From the blissful simplicity of spontaneous, unprotected sex to the scientific complexity of in vitro fertilization . . . and everything in between.
It used to be that the road from couple to family was pretty straightforward. But in the last few decades medical technology has devised ever more ingenious technologies to help couples who’ve been frustrated by the old-fashioned method. Now the path to parenthood may lead from the bed to the clinic to the laboratory . . . and even beyond. Here’s a progression of the roadways to conception, from the least technological (the scientific equivalent of a sleepy country lane) to the high-tech superhighway.
Low-Tech Ways to Conceive
Start by having unprotected sex.
Ditch the contraceptives and relax. Remember that most couples will have no trouble conceiving naturally. Set a time limit—usually a year (but ask your ob/gyn for specific recommendations) for “trying” before you consider consulting a fertility specialist. Women over 35 may want to see a fertility expert after six months. According to Sherman Silber, M.D., head of The Infertility Center of St. Louis and author of How to Get Pregnant with the New Technology (Warner Books, 1998), there's no reason to see a fertility expert earlier, unless you or your partner have a known risk factor for infertility, such as a history of pelvic infections or a past vasectomy.
Try an ovulation test kit
(available over-the-counter at drugstores). If a few months of unprotected sex haven’t led to pregnancy, and you’re not ready to consult a specialist, try timing your intercourse to include your most fertile times. There are many fertility monitors on the market, and most work by detecting high levels of LH (luteinizing hormone, which triggers the release of the egg from the ovary) in urine (other monitors test saliva or even sweat). The test reveals the day you ovulate and the day before, when LH first surges; these days are among your most fertile.
Take the next step: get tested.
“If your deadline passes and you’re still not pregnant, schedule fertility testing for you and your partner. Contrary to popular belief, male infertility is just as common as female,” says Laurel Stadtmauer, M.D., assistant professor of obstetrics and gynecology at The Jones Reproductive Institute at Eastern Virginia Medical School.
High-Tech Ways to Conceive
Bringing more science to conception
Depending on the results of your tests, the next step in your quest for conception may be treatment for a detected problem. Doctors will usually start with the least invasive (and usually lowest-tech) options first, before bringing out the “big guns.” Super high-tech treatments like in vitro fertilization and embryo freezing gets lost of publicity, but 85 percent of patients can be treated with simple medication or surgical repair of reproductive organs.
Simple medication for women:
Clomiphene citrate (brand names, clomid and Serophene) is a relatively inexpensive drug that can be used in patients with long cycles where ovulation is unpredictable, and in women with polycystic ovarian syndrome (PCOS) who don’t ovulate at all. Clomiphene works by tricking the hypothalamus and pituitary into “thinking” there’s an estrogen deficiency. In response, they produce extra FSH and LH—which stimulates follicle production. Clomiphene can also be effective in women with luteal phase defect, in which the low levels of progesterone are produced by the follicle after ovulation—leading to miscarriage. The medication is often used with IUI (intrauterine artificial semination with sperm that has been “washed” in the lab to increase its fertilizing potential). Recently it’s been found that the success rate for some women with PCOS who don’t respond to clomiphene alone can be improved by adding the diabetes drug, metformin (Glucophage).