Couples should try for at least a year before getting fertility help

Although classically the time to proceed with a fertility evaluation has been based on the female partner’s age, these rules are not hard and fast.  The American Society for Reproductive Medicine (ASRM) 2013 Committee Opinion defines infertility as “the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed intercourse or therapeutic donor insemination.  Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years”.  Examples of scenarios where factors may warrant early evaluation include women with infrequent or absent periods, women with symptoms suggestive of endometriosis or a known history of endometriosis, and a history of low semen parameters or risk factors for male factor.  The American Urological Association (AUA) Best Practice Statement recommends the following on the timing of a male fertility evaluation: “A couple attempting to conceive should have an evaluation for infertility if pregnancy fails to occur within one year of regular unprotected intercourse.  An evaluation should be done before one year if 1) male infertility risk factors such as a history of bilateral cryptorchidism (undescended testicles) are known to be present; 2) female infertility risk factors, including advanced maternal age (over 35 years), are suspected; or 3) the couple questions the male partner’s fertility potential.”  Although we try to set criteria for the timing of an evaluation, it seems more than reasonable for a couple to go ahead and get checked if they are concerned about their fertility potential.  Fertility is a stressful journey for some couples to go through, so if there is concern or anxiety about the possibility of infertility, that couple may certainly be evaluated prior to the set time frames.

It can take a long time to conceive if you’ve been on birth control. 

If a woman previously had monthly, ovulatory menstrual cycles prior to taking birth control pills, then she will most likely be ovulatory within 1-2 months of discontinuing the birth control pills.  If there are not any know fertility factors among the couple, then the couple will be thought to have the baseline general population pregnancy rate of 20-25% per month once the woman is ovulatory.  Therefore, there is the potential to become pregnant soon after discontinuing birth control pills.

If a man has already fathered a child, it’s not possible he can have fertility issues.

This is certainly not the case.  In fact, there is a separate category of male subfertility that is termed secondary subfertility for just such men who were successful having children in the past and are now struggling to achieve a pregnancy.  There are a number of things that can affect a man’s ability to father a child which can change over time.  A varicocele, an abnormal dilation of veins around the testicle, which can have a worsening effect on a man’s fertility over time, is one of the most common culprits.  If the man has gained weight or had changes in his hormonal parameters it can affect his fertility.   If he has picked up habits like smoking, drinking more than mild amounts of alcohol, smoking marijuana, or stopped eating a good diet and exercising, these can change his fertility for the worse over time.  Some men are reluctant to have a semen analysis performed if they have a past history of proven fertility even if the couple has been having a difficult time conceiving recently.  The conclusion of a study in the journal Fertility & Sterility, co-authored by Dr. Shahryar Kavoussi, was that “a history of male fertility is not an accurate predictor of a normal semen analysis result. The semen analysis should remain part of the evaluation of the infertile couple even in cases where a history of male fertility is reported”.

Link:   http://www.ncbi.nlm.nih.gov/pubmed/16169428

Couples should have sex daily to improve their chances of conceiving.

Actually, the medical recommendation previously was for couples to have intercourse every other day around the time the woman is ovulating, because the man’s semen volume will drop a bit if they have intercourse every day, which was thought to be potentially deleterious to their ability to conceive.  Better data have shown that pregnancy rates are equivalent if couples have intercourse daily or every other day around the time of ovulation, so either option is good.

Certain positions improve the odds of getting pregnant..

Although some women feel that their chances for pregnancy will improve with certain coital positions or after laying down for a certain amount of time, there is no evidence that such practices are beneficial.  Based on prior studies, ejaculated sperm can be found at the cervix within seconds regardless of coital position.  In addition, sperm can be found within the fallopian tubes within minutes.

Women should have intercourse when their temperature rises.

In order to optimize fertility and the chances for pregnancy, it is ideal for the couple to have timed intercourse every 1-2 days during the 6-day fertile window which ends on the day of ovulation.  The rise in body temperature correlates with rising progesterone levels and occurs after ovulation.  Therefore, it is quite suboptimal to wait until a temperature rise before having intercourse.

Prenatal vitamins and other supplements help with fertility.

From the female factors side, prenatal vitamins and omega-3 supplements do not help with fertility.  The ingredients within these supplements are beneficial to the woman who is trying for pregnancy as well as the pregnant woman and her fetus.  Folic acid can minimize the risk of neural tube defects such as spina bifida in babies and omega-3 can improve fetal brain developments.  Although enzyme CoQ-10 is used by some women and has been thought to improve oocyte mitochondrial activity in women with aging oocytes or diminished ovarian reserve, well-designed convincing studies to support its use are lacking at this time.  The majority of the current medical literature concludes that there is a lack of data to support the use of food and drug supplements to improve fertility.  From the male factor side, there has not been any strong data showing significant improvement in sperm parameters or fertility with the use of expensive vitamins.  If a man wants to take something, a simple, inexpensive, over the counter antioxidant, such as Vitamin E or CoQ10 can be used.  Other studies have looked at Zinc and Folic Acid, however; none have shown significant improvement in sperm parameters.