[beginning fertility issues]

Information for TTC Couples...

Written by TTC Couples.

 

Low-Tech Ways to Help You Conceive - Chapter 6

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Low-Tech Ways to
Help You Conceive


6. HOW LONG IS IT "SUPPOSED" TO TAKE TO GET PREGNANT?


    6.1 General

    6.2 For Women Over 40

6.1 General

RAH - The current recommendations for "how long to try before you go see the doctor" are summarized in the first post below, which I wrote in response to a question on misc.kids.pregnancy last year. - RAH


Don't worry! Your timespan so far [five months trying] is well within normal limits. If you're in your 20s the recommendation is to wait 8 months to 1 year before conditions warrant looking into medical treatment. For those in their 30s, the rule-of-thumb is six months of trying. And, you can cut it down to 3-4 months if you are using Fertility Awareness methods like charting BBT, observing cervical [fluid], monitoring cervical position, using OPKs, having sex every 24 hours during the week before & including ovulation, boxers, no hot tubs, blah blah blah... :-)

There is only a 20-25 percent chance of conceiving in any given month, even under optimal conditions (intercourse near ovulation, healthy egg & sperm, etc.) So you *do* have time -- it's not alarming that you haven't conceived yet.


I'm 32 years old, and trying for my second child. It's been 6 monthsand no luck getting pregnant yet. I had my son after only 3 months of trying.

Likelihood of Pregnancy in Fertile Women - How Long Should It Take? ... You basically asked when you should start worrying. Here is a table from "How to Get Pregnant" by Sherman J. Silber MD.:

[RAH - I snipped out this table, since I don't have the author's or publisher's permission to reproduce it here. In essence, it is a more detailed breakdown of the odds by age categories. It's worth looking at Dr. Silber's book for the table, which appears on p. 60. - RAH]


From what I've read (in month 6 or 7 of trying, when I was convinced we had an infertility problem), women in their thirties have only a 15% chance of conceiving in each month even when everything's in working order. That's down from 20% a month for women in their twenties, still a surprisingly low figure. That helped me be patient for another month or so (and I conceived in month 8). There are an amazing number of things that have to be just right for conception to happen, and so much of it is just chance.

My HMO wanted us to wait until we'd tried for a year before any infertility work up. If I'd been in my mid or late thirties I might have pushed them for action after only six months. They *were* willing to explore the possibility of endometriosis in me in month 7 of trying, since I was having pain. Your care provider might be willing to do a sperm count if there's some indication you are at risk of having a problem (like a past or current STD).

It is rough when you've always expected it would happen as soon as you start trying!


You might like to read _How to Get Pregnant_. The doctor/author [Sherman J. Silber, MD] makes a BIG point about how much LUCK is involved in getting pregnant. He explains that many people get pregnant quickly the first time or two, then take many months of concerted trying for subsequent pregnancies. These people start to think something is wrong with them and that it "should" be just as easy to get pregnant the third, fourth or whatever time as it did the first or second. What they don't realize is that they were not more fertile the first time or two, they were *luckier*.

My friend has four children. Babies one and two were conceived during the first month, each time, of going without contraception before they were officially "trying." But to conceive baby #3 took seven months of "sex all the time", as my friend's husband put it. They were starting to think something was wrong when pregnancy occurred. When they wanted a fourth child, there was a big celebration and they wound up in bed [without] contraception, figuring it would take them awhile, again, to conceive, so not minding the one night without protection. They had planned to start trying in a few months. Well that one night was all it took. So, four pregnancies with three of them conceived in the first month of not even really trying and one pregnancy that took seven months of trying before success.

FWIW, my friend did not chart BBT, [cervical fluid] or cervical changes or use an ovulation prediction kit. She barely even looked at a regular calendar to keep in mind of the approximate time she expected to be fertile.

.. Another friend, she tried for 18 months before finding out she wasn't ovulating. She went on Clomid and conceived. Child number 2 was conceived in the first month of half-heartedly trying, without Clomid.

Sources vary, but for a healthy couple under 35, several experts say that even with perfect timing, there is only a 20-25% chance of conceiving in any one month, as pointed out above. For a healthy couple over 35 with perfect timing, I've heard the chances are only 15%. My midwife puts the statistic at an even more grim 8%.

It's not all so different from flipping a quarter. You know that on average, in a 100 flips, 50 are going to be heads and 50 are going to be tails. If you're betting on its being heads, though, you could still get 50 flips that were tails before you finally got heads. And with conception, the odds aren't even 50/50.


Be aware that it takes the average healthy couple in their 20's 6 months to conceive (and that means that for every woman that gets pregnant on the first try, there is another perfectly normal and healthy woman that takes a year!) Both [our children] took us 7 months to conceive, and we were sure we were hitting the right days.

Good luck! I wish you a short ride on the particular emotional roller coaster you have just gotten onto!


How long did it take you to conceive -- i.e., how many months of "trying"?

1st child - 14 months 2nd child - accident!! 3rd pregnancy - ectopic, took 18 months of trying, 2 months on clomid


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6.2 For Women Over 40

RAH - Nowadays, unlike any previous time in history, women have been waiting into their 30s and even 40s before trying to conceive. The reasons behind this are too complex to list here, but the result is fairly straightforward: The odds of conceiving go down as you grow older, and the decline becomes dramatically lower when you pass age 35, as a rule of thumb. Some of these factors are not difficult to overcome -- e.g., since one factor is that frequency of intercourse goes down as you grow older, you can try to arrange for sex more often. Others, however, are more difficult to overcome, such as a greater number of anovulatory cycles; and there is no easy solution to the latter category of problems.

The best advice for women over 40 is "don't delay too long before seeking professional medical advice and assistance." - RAH


Hi, I'm new here and have a question and a problem. I've been seeing a specialist concering fertility. I'am 42 and the RE I'm seeing keeps stressing you are 42. I've had a surgery and they found nothing significant, but he once again said "you're 42." I have another appointment on the 22 April for follow up, what is next? I've started this with great positivity and now I feel I am doing something not quiet expected in society. I should of done this when I was in my 20 or 30's. I never had a clock ticking then, but he makes me feel I missed the boat. Is this the norm?

You might want to join the "fortility" mailing list [for women over age 40 who are trying to conceive]. A lot of us are going through the same type of thing. I copied the info from an early post about the group in case you're interested. I hope the instructions are still the same. There is a later post, but I can't find it right now.

[RAH - I've put the instructions below, at the end of this
subsection. - RAH]

Basically, we are all hearing the same type of thing, although it seems that OB's are more optimistic than RE's -- maybe a matter of OB's seeing successes, while RE's see those struggling to conceive. RE's look at IVF clinic stats and see little success at 42 or after. It's difficult sometimes to swallow the stats after (and while) being told by society, women's movement, and doctors that there is no problem in waiting (maybe even desirable). We walk around and see older moms pregnant or with babies "out there". I can relay many success stories (they do keep me/us going), but I fear these anecdotal successes might add up to a very insignificant percentage. More studies are needed, it seems, to know what the actual rate of decline is in fertility among the population at large (not just among IVF patients). Unfortunately, everything I read points to a definite and serious decline with age, especially over 40 ( with significant drops at around 30 and again at 35). I have seen nothing encouraging for the over 40 crowd among the studies or stats.

The most pervasive argument against delayed childbearing seems to be the notion of "old eggs." Old eggs are often chromosomally damaged and either don't implant or end up as early miscarriages. Older women are at far greater risk for miscarriage because of this (I heard 35%, 50+%, and maybe even 75% for 45 or older) and are at significantly higher risk for Down's Syndrome than younger women (but still not an overwhelming risk, if a pregnancy gets that far -- "if" is the key word.)

I was told by several RE's and others that I have a less than 5%, and maybe just 1-2% chance, of taking home a baby with my own eggs. I was also told my chance of conceiving on my own was less than 1%, but I did do that last May -- so you see why I can't put all my "old" eggs into the IVF statistical basket? And, everyone is different with different factors affecting their reproduction, so it's dangerous to generalize stats too much to each and every individual. That's why I have decided to try some low-tech treatment and others try high tech or even no tech.

When I first posted here, I was very, very upset that a relative (a new MD) blurted out to me that I was "crazy" to try to have a baby and that it was "nearly impossible" after age 42. I had just had a miscarriage and wanted that pregnancy back! After coping quite well for a month before hearing this from this relative, I ended up crying for months, almost non-stop. I received a lot of encouraging, if not angry (at my relative) newsgroup responses -- lots of success stories. A few people recommended the donor egg option, which at the time I thought was a cruel joke. Several said RUN to an RE and get as aggressive as I could as soon as possible (I was 44; now speeding toward 46). Now, I am desensitized to the grim stats, am sharing them with anyone who wants to hear it, and am considering going for donor egg or will try to move on after my upcoming second attempt with Metrodin/IUI. Lots of changes in a short time.


HERE ARE THE FORTILITY INSTRUCTIONS:

If you are interested in subscribing to our list, please read on! We decided on a mailing list rather than another newsgroup because 1) several readers have read-only access to newsgroups and thus can't fully participate in newsgroups (whereas we all have access to email), and 2) the forum is a bit more personal, since only subscribers will have access to our messages. Since this is a mailing list, any email you send to the group will go to all our subscribers, and all mail that others send to the group will show up as email in your account.

    To subscribe to the list, send an email message to:
    fortility-request@columbia.edu
    In the body of your message, type:
    subscribe
    (don't type that in the 'subject' line, as the system won't understand).

Once you have subscribed, you will get an automated message welcoming you to the group, with info on how to send messages, how to get help (with the mailing list, not with fertility!), and how to unsubscribe.

If you have any questions, feel free to send me a message: hgs6@columbia.edu (I'd especially like to know if there are problems with subscribing.)


Does anyone know how to find out about the rate of deterioration in women's fertilty between the age of 35 and 40? Is it a steep decline? Gradual? How fast? My girlfriend (35 last month) is trying to figure out how much more risk she will incur by waiting 1,2,3,4,etc. years before she quits her job to have babies.

A lot depends on whether she is subfertile, but of course she won't know until she tries. We have found that in the group of infertility patients we see there is a steep decline at about 38 years of age. By age 42, the PG rate is almost zero. This is due to two major factors. One, older women stimulate poorly with gonadotropins and by the time we see this group of women they have tried everything else. Second, older women produce eggs of which over half of them are chromosomally abnormal (the actual rate of chromosomally abnormal eggs may approach 75%.) I believe the goal for women wanting a pregnancy should be by 35 years of age. This allows for some therapy if she is found to be subfertile (which is common by this age). One report (Cohen, Mangement of Infertility, Essential Medical Systems, 2nd ed. page 35), indicates that the decrease in the incidence of pregnancy of women between the ages of 35 and 40 has almost plateaued. This means that although there is a fairly gradual decline from age 25 to 35, by age 35 to 40 that decine has hit the bottom.


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