Dr. Pari was featured as a guest contributor in the article below, originally posted for Glamour Health by Korin Miller.
Most of us spend years trying to avoid getting pregnant. But, when you actually want to conceive, it can be harder than you thought.
If it’s taking time for you to get pregnant, doctors stress that you shouldn’t freak out and assume you need in vitro fertilization (IVF). Not that there’s anything wrong with IVF, of course—it can just be costly, doesn’t have a guaranteed success rate, and can be tough on you and your partner.
Luckily, there are many other things doctors can try first. “IVF is not necessary in most cases,” says Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine and author of Sex Rx: Hormones, Health, and Your Best Sex Ever. “There’s a protocol we go through. Nobody goes straight to IVF.”
Board-certified ob-gyn Pari Ghodsi, M.D., also points out that a third of fertility problems can be attributed to the guy, and another third are due to unknown factors, so it takes some trial-and-error. “There are many tests to diagnose the problem and each has individualized treatments,” she says.
Most doctors won’t want to have the fertility talk unless you’ve been having regular, unprotected sex for a year without getting pregnant, Dr. Ghodsi says. (But, if you’re 35 or older, they’ll want to talk after six months.) At that point, there are a variety of options they can look into:
Track your ovulation: “Just because you’re having regular periods doesn’t mean you’re ovulating,” Dr. Streicher says, which is why she recommends that women use an ovulation predictor kit to see if they’re ovulating. Your doctor may also monitor your cycle with blood work (to make sure your hormone levels are correct) and an ultrasound to see if there’s a follicle forming and the lining of your uterus is thick enough. Then, you may have your blood progesterone level checked to see if you actually ovulated. “From that first basic set of tests, we’re really looking at ovulation—if they’re doing it and when,” Dr. Streicher says. “You can’t assume.”
Test his sperm: It takes two people to make a baby, and that can mean your difficulty getting pregnant may not be due to something on your end. “I don’t do anything that’s painful or invasive until we do a semen analysis,” Streicher says. “If there’s a man in the picture, too often we find the guy has no sperm or it’s moving in the wrong direction. For me, that’s part of the initial fertility evaluation.” If everything on his end looks good, doctors will then move on to the next step.
A hysterosalpingography (HSG): It’s a mouthful, but this diagnostic test looks to see if your fallopian tubes are open. Basically, your doctor will inject a special dye into your vagina and take an X-ray. And, for whatever reason, women tend to get pregnant after having it done. “Nobody really knows why, but we know that fertility increases afterward,” Dr. Streicher says. “The simple explanation is that we’re cleaning out your tubes.”
A saline ultrasound: Similar to an HSG, saline ultrasounds are used to see what’s happening in there. And, like HSGs, they’ve been linked to an increase in fertility. “If you want to move this ahead as quickly as possible and particularly if we know you are ovulating and we don’t have any explanation, it’s relatively easy to do,” Dr. Streicher says.
Clomid: This drug is used to stimulate ovulation. “It will definitely enhance fertility in someone, even if they’re known to have normal ovulatory function,” Dr. Streicher says. Typically, your doctor will give you Clomid and monitor your cycle to make sure you’re not being overstimulated.
Human chorionic gonadotropin (HCG) injections: Your doctor may also give you a shot of HCG to force ovulation and maximize your cycle. This can be done with artificial insemination (where your doctor puts your partner’s semen inside you), as well, depending on what you and your partner are up for.
If your ob-gyn knows about fertility, he or she should be able to do all of this for you. But, if your doctor doesn’t take these steps, Dr. Streicher advises going straight to a fertility specialist for them. “You don’t want to waste your emotions, time, and money,” she points out. And, if you still should need it, there’s IVF, which has helped many women get pregnant. But it’s just good to know there are other options you can check out first.