Monday, April 30, 2012

Ask Us Anything: Am I Infertile?

"My husband and I have been trying to have a baby for about one month.

I stopped taking birth control the month before we started trying; however, I still haven't had my period and am worried that I might be infertile. I've taken pregnancy tests, but they have all been negative. Could my previously having been on birth control be affecting my ability to conceive?

I am also experiencing stress at work and am wondering if that might prevent us from conceiving. I know that it may be a little early to worry, but my not having my period makes me think that there might be a health issue that needs to be addressed.

What could be preventing me from conceiving?"

Dr. Julie Gavin Responds:

Congratulations to you and your husband. This is such an exciting time in your lives.

At this point, it does not seem that you have any cause for concern about infertility, and there is no reason to believe you won’t be pregnant by the end of the year.

Infertility is defined as the inability of a couple to achieve a pregnancy after one year of regular, unprotected sexual intercourse. You’re just getting started; there is nothing preventing you from conceiving.

That being said, it is important that you make an appointment with a gynecologist for preconception evaluation and counseling.

Preconception Care

Preconception care provides an opportunity for you to voice your concerns and to inform you about fertility and pregnancy issues. Your doctor will identify any health issues or risks of pregnancy for you and your future baby based on your pre-existing medical, gynecologic and obstetric history, current immunization status, medications, family and social history, lifestyle and physical exam. She or he will then educate you about these risks and institute appropriate interventions, if possible, before conception.

Optimizing your health before conception is the most important factor for improving pregnancy outcomes.

Menstrual Cycle

It had previously been thought that women who used oral contraceptive pills were at risk of developing subsequent irregular periods or no period after stopping birth control. Rest assured that after stopping the pill, the median time to return to a period is approximately 32 days, and spontaneous menses or pregnancy occurs in approximately 90 days in most women.

If you do not get your period in the next 3 months and a pregnancy test is negative, you should be evaluated. This is especially true if you had irregular menstrual cycles before starting birth control, you are obese, have an abnormal hair growth pattern, or symptoms of estrogen deficiency, such as hot flushes or vaginal dryness.

Ovulation

Once established, regular menstrual cycles between 28-32 days are reassuring that you are ovulating every month. Taking your basal body temperature is not necessary to document that ovulation occurred.

Ovulation occurs approximately 2 weeks before the next expected menstrual period. Ovulation test kits predict when ovulation is about to occur. This is a more helpful tool because you want to have daily intercourse before ovulation occurs. The egg only has 24 hours to be fertilized after it is released. You want sperm present and ready to attack.

The odds of conceiving in any one menstrual cycle is only 20%, so don’t get disappointed, just try again next month.

Menstrual cycles that are shorter than 21 days or longer than 35 days are not likely to be ovulatory, and need to be investigated.

Stress

There are some studies that suggest stress can cause infertility; and in turn, the diagnosis and treatment of infertility can cause stress. However, no study has shown that reducing stress prior to attempting pregnancy or infertility treatment improves pregnancy rates.

If work is preventing you from engaging in regular intercourse during the fertile time of your cycle, this will clearly decrease your chances of conceiving.

Stress can also be associated with other mental illnesses such as anxiety, depression, domestic violence and lack of social support; all of which should be identified and treated prior to pregnancy.

Untreated or inadequately treated psychiatric illness can result in maternal suffering and a variety of consequences, such as poor compliance with prenatal care, poor nutrition, substance abuse, or disturbed relationships between the mother and her infant. Some women may need medication and/or psychotherapy.

Prenatal Vitamins

For now, you should be taking a daily prenatal vitamin with folic acid 400 mcg. This reduces the risk of neural tube defects, as well as other congenital anomalies. The neural tube closes between 18 and 26 days after conception, so folic acid supplementation after the diagnosis of pregnancy is too late to reduce the risk of neural tube defects.

Lifestyle Changes

In addition, adopt a healthy lifestyle.
  • Stop smoking
  • Exercise regularly
  • Get adequate sleep
  • Follow a balanced diet
  • Achieve a normal body mass index
  • Limit your alcohol intake
  • Avoid recreational drugs and environmental toxins, such as lead 
  • Avoid artificial lubricants

Infertility Evaluation

An infertility evaluation should only be undertaken for couples who have not been able to conceive after 12 months of unprotected and frequent intercourse. Earlier evaluation can be undertaken based on medical history, physical findings, and in women over 35 years of age.

— Dr. Julie Gavin

Dr.  Julie Gavin is an OB/GYN who sees patients at her practice in Kenmore. Click here for Dr. Gavin's contact information
 
If you have a question about your health, click here to ask our experts.

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