Fertility: Options & Things to Consider Before You Start Trying to Conceive

Infertility. If you’re like most women, you probably didn’t think much about this word growing up. Many girls dream of being mothers, but rarely does that dream involve problems with conceiving. However, according to the CDC, “in the United States, among married women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after one year of trying” which is the official definition of infertility. 

Most women who have vaginal intercourse with a male partner will conceive within a year of having unprotected, regular (every few days) sex if they are not using contraception. However, the probability of conceiving decreases as a woman ages. 

In order for a pregnancy to occur (conception), several steps need to happen:
Step One: An egg needs to be released from the woman’s ovary
Step Two: The egg needs to connect with sperm from a man and travel through the fallopian tube to the uterus
Step Three: The embryo must implant into the lining of the uterus for a pregnancy to occur

This entire process requires a complex “dance” of hormones. If any part of this pathway doesn’t happen, infertility can result. This is why determining the cause of infertility is complicated. 

Infertility and the various treatment options can be complex, so we’ll try to break it down for you so you can feel empowered and supported as you enter this new journey.

How do I know if I have infertility?

If you’ve been trying to conceive for 6 months or more unsuccessfully (particularly if you’re 35 years or older), you may be experiencing infertility. At this point, it would be good to schedule a preconception counseling session with Diana Health or your preferred healthcare provider. 

During these sessions, we will discuss your family history, health history, and conduct some simple lab tests to check your fertility hormone levels, conduct an ultrasound or hysterosalpingogram (a test that checks to see if the fallopian tubes are open), and/or a semen analysis of a partner. These results will sometimes tell the story of your fertility journey and help you understand where to go next.

If I do/am experiencing fertility, what are my options? 

The options that you have for addressing infertility, depend upon the underlying cause of the infertility. Sometimes the underlying cause may be identified while for some, the cause may never be known. Also, the cause of infertility may be with either partner or even both. There are many factors to be explored with infertility so that you can best understand the options that your healthcare provider will share with you. Here are some of the possible options, though again, the right option for you will depend on your specific situation and needs.

• Fertility Medications: There are oral (eg. clomifene and metformin) as well as injectible medications that may be prescribed by your healthcare provider, depending on the type of fertility issue. 
• Surgical Procedures: Surgery may be indicated to explore the reason for infertility or for treatment to enhance fertility in certain cases. A woman may have surgery if scarring is impairing her fallopian tubes, or a man may have surgery if the tube that transports sperm is blocked.
• Assisted Conception: If the infertility issue involves difficulty with adequate sperm reaching the egg, intrauterine insemination (also called artificial insemination) may be used to put the sperm directly into the uterus with a small tube. In vitro fertilization is another form of assisted conception where the egg and sperm are united outside of the body and then the embryo is placed in the uterus to develop. 
• Other options: There are other options such as egg donation, sperm donation, having a surrogate, adoption, or deciding to not pursue fertility treatments. Ultimately, the decision is one that you will make through a shared decision-making process with your healthcare provider. There is no “right” or “wrong” treatment for every woman. You deserve to know your options and to make informed decisions that align with your values and desires. 

Before beginning infertility treatments, here are some of the things to consider:

• Your healthcare provider: Talking with a healthcare provider with expertise in women’s health and fertility is important if you are struggling with fertility. Your CNM or OB-GYN may be able to help you with your fertility challenges, or they may refer you to an infertility specialist (also called a Reproductive Endocrinology and Infertility (REI) specialist). 
• Finances: Some infertility treatments are usually very inexpensive (such as the medication clomiphene) while others require a large financial investment (such as in-vitro fertilization). It’s important to ask questions about the costs of treatment options as you consider how to proceed. 
• Insurance: Reach out to your insurance to learn if any infertility treatments are covered. Even if they aren’t covered, you may be able to use your Health Savings Account (HSA) funds if you have this. 
• Probability: Depending on the underlying cause of the infertility, your age, and other factors, your healthcare provider can share with you the probability that the treatment will result in conception and also in the delivery of a baby. This is important to understand as you weigh the time, medical complexity, and cost involved. 
• Risks: Most of the medications and procedures used in infertility treatments are very safe; however, some have risks. It’s important to ask your healthcare provider about potential risks of the treatments. 

If you are struggling with fertility, we encourage you to keep the lines of communication open with your partner. This can be a stressful time for both of you and it’s important to maintain honest and supportive communication.

At Diana Health we care about you and your partner. We are here to answer your questions openly and honestly, to have discussions, and to support you as you make important decisions about the future of your family. We support shared decision making and are here to empower you. We are only a phone call away so please reach out and make an appointment if we can help to serve you. 

In fact, if you’re considering getting pregnant and have not had a pre-pregnancy visit, please reach out and schedule one now with your Diana Health provider. If you aren’t already a part of the Diana Health community, now is an ideal time to get connected and if you don’t live in an area with a Diana Health facility, please reach out to a local Certified Nurse Midwife or OB/GYN.

Pre-pregnancy care is recommended so that you can meet with one of our Certified Nurse Midwives or OB/GYNs to discuss your timeline for wanting to conceive, your past medical history, your family history, medications and supplements you may be taking, and how you can optimize your chances of a healthy pregnancy. Also, your Diana Health provider can give you input on nourishing yourself with healthy foods as you try to conceive, regular physical activity, stress management, and sleep prioritization. They can also discuss prenatal vitamins, optimizing your chances of conceiving by helping you understand the most fertile times in your cycle, and answer questions.