Nancy Karabaic and her husband Chris LaChat of Wheaton, Md., are self-professed "late bloomers." They courted for five years before deciding to tie the knot, but they never expected the pattern to follow them into parenthood. It did. They tried to conceive a baby for a full three years before Karabaic finally got pregnant.
"It was a surprise because I fully expected, like every woman does, that when the birth control was gone, it would happen next month," she says. The couple had even begun some initial infertility testing to make sure everything was OK, although Karabaic got pregnant shortly thereafter.
Their story is common. Maybe we all learned our lessons too well back in junior high, squirming uncomfortably in our desks as our sex ed teacher ominously warned how easy it was to get pregnant. Many of us certainly devoted enough effort trying to avoid it all these years until the time was right.
The fact is, however, that getting pregnant is often more difficult than we've assumed, especially the older we get.
"Many people think that human reproduction is a much more efficient process than it really is," agrees Dr. Robert Stillman, medical director of Shady Grove Fertility Centers in the Washington, D.C., area.
So to avoid the surprises -- and disappointments -- that might come with failure in those first few attempts, here's the lesson you probably never heard from your parents or teachers on how to get pregnant.
The Odds Are in Your Favor
First of all, rest assured that the odds are definitely with you. About 85 percent of all couples will get pregnant within a year, but it's also wise to have some realistic expectations. The average time it takes to conceive, for instance, is about six months, and women under 35 should wait until they've tried for a year before they consider calling their doctor or a fertility specialist with concerns, says Dr. Stillman.
For older women, the picture changes. Not only could it take longer to conceive, but there are fewer chances of succeeding.
"Women 35 and older who think things aren't quite right, maybe their menstrual cycle is off, should bring that to someone's attention fairly quickly -- within three months if they're not pregnant yet," says Dr. Michael Zinaman, director of reproductive endocrinology at Loyola University Medical Center in Chicago. "If things seem absolutely fine, then they should contact someone after six months."
The problem is that many women nowadays who are postponing children until later in life for a variety of reasons often don't realize until it's too late about the reduced odds, says Dr. A.F. Haney, chairman of the division of reproductive endocrinology and infertility at Duke University Medical Center.
"There's this Susan Sarandon effect -- everyone sees a 42-year-old woman getting pregnant, and they think there's no problem waiting," Dr. Haney says. "They need to understand the biological realities that go along with those life choices -- that by waiting, there's an increasing risk they'll stumble or be unsuccessful -- and many people, had they known that information beforehand, might sequence things differently."
Do Any Tricks Work?
Mustering the patience until you conceive is often easier said than done. Standing on your head after intercourse, hanging upside down by moon boots, hypnosis -- they're all examples of measures that couples might only reluctantly admit to.
A British study even shocked the medical community by claiming recently that a late afternoon roll in the hay is the optimum time for conception because that's when female hormones that affect fertility and sperm count and potency are at peak levels.
So far, however, experts say there isn't enough evidence to prove that any particular positions, time of day or activity after intercourse make a difference.
"Remaining supine for a couple of minutes is more than adequate," Dr. Stillman says. As for that romantic little getaway? "There's nothing wrong with maintaining romance, or even a sense of humor, while trying to conceive, but a candle at the head of your bed is probably as useful as a candle at the Four Seasons, and it's a whole lot less expensive."
The fact is, there's still only one way to get pregnant -- by a sperm fertilizing the woman's egg, which can happen for only about 12 to 24 hours after ovulation -- approximately 14 days before the end of a woman's monthly cycle. Ovulation sometimes can be harder to predict if a woman's cycles are irregular. And for women who are getting older, monthly cycles first get shorter, then longer the closer they get to menopause.
Common signs of ovulation are increases in vaginal mucus discharge and abdominal discomfort on either side of the pelvis (called "mittelschmerz"), but most women usually aren't attuned to those signs, says Dr. Zinaman.
To minimize the guesswork and help you get pregnant as quickly as possible, drug stores now carry a handy home test called an ovulation predictor kit, which range from about $15 to $40. Using a urine sample, the ovulation predictor kit measures the level of luteinizing hormone (LH) that increases significantly before ovulation, giving couples about a day or two's notice of a woman's most fertile period and maximizing the chances of conception. In addition, the maker of the Clearplan Easy ovulation predictor kit is introducing an even more high-tech gizmo that claims to give couples a six-day window of opportunity for conceiving. This handheld computer tests and records women's LH and estrogen levels by reading a urine sample stick, and notifies them of low, high and peak fertility times. The device retails for about $200, plus $50 for a package of 30 test sticks.
These kits definitely beat the old-fashioned method of charting your temperature, which not only has the potential to drive women -- and their spouse -- nuts, but which isn't even very effective because by the time you notice a temperature change, you've already ovulated and it's too late to conceive. "It was kind of like watching a calendar, but not quite as tense because you know you have one or two days," says Karabaic, who used one of these kits before getting pregnant. "It's as obsessive as I got about tracking the best time to get pregnant because I knew that it would be counterproductive."
Clearing Your Head
There are some relatively controllable factors that may be slowing down a couple's ability to conceive. For women, they include being too overweight or underweight, eating disorders, excessive exercise, smoking and drinking. For men, smoking and drinking also can reduce sperm count, as can marijuana use and even hot tubs. However, there are also a lot of old wives' tales out there, too. There's no merit, for instance, to common folklore cautioning men that briefs hinder sperm production more than boxer shorts.
As for stress, the jury is still out. There are lots of examples of couples who had trouble conceiving until they cleared their heads and relaxed a little more -- say, they decided to adopt a baby instead, take a trip, or became distracted with moving into a new house. There's even some evidence that depression may cause physiological changes that hinder some women from getting pregnant, says Dr. Alice D. Domar, a clinical psychologist and director of the Mind-Body Program for Infertility at Beth Israel Deaconess Medical Center in Boston.
It's also true that most individuals juggle a lot of stress in their lives and still manage to get pregnant. But while the mind-body connection continues to be explored, experts say that at the very least, noninvasive stress reduction techniques such as biofeedback and meditation can't hurt. In fact, they'll probably enhance one's overall well-being, making the process of conception -- and pregnancy -- a whole lot more enjoyable.
"I'm convinced that for some people, it's actually why they got pregnant," Dr. Zinaman says. "You can definitely in your head stress yourself enough to throw out your ovulation in subtle ways. What's more, pregnancy itself -- or even going to an infertility doctor and starting treatment -- can be stressful, so with some patients, anything they can do to make this a little more tolerable is going to help them in the long run."
