How to Have a Baby When You've Been Trying to Conceive for Awhile

1
Don't Hesitate to Get Help

Doctor and a couple talking about infertility
Don't wait too long before getting help, or your odds for successful treatment may go down. Skynesher / Vetta / Getty Images

If you're wondering how to have a baby, especially if you've been trying for awhile, this multi-part, beyond-the-basics article is for you. However, if you're just starting out on trying to get pregnant, you should read this article: How to Get Pregnant - TTC for Beginners

Don't Hesitate to Get Help When You Need It

Doctors recommend seeking help for fertility if...

  • you're 35 years old or younger and you've been unable to get pregnant after unprotected intercourse for at least one year.
  • you're over 35 years of age, and you have not been able to get pregnant after six months (because the chances for successful treatment rapidly decline after 35, so prompt diagnosis and treatment is important).
  • or, if you've been able to get pregnant, but have had two or more consecutive miscarriages.

If you have any symptoms of infertility earlier on, though, you don't need to wait before speaking to your doctor.

Despite these recommendations, many couples do not seek a fertility evaluation. One informal survey, conducted by Conceive Magazine and Fertility LifeLines, found that 38% of couples tried unsuccessfully to get pregnant for more than a year and still had not sought help.

I understand why you may hesitate seeking help. To ask for help is to admit that something may be wrong, and it's likely to intensify your anxiety that you and your partner are fertility-challenged. Also, if you're unsure whether or not you will want fertility treatments, you may think getting help isn't worth the trouble.

While I understand this, I also know that waiting too long can backfire. There are some causes of infertility that worsen with age. Also, some causes of infertility can be resolved without fertility drugs, so even if you're sure you don't want Clomid or IVF, your doctor may be able to treat your problem in another way.

And besides all this, infertility can sometimes be a symptom of a more serious health problem, which needs to be resolved whether or not you decide in the end to seek fertility treatments.

For all these reasons, it's better to get tested now than to keep trying on your own.

More about infertility symptoms and getting help:

2
Find a Fertility Doctor That's Right for You

Couple researching fertility doctors online
Interview your fertility doctor before you hire him. It's okay to check out more than one clinic before making up your mind. David Lees / Getty Images

After you've decided to seek help, you may be wondering who to call. Your best bet is to start with your gynecologist. He can take a basic history, get started on some basic fertility testing, and refer you, if necessary, to a reproductive endocrinologist.

Some gynecologists are comfortable with prescribing very basic fertility treatments, like Clomid. On the other hand, gynecologists who are not fertility doctors may not monitor treatments as closely, or they may not offer thorough testing before treatment.

If a semen analysis is abnormal, or there are other signs or symptoms of male infertility, the male partner should see a urologist.

Something else to keep in mind: the best fertility doctor for you may not be the one your gynecologist personally recommends, or the fertility doctor who helped your friend. You should find a doctor who has experience with your particular treatment needs.

Sometimes this will mean switching fertility clinics after fertility testing with another doctor or after numerous failed treatments. Don't worry about hurting your doctor's feelings by seeing someone else. You should do what's best for you, not what's "nice."

Finding a fertility doctor:

3
Begin Tracking Your Cycles in Detail

Keeping a detail fertility chart may help your doctor make a diagnosis faster.
Keeping a detailed fertility chart may help your doctor make a diagnosis faster. Photo © iStockPhoto

While you wait to see the fertility doctor (a few months' wait is typical), you may want to begin tracking your cycles, if you haven't done so already. A few months of detailed fertility tracking can help your doctor detect anovulation or other female fertility symptoms, like a luteal phase defect.

You'll also need to know where you are in your cycles for certain fertility tests, and tracking your cycle will help you schedule tests with more ease.

The best method for tracking your cycles is with a body basal temperature chart, complete with your menstrual symptoms (like cramps, spotting, and mood swings) and cervical mucus changes. For those who don't want to or can't do accurate BBT charting, keeping a less detailed menstrual cycle log is better than no information at all.

You may also want to read about what are considered to be normal period symptoms, so you can mention anything abnormal to your doctor.

More about charting and fertility tracking:

4
Understanding Infertility Diagnosis and Testing

Lab technician holds vial of blood for fertility testing
It's normal to feel anxious about the results of your fertility tests. Don't be shy about asking your doctor to explain the tests or results to you. Rafe Swan / Getty Image

I'm sure you've heard the saying, "Knowledge is power." In the fertility world, understanding the testing and diagnosis process can help you advocate for yourself, understand test results, and make smarter decisions about testing and treatment.

Also, when you know what to expect during testing, you may feel less anxious about the tests themselves. There is already enough anxiety dealing with not knowing why you can't get pregnant. The last thing you need is anxiety over not knowing what the diagnosis and testing process may involve.

One way to get a better idea of what to expect is to ask your doctor. While he or she may be focused on only the very next step, that shouldn't keep you from asking about the big picture.

Something else important to keep in mind is that until fertility testing has, at the very least, checked the female partner's hormone levels, ovulation issues, and structural issues (like checking for blocked fallopian tubes), along with evaluating male fertility with a semen analysis, it's usually not smart to pursue treatment.

On the other hand, sometimes certain basic fertility tests don't need to be run. For example, if a semen analysis has found that IVF is required due to male factor infertility, it's probably not necessary to check for blocked fallopian tubes (since IVF doesn't require open tubes). This is a good reason to do a semen analysis before more invasive tests, like an HSG.

Another reason to be sure you get the testing you need before treatment -- there are doctors who will write a prescription for Clomid before basic fertility testing. While you may feel tempted to get started on treatments quickly, this isn't a smart choice. Clomid can't help you if you have blocked fallopian tubes or if your partner has low sperm counts.

More about fertility diagnosis and testing:

5
Men Need Fertility Testing, Too!

Doctor speaks to a male patient about his fertility
Fertility is not a female issue -- it affects both men and women. Blend Images Jon Feingersh / Getty Images

Speaking of fertility testing, it's essential that both partners are tested. Since a woman typically sees her gynecologist to talk about fertility issues first, she is more likely to get at least basic fertility testing. But the male partner may sneak by unevaluated, especially if the gynecologist is focusing solely on the woman.

For some couples, though, it's not the doctor's failure to suggest testing that leads to problems -- it's a man's refusal to do the test. There are men who will not agree to semen analysis, either because they are afraid of negative results or they have religious objections (not wanting to "spill seed" or masturbate to produce the sample).

The problem is that male infertility affects up to 50% of couples trying to conceive, with some couples having male factor infertility the sole issue and other couples having combined fertility problems. Some fertility treatments have little chance of working if sperm counts are low. If sperm counts are completely non-existent, treatment not taking this into account is doomed to failure.

Nobody likes fertility testing. But even worse is to go through treatments that cannot succeed, due to undiagnosed male infertility.

As for those with religious objections, you may want to speak to a religious adviser, like your pastor or rabbi. There may be exceptions that you're unaware of, especially in the case of medical need. For example, if self-stimulation is taboo, you may instead be able to use a special collection condom during intercourse to get a testing or treatment sample.

More about male infertility and testing:

6
Empower Yourself With Knowledge of Fertility Treatments

Woman reading books on fertility
Be an informed patient. Read books, look at reliable sites online, ask your doctor questions, and speak to those who have experienced fertility issues. Mark de Leeuw / Getty Images

The more you know about fertility treatment options, the better you'll be able to make treatment decisions.

For example, if you're concerned about getting pregnant with multiples, you may pass on IUI treatment and skip to single-embryo transfer IVF, or maybe mini IVF. Or if you need donor eggs, but don't have the funds for the high cost, you may want to consider donor embryos, which cost significantly less.

Something else to know is that, generally, it's not worth doing the exact same treatment more than three times in a row. If three months of Clomid at the same dosage doesn't help you get pregnant, it may be time to increase the dosage, change the treatment protocol, or move on. If three cycles of IUI don't help you get pregnant, that may mean it's time to move onto IVF.

I can't tell you how many women have told me stories of taking Clomid for over five months at the same exact dosage level, or women trying six or more IUI treatments. Statistically, the chances for success begin to drop after the fourth failed treatment, and generally, more than six months of Clomid or six months of IUI is not recommended. You're not just wasting time and money by sticking with treatment that doesn't work, but also wasting your emotional reserves.

Some couples insist on multiple IUI cycles because they are concerned with the high cost of IVF. However, if IUI treatment is unlikely to succeed because of your age or cause of infertility, you're just throwing away money that could be saved for an IVF treatment, which may have a much higher rate of success.

More about fertility treatment:

7
Consider Complementary Medicine

Couple attending yoga class to improve fertility
Yoga is one kind of mind body therapy that may help you cope with the stress of trying to conceive. Vegar Abelsnes Photography / Getty Images

Complementary medicine, meant to work alongside mainstream medicine, may be something to consider when you're trying to get pregnant. Many fertility clinics are opening complementary medicine centers, so patients can get their acupuncture and yoga in the same place as their ultrasounds and embryo transfers.

Acupuncture is particularly popular, with some studies finding a higher rate of pregnancy success when coupled with IVF. (Other studies, however, have not found improved pregnancy rates.)

Mind-body medicine may be a good way to cope with the stress of fertility treatments. Mind-body therapies include things like meditation, cognitive behavioral therapy, guided imagery, support groups, yoga, and prayer.

While research has not yet found a strong connection to increased fertility and mind-body therapies, many studies have found them beneficial for lowering stress, depression, and anxiety. Some couples drop out of fertility treatments due to stress and anxiety. Mind-body therapies may help you get through treatments long enough to achieve success.

As always, be sure to let your doctor know if you're trying any alternative remedies, especially herbal or vitamin supplements. Some alternative treatments can interact with fertility drugs, sometimes in dangerous ways. So just keep your doctor informed.

More about alternative and complementary medicine:

8
Be Aware of Alternative Options

You don't have to be a parent to play an important role in a child's life.
You don't have to be a parent to play an important role in a child's life. Photo © User asifthebes from Stock.xchng

Through it all, remember why you're doing this: you want to have a baby or be an important part of a little one's life. While there is reason for hope -- with 80% of infertile couples eventually getting a baby after treatment -- not everyone succeeds in getting pregnant.

You may not have wanted to think about using an egg donor, sperm donor, or embryo donor when you just started treatment, and you may not be ready to consider it now either. But just knowing it's a possibility can help.

The same goes for surrogacy. Few couples begin their journey to parenthood by saying they want someone else to carry a baby for them. However, surrogacy has helped many people build their family.

Adoption is another option, one that some men and women will choose without ever attempting fertility treatments and others will turn to only after trying everything else first. Neither path is better or worse.

What If You Can't Have a Baby

Not every person facing infertility will go onto have a baby or child of their own.

Some choose to become a foster parent, a Big Brother or Big Sister, or volunteer in a youth organization, like scouting. Some enjoy being an "aunt" or "uncle" to the children of their friends or family members.

No, it's not the same as becoming a mother or father yourself, and I'm not saying it will erase the pain of infertility. But it's important to remember that you don't need to be a parent to be an important person in a child's life.

Some will remain child-free after infertility, choosing not to adopt or foster children (or not getting approval to adopt or foster children.) Some decide on a child-free life and never try fertility treatment, and others only come to a child-free life after trying treatment. Both are legitimate paths to take.

Infertility can quickly take over your life and color everything. Whether you consider yourself child-free by choice, or child-free not by choice, it is for some a time of healing and a time to let go of the striving for pregnancy and parenthood. It is a time for redefining what your life and future will be without children.

When a person or couple decides to stop seeking treatment, stop trying to conceive, and stop trying to adopt, it can lift an enormous burden from their hearts and allow them space to heal. That is to say, life goes on after infertility. It may be different than the life you once imagined having, but it does go on. You have reason to hope for your future, however uncertain it seems right now.

Sources:

Dovey S, Sneeringer RM, Penzias AS. "Clomiphene citrate and intrauterine insemination: analysis of more than 4100 cycles." Fertility and Sterility. 2008 Dec;90(6):2281-6. Epub 2008 Jan 14.

General Infertility FAQ. INCIID. Accessed online on July 12, 2011.http://www.inciid.org/faq.php?cat=infertility101&id=1

In the Know. Fertility Lifelines. Accessed online July 13, 2011. http://www.fertilitylifelines.com/intheknow/index.jsp#itkfemale

Recent Survey Tells What Women Want to Know About Infertility. Island Family Magazine. Accessed online on July 12, 2011. http://www.vuzix.com/UKSITE/site/_news/06-08-VUZ-IslandFamily.pdf

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