Fertility 101: What You Need to Know

By Prati A. Sharma, MD

First comes love, then comes marriage, then comes “so-and-so” with the baby carriage. We have all heard this proverbial saying many times and in the back of every woman’s head is the dream of this coming true! In reality, however, this idea doesn’t leave room for all those things women in this day and age are striving for—extended education, a professional career and perhaps the desire to travel and explore the world prior to having children.

Whereas ten years ago, over 50% of women were conceiving their first child prior to the age of 35, research shows that women are becoming pregnant later and later with the average age now approaching 37-38. With that comes the increasing prevalence of infertility,

now experienced by up to 30% of couples.

As infertility awareness is rising in every community, physicians and patients alike are becoming keener on targeting problems with conceiving early on.  As an infertility specialist, I couldn’t be happier about this! For any couple that is thinking about starting a family, the process is daunting, especially with all the information on the Internet, words of wisdom from mothers, relatives, friends and physicians alike. There are many myths and misconceptions out there and just clarifying these can get couples started off headed in the right direction and on a faster route to pregnancy!

5 common fertility myths:

1)   Fertility only declines in your 40s

We have all heard that the “magic” number where fertility declines, miscarriage and Down’s syndrome increases are age 40. While this is definitely true, age-related fertility decline is a continuum, with fertility rates decreasing after the age of 30 and rates accelerating over the age of 37. The reason for this is that women are born with a finite number of eggs (oocytes). With every menstrual cycle, a group of oocytes are lost (undergo “atresia”) and as we age, the better, or more genetically normal oocytes are ovulated earlier, leaving women with less numbers and less good quality eggs as we get older. Particularly at 35+ this decline gets faster. In fact, the data shows that patients over 35 should be referred to an infertility specialist after 6 months of trying naturally without conception and that once they see a specialist, aggressive treatment should be pursued sooner (i.e. IVF).

2)   Position matters

Women often ask me if they should have intercourse in a certain position or lay in bed with their legs up for a period of time afterwards. The truth is, and the data supports this, no position in any way increases or reduces the chances of conception. In fact, sperm enters the fallopian tubes (the connection between the ovaries and uterus where fertilization occurs) within a minute after ejaculation occurs.

3)   No more Starbucks or Tim Horton’s

Many patients cut out all caffeine as a “cleansing” prior to attempting conception. There is no absolute need for this. Up to 200 mg/day of caffeine consumption (the equivalent of 2 tall caffeinated Starbucks coffee) is not associated with infertility or increased risk of miscarriage. However, more that 200 mg/day is associated with a higher rate of pregnancy loss. Therefore, I encourage patients to keep their caffeinated beverage intake while trying or when pregnant to a limit of 2 per day.

4)   The best time to conceive is in the middle of the menstrual cycle

Timing of intercourse can be tricky especially with work schedules, stress, travel etc.  When starting out, one of the first things to do is to have a menstrual calendar or diary. Now there are many IPhone/PDA apps that can track for you. Optimal timing for intercourse is day 10-14 every other day for a woman with a 28-day cycle (day 1 being the first day of full flow menses). For those women with longer cycles, shift the start day by the number of days in excess of 28days (i.e. For a 35 day cycle, optimal timing is day 17-21). Oftentimes, women focus on things like cervical mucus changes (increased thin discharge at ovulation) and basal body temperature (rise in temperature once ovulation occurs). These are often subjective, and often happen after ovulation, which is missing the best window for intercourse. Also, women without these changes are usually still ovulating and will miss many opportunities for trying! The best way to fine tune best fertile days is by using urinary ovulation predictor (LH) kits that can be purchased in most pharmacies. Start checking on day 10 and once the kit is positive (two lines are same color or second line is darker), try for that day and the next day.

5)   It must be my issue, not his

Many women are convinced that they are the problem when conception doesn’t occur in a timely fashion. Male factor, however, is a very common infertility problem. At least 25% of infertility is due to a male issue. Men often lack any outward sign of infertility, as they don’t have the menstrual cycles women do which reflect issues with reproduction. Therefore, one of the first tests to obtain when evaluating a couple for infertility is a semen analysis. I always encourage patients to bring their partner to the initial infertility evaluation and support male testing in parallel with female evaluation for these reasons.

Infertility is a common problem but its important to remember that most couples who have been trying to conceive for one year will conceive in the second year of trying just by keeping at it! However, beyond one year, it is important for couples to be evaluated to pick up on any correctable issues that can be targeted early on.

More about Dr. Prati A. Sharma

Dr. Prati A. Sharma is an American Board Certified Reproductive Endocrinologist who practices at The Create Fertility Centre in Toronto, Ontario. She did her residency and fellowship training at Cornell and Columbia University in New York, NY. She specializes in Polycystic Ovary Syndrome, Advanced In vitro Fertilization procedures and Reproductive surgery. You can reach her at: www.createivf.com  where she’s currently accepting patients.

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