7.81 MB | 19:28 Min
Dr. Ronald Young is the Director of the division of Gynecology at Baylor College of Medicine. Dr. Young specializes in Gynecology, Reproductive Endocrinology and Infertility.
Welcome to your Pea in the Podcast, I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy.
This week, maybe you’ve joined us because you want a baby and you haven’t gotten pregnant yet, or you have a friend who wants to be as happy as you are, but it’s taking a little time. Well, we’ll tell you what you need to do to get started…
“Eliminate or sharply reduce those aspects of her lifestyle, which may harm either her ability to get pregnant or may harm the pregnancy itself.”
What are they? We’ll find out, and we’ll find out what you need to do to get there.
“You should have sex that night and the next night.”
And when do you pee on that stick?
“They may get pregnant the night they ovulate, in theory, but everyone knows that you’re going to have to wait at least 2 weeks to see if your period comes.”
We’re talking to an expert in the field of getting you pregnant in this Pea in the Podcast.
You’ve known about the birds and the bees since you were a kid, right? Well, for some people that’s all you need to know to get pregnant, but for others, a little more knowledge goes a long way. Ronald Young is the Director of Gynecology at Baylor College of Medicine, and he says a healthy pregnancy begins before you even start trying.
“A woman who is wanting to get pregnant doesn’t really have to do a lot except make adjustments to her lifestyle, which would eliminate or sharply reduce those aspects of her lifestyle which may harm either her ability to get pregnant or may harm the pregnancy itself. Most of these are no-brainers. Some of them are a little bit more difficult to understand.”
“I mean, obviously, you know, we beg and plead with the smokers, women who are heavy drinkers or have other bad social or even illegal habits to eliminate those habits or try to sharply reduce them before they would even attempt to get pregnant. Many of them all by themselves cause problems getting pregnant in the first place.”
Dr. Young mentioned one of those things that many women don’t know might hinder their fertility, but can: smoking.
“It has been estimated that somewhere between 10 and 15% of women who are if they are not absolutely infertile, but sub-fertile or having trouble getting pregnant, maybe 10-15% of those cases may be attributable to tobacco use.”
This is not just an urban legend or a doc trying a scare tactic to get you off the smokes. Dr. Young says there is science to back that claim up.
“Tobacco has definite anti-estrogenic effects in many women. It’s through a complex mechanism in the brain, but there is no question that women who smoke will interfere with the estrogen effects and estrogen metabolism, which are normal in their system.”
And that will lower your fertility.
And weight. If you’re over your ideal weight, you may be somewhat less fertile. Particularly if you have a disorder called polycystic ovary syndrome.
“Weight gain is a problem with the PCO patients. Losing weight certainly helps reverse some of the aspects of the PCO, no question about it. These patients are pre-diabetics and losing weight certainly helps a large number of them.”
Losing weight can also help a woman with PCOS ovulate, and losing a little weight can go a long way. I have PCOS and lost about 10 pounds, and then I got pregnant with my daughter.
Some people are surprised to find out that weighing too little can also impair fertility.
“Too much dieting, getting the ideal body weight a little bit too low or excessive exercise. You know exercise is something we praise and recommend, but there’s certainly evidence that overdoing the exercise can be associated with reduction in fertility rates.”
So everything in moderation as you prepare to try to get pregnant.
Some doctors will also recommend that you add a prenatal vitamin to your diet, but all doctors suggest that all women of childbearing age take folate, a vitamin in the vitamin B family. You want to be taking at least 400 micrograms of folic acid before you get pregnant so the levels will be high enough in your body to head off neural tube defects like spina bifida in your baby. The reason doctors want all women of childbearing age to take it is because so many pregnancies are unplanned. But you’re planning your pregnancy, so if you’re not taking at least 400 micrograms of folic acid right now, listen to the rest of this Podcast, then head out to the store. Okay?
Okay, so you’ve quit smoking, you’re watching your drinking, you’re taking your vitamins. You want a baby, darn it, and you want it now!
“People are very anxious. You know, we live in an age of instant gratification that’s sort of been promulgated at us in all sorts of areas, consumerism and others, and it’s probably no different in fertility. So here’s the deal: a couple who has no obvious problems, if they consult you around the time of their marriage or just after their marriage or just before and they say ‘look, we are getting married or we just got married and we’d really like to conceive’ I mean, unless you can spot in that couple obvious problems, and I’ll outline a few in a second, then the best thing to do is to tell them to go ahead and, you know, cohabit with each other and make a baby. And that they should not really worry about it unless close a year, at least a year or close to a year goes by, and they have been unable to conceive.”
Dr. Young says more than 85% of you will have conceived when that year is up. But it will take the entire year for that 85% to get that positive pregnancy test. After a year, if you’re a normal, healthy couple with no obvious reasons for not being pregnant yet, talk to your doctor. But as Dr. Young hinted, there are some couples who should not wait that long before talking to their doctor.
“The husband’s been married 4 times before and none of his wives could ever conceive even though they always wanted to have babies. Then, obviously, there is a big problem probably brewing in him. If the wife has had a history of sexually transmitted diseases, had tubal infections 10 times in her teens or a ruptured appendix with emergency surgery and a lot of adhesions and has that history or she’s been married before or a couple of times and never was able to conceive. Or her periods are totally, totally irregular and unpredictable, then it’s silly and almost a bit hypocritical to tell that couple to wait a year.”
If you recognize yourself or your partner in there, go ahead and talk to your doc. Also if you’re a woman who waited a little to start her family, you might not be as fertile and you might want to talk to your doctor.
“There’s no question that fertility does change. The peak year of fertility in a woman’s life is about 25, although she’s on a long plateau around that time. But in theory a woman around 25 is even more fertile than a woman at 24 or 26, but it’s a slight nuance at that age. She’ll stay in pretty good shape for fertility until maybe she gets to her mid-30s. There was an attempt to portray the age of 30 as a watershed in fertility many years ago, but reanalysis of data showed that 30 was not that big a watershed, not that many changes at 30. But now we come to 40, and for sure 40 is a watershed because the spontaneous pregnancy rate, even in very healthy people with no obvious or hidden problems, is very low. You get to the mid-40s, spontaneous pregnancy rate are in single digits despite your best efforts.”
So Dr. Young wants to see you right away if you’re older and ready to have a baby.
“They are just starting to really go against them, after you turn 40 and head on into your mid-40s, and when you consider that the workup takes time and it can’t be hurried along. Once you get in the situation of a fertility workup, it’s very difficult to cut corners or hurry it along or coax it along. You have to turn over every rock in the garden. You have to look at all of the potential causes of infertility, and they have to be ruled out or identified if they are ruled in and, you know, that takes time, takes money, it takes a lot of investigations, takes a lot of procedures, frequently takes minor surgical procedures such as laparoscopy. You don’t have a lot of time to play with.”
But whether you’re a mom-to-be in that one-year period of trying to conceive or a mom-to-be who is getting a little help, all of you are going to be doing the same thing to get that baby. Here is your advanced lesson in the birds and the bees, or what mama never told you you needed to know to get pregnant…
There really are only a couple of days a month during which you can have sex that will get you pregnant.
“It’s really a very short window, and the window is really based on the viability of sperm because the fertilizability of the egg is really in a very short window and sperm live a little bit longer, they can fertilize a little bit longer, so, I mean, if you happen to have sex before the woman, your wife ovulates or your partner ovulates, if she ovulates a good egg, even a few days later it is quite possible for those sperm to fertilize that egg and make a baby.”
Because your egg will only be viable for about a day past ovulation, while sperm can live for several days, swimming toward your egg all the while. It is key to know when you ovulate. But how do you know?
“There’s a lot of things to look for including temperature changes, cervical mucus changes. Some of those can be a bit of a pain in the neck, you know, if you have to track them every single month that puts a little bit of stress into the situation, and stress is the last thing that we want to creep into this. Let me just say this, and even though I may have colleagues who are not in total agreement, but I feel — and I’m not a mathematician — that if a woman is having a regular, predictable period month after month after month after month after month, the likelihood is that she ovulating in a regular, predictable manner. The chances that she could have a regular period without ovulating regularly, it’s there, but it is extremely minute. Therefore, it is really a fairly simple matter. If your average period is 28 days or 30 days or 32 days or in between there, then around halfway through the cycle is when you are going to ovulate. And, you know, if you think you need to do an ovulation kit or check your cervical mucus or check the pH of the vagina or do your temperatures, then, you know, that may back up your intuition as to when your fertile time is. But I feel, for the average couple, if they’re healthy and otherwise have no problems and the woman’s periods are regular, then just timing ovulation to the mid-cycle should greatly enhance their chances of getting pregnant and produce a pregnancy within a year, if nothing else is wrong with either of the partners.”
Ah ha! But if you think just having sex on day 14 if you have a 28-day cycle will be enough to get you pregnant, you’d probably be wrong, even though we all know that it can take just once. Those little swimmers have to meet the egg in the fallopian tube before she breaks apart, and it takes some time to get there. So Dr. Young says it is best to get busy before you ovulate.
“If you knew, if a little spot appeared on your forehead that you’re going to ovulate the day before you ovulate, if you knew that you were going to ovulate tomorrow, probably you should have sex that night and the next night. In other words, the night before ovulation and the night of ovulation should really cover it every single month. So that if you have pretty much like clockwork of 30 or 31-32 day cycle, so that around day 15 -16 is when you are ovulating, you should have sex on day 14 and 15 or day 15 and 16 and every other day around there, too. I mean having sex every day is not really too injurious if you’ve got a sufficient sperm count.”
Yeah, that brings up the question of how much you should have sex around ovulation. Many doctors say do it every other day or so for the week up to and including your ovulation day so as not to reduce the man’s sperm count. But you might be able to get away with a little more, if you’re feeling frisky…
“The more frequently you have sex, the count gets cut down a little bit with each excessive ejaculation. On the other hand, motility goes up a little bit. So the more frequent a man has sex, the better his motility gets in any given cycle for the most part, that’s a generalization but for the most part.”
But this is also scientific! Dr. Young says the big danger when you’re having baby-making sex is that you’ll forget that you think your partner is hott and you’re having sex with them because it’s fun. Okay, he didn’t say exactly that, this is what he did say…
“You’d be surprised, if you’re really desperate to get pregnant, how the fun goes out of it rather rapidly, you know. It becomes a chore, a task, a challenge. Sometimes the husband is under the extreme tension and stress, have erectile problems because the wife is, from the minute they sit down to dinner, you know, ‘we got to do it tonight. My doctor said we got to do it tonight.’ And a lot of husbands resent that. It is a good admonition for physicians not to be too officious in this enterprise. You know, ‘you go home and have sex with your husband tonight’ and she goes home and ‘my doctor said that we have to have sex tonight’ and the next thing you know, he can’t perform because he just got all stressed out by the order. And so it’s best to try to keep stress out of it as much as you can.”
But Dr. Young is the Director of Gynecology of Baylor College of Medicine, so he’s been doing this awhile, and he knows it is not always that easy.
“You walk around in a world in which everyone is pregnant, or it appears that way to you. Half of the people that are pregnant are moaning because they didn’t want this pregnancy, and you’re desperate to get pregnant so everything grates on you, everything wears on you. So it’s really the job of the doctor not necessarily to try to turn it into a trip to Disneyland, that it’s never going to be, but to try to remove the doom and the urgency and the extreme stress out of it as much as possible, because that’s going to be there. Women just live on the clock and the calendar. They’re praying and hoping this period is late or doesn’t come, you know, it really overrides everything.”
And that’s why women who have been trying to get pregnant for a while dread the 2-week wait. What’s the 2-week wait, you ask?
“They may get pregnant the night they ovulate, in theory, but everyone knows that you’re going to have to wait at least 2 weeks to see if your period comes or maybe a little less than that to see if you’ve got a positive pregnancy test.”
And taking a pregnancy test is oh, so very glamorous. It involves you and your pee and a dipstick.
“They’re mostly tests in which you test the urine against chemical markers and if you’re pregnant, they’ll come up with a certain marker. There is a whole bunch of them on the market. They are pretty reliable, for the most part. They are almost as reliable as the blood test that you get in the doctor’s office, which costs a lot more. But patients should be told, you know, even though some of them may theoretically show positive before 14 days, you probably should wait the 14 days just to be on the sure side and then take the test.”
Now I know it is so hard to wait those 2 weeks. I have been there. But one of the dangers of testing too early is that you’ll get a false negative. Those tests are so expensive, you don’t want to have to buy too many, and negatives are no fun if you’re trying to get pregnant, so it’s best to wait until you know whatever answer you get is the real answer.
Another danger of early testing is that you’ll get a positive. Yay, right? Well, maybe. They say in circles where women are trying to conceive that line is a line, meaning a line — no matter how faint on a pregnancy test — indicates pregnancy. That is almost always true, although you do hear about evaporation lines; they are rare. But sometimes those very new pregnancies can fail very early, too. Those are called chemical pregnancies. Now that doesn’t mean they’re not real, they’re real pregnancies. It just means they’re too new for anything to be detected by an ultrasound. They are just detectable via chemicals — a positive pregnancy test. When those pregnancies end, for whatever reason, it’s a miscarriage. But if you hadn’t tested, you might have never known you had a baby and lost it. You might have just thought you had a late period. For some, that is easier because an early loss can be devastating. I know, I’ve had one. Just because I only knew there was a baby in there for a couple of days didn’t make it any easier to lose. So if you are trying very hard to get pregnant (or even if you’re not. I wasn’t), sometimes it is better not to know.
Dr. Young is aware of this possibility.
“I tell my patients to just not do a pregnancy test until 14 days come, and if they get a period before then or around that time, then we’ll just go back and work the next month.”
Because there is always next month, mommy.
Okay, now if you’ve been trying for a year and you’re still not pregnant, it’s time to see your doctor. In a future Pea in the Podcast we’ll talk to Dr. Young again about your options and we’ll talk to a therapist who struggled with infertility herself about how to keep your heart whole during your struggle to become a mom. Please join us for that podcast on infertility.
We hope you’ve enjoyed this Pea in the Podcast: Getting Pregnant. Please visit our website PeaInThePodcast.com for more information about our experts, to find links and transcripts and to register to receive tailored week-by-week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie. Thanks for listening.