hate them. (No, not really, but I'm afraid it will get to that point sooner or later). Sigh...

[RAH - This person successfully conceived the following month; as of this writing she & baby are healthy and well! - RAH]

From what I have learned, the best time for intercourse is just before ovulation occurs. The reason for this is that the cervix is primed and ready to let sperm through. The cervical [fluid] is right, and the cervix is open and in the best position for the sperm to get in. Within 24 hours after ovulation occurs, the cervical [fluid] becomes hostile, and the cervix closes up and changes position (towards the back) to keep nasty things like bacteria, etc. out, to protect a fertilized ovum. If you are taking your temperature, and you see the temperature rise associated with ovulation, I have read that it is probably too late for intercourse to do any good, because that means that ovulation has already occurred.

This is what is good about using (accurate) home ovulation tests. They tell you when the LH surge which triggers ovulation occurs. I think that ovulation then occurs within 24 hours after the LH surge. And, as they say, you should have intercourse the day you test positive because it is your most fertile day due to the factors I explained above. Also, it is good to have sperm present when the egg starts traveling down the fallopian tube, because I have been told that the egg should be fertilized within 24 hours of ovulation, otherwise it dies.

The egg lives only up to 12 hours, or so after ovulation. The best times to try are the few days before you ovulate... The best way to determine when you ovulate is to do the Basal Body Tempreture charts. I know that it is tedious, but it is worth it. Once you have determined your ovulation dates, time intercourse for the days preceeding ovulation. That is generaly the best way.....

Actually, the ovulation predictor kits do tell you when you are going to ovulate. So, they can be excellent ways to predict ovulation -- when you see that blue line, ovulation will take place in 24-36 hours, so you had better get to it if you don't want to be too late! An RE told me it was best to test in the afternoon or evening, as you usually have your LH surge during the late morning, and testing in the am after the surge and waiting until that night to have sex may be waiting too long (assuming that sex is your method of fertilization :) ). The problem with the Ovulation Predictor Kits is that they are pretty expensive to use every month and can sometimes be hard to read.

BBT is a good way to get more evidence that you are ovulating and to predict ovulation by learning your patterns over several months. Once your temperature goes up, however, it is usually too late for success. There are some good books out there (Taking Charge of Your Fertility, Your Fertility Signals, and others) that can help you interpret your BBT.

In answer to the original question, there actually is no way to be totally sure that you have ovulated. If you are taking BBT and you see a rise, you probably have ovulated. Your doctor can do a progesterone test about 10 days after you think you ovulated; if it is elevated, you very likely have ovulated.

If you try to use the BBT to predict ovulation of the current cycle, you'll only predict it in 10% of cycles (Fertility and Sterility 1987, vol 47, page 259-.) One study (Fertility and Sterility 1988, vol 49, page 1026-) found identical pregnancy rates when BBT plus [cervical fluid] scoring were used as when an LH (Ovulation) detection kit was. This study was done with donor semen, and it may be more important to have more exact timing with male factor semen. With more inseminations (or intercourse), timing can be less exact.

You should still follow your BBT in the treatment cycle, because if an upward shift in temperature is noted, then you have probably already ovulated.

For [cervical fluid], look for [fluid] that is clear and will stretch about 2.5 inches before breaking.

[RAH - Cervical fluid that stretches 2.5 inches before breaking is remarkably good! It's not necessary to have more than about one inch to qualify as top-quality, egg-white fluid. See p. 58 in TCoYF. - RAH]

The new LH kit technology aids some women in testing for the LH peak, but it also has variables associated with it and its accuracy depends on how often you test, when you test, and when you ovulate in relationship to when the test turns positive.

I think it would be a good idea to mention that prior to trying the woman should have her immunities tested. Some vaccines never worked way back when, and some women were never vaccinated, so its a good idea to check. It can be done with a simple bloodtest. Measles, chicken pox and mumps, I think, are the diseases for which they test. If you do not have immunity, then get vaccinated and wait a few months (I'm not sure how many) before trying. (I am surprised that ob/gyns do not verify immunity in their patients routinely.)

Also, start taking a daily vitamin with folic acid to reduce change of spina bifida in the baby. Its a good idea to quit caffein too since studies show it contributes to a higher miscarriage weight. If you smoke -- quit. Also, no more alcohol or drugs if there is a chance you have conceived, and be careful about that hot tub.

You know--most women can get up in the three hours prior to taking their [BBT] temps, provided that they don't do anything much during that time. I often have been up in the night for a couple of hours, then gone back to bed to take my temp or (if I'm lucky to sleep for 2-3 hours before taking my temp and have never noticed a difference in the temps. YMMV.

Increasing fertility? Charting BBT will certainly increase your knowledge of your fertility--show if you are ovulating, tell you your luteal phase, allow you to calculate a more accurate due date from the first day of temperature rise, reveal a low thyroid condition (your waking temps will be in the low 97's), tell when you are pregnant (temps stays up for 7 days longer than your longest luteal phase ie for average woman for 21+ days). But it doesn't, aside from timing of intercourse, increase fertility (the way that boxer shorts for men would do.) I suppose I would suggest improving your nutrition while trying to conceive and for the three months before (Marilyn Shannon's Fertility Cycles and Nutrition: can what you eat affect your menstural cycles and your fertility? is an excellent book for that sort of info.) Also: supplementation with folic acid for 6 weeks prior to conception and 6-8 weeks after to prevent/lessen the chance of neural tube defects.

BTW, all-the-time [cervical fluid] can often be improved by improving nutrition, particularly increasing vitamin A consumption (eg a carrot a day) to produce better more fertile [fluid]. Rereading your message I find that you actually said -- [your [cervical fluid] is] not present at all. The vitamin A would help with than--but also taking [fluid] directly from the cervical os with your fingers and/or looking for [fluid] after a bowel movement are ways of finding [cervical fluid] that is more elusive.

I'm using the fertile [cervical fluid] method and ov kits to try and pinpoint ovulation time. I always see the [cervical fluid], but the kits never register an LH surge! I've done this five months now. Also, I've heard that your period is supposed to come 14 days after ovulation. Mine came 20 days after ovulation last month. Anyone else with this kooky stuff?

I had an awfully difficult time timing ovulation: the bbt (basal body thermometer) method looked like a mountain range rather than a neat rise and fall, the ovulation kits seemed to work backwards (as I got closer to ovulation they got weaker) and that [cervical fluid] thing had a lot more to do with my sex life than anything else. I have since found that I do ovulate regularly and that those other methods work fabulously on some people and not at all on others. Even on Serophene (ovulation enhancing drug, same as Clomid) the ovulation predictors didn't work.

The good news is that if you use a few methods at a time you can probably at least narrow ovulation down to a few days. Don't worry about trying to get the exact moment - that is something that Hollywood made up so that they could make funny movies about people trying to get pregnant. If you know the general time you are ovulating and you have sex every one to two days, you will probably get pregnant. Even for the most fertile couples it takes a few months or even up to a year. I can't tell you how many people I know who have a few kids and one was conceived by accident and the other took several months.

BTW, my doctor says that the Clear Plan Easy kits are one the best. There are also some good books about conception/infertility ("How to Get Pregnant" by Sherman J. Silber, Warner Books)

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