Sunday, November 11, 2012

Making a Baby: Part I- Trying To Conceive And Everything Inbetween

I'm just now realizing that I have never done a post about my inside take on the whole trying to conceive game after our struggles with getting pregnant the first time around.

To make a long story short, we tried for 9 months to get pregnant with baby #1. This was an awful experience full of tears, pelvic exams, bloodwork, ovulation kits, pregnancy tests, and newlywed strife. I am happy to say, obviously, that the end result was a wee little babe who has rocked my world for 3 years now and so I offer the following advice and insight for fellow trying-to-be-mommies and daddies on what we learned.

First off, the classic standard is to try for a year without success prior to seeking help, let me be the first to say DON'T wait that long. Now I wouldn't be rushing into the fertility clinic after hitting the sheets for 2 months with no baby but this is what I will say: if you've been trying, the right way, using ovulation kits, and have no 'risk factors' (ie. age, PCOS, etc), for SIX months call your OB.

This is my personal advice. A lot of doctors will laugh at you and tell you to keep trying and call back after a year. If you find one of these docs, fire them, and get a new one that will actually listen to your concerns and at least draw a progesterone level for you. In our case, we were both young with no health issues and no family history of infertility so I started seriously looking into fertility clinicians after 6 months without success. I finally went in for a consultation with my OB after 8 months.

I will break down the rest into 2 parts: First, the trying to conceive game and everything we learned here. Second, the infertility battle and the details of that process and treatment options.

TRYING TO CONCEIVE:
I was privileged to work for a phenomenal doctor who had struggled with infertility herself and shared some great wisdom with me. We started out with the basics, I call this "Prime Time"- once you're ready to try for a baby the goal is to have sex on days 10-14 of your cycle, every other day to allow the sperm to regenerate inbetween. Many people think that if you want to get pregnant you just start going to town 100x a day and you end up with a baby, this is not how the body operates and will actually decrease your chances of getting pregnant. The goal is NOT quantity, it's timing.

For the real newbies, your cycle starts out as Day 1- the first day of your period and for most women goes for 28 days. (I happen to have a 30-32 day cycle which affected our "prime time" slightly, and these subtle differences can mean everything).

Now in order to find this "prime time" more precisely you can turn to ovulation kits which will tell you exactly when to try. A little science background here: "prime time" is based on your LH surge which is simply when your body tells itself to ovulate. If you catch the surge and time your relations appropriately the sperm should reach the egg at the perfect time. It is a simple concept but it's anything but simple when things aren't working like you thought they would.

The basics of ovulation kits: once the test is positive your opportune time to conceive is within 24-36 hours.

I tried every ovulation kit known to man and this is what I found. Most ovulation kits come with 7 days of tests, for these kits you are expected to already have an idea of when you ovulate and just confirm this with a week's worth of testing. Problem is that some people have no clue when they ovulate, they may have 2 LH surges during the month instead of 1, they may have it earlier or later than most women and therefore a week's worth of testing may not be enough to really see what's going on. I decided to test every single day because I wanted to get a full picture of my entire cycle rather than a concentrated look at 7 days. With this comes a price. If you've browsed ov kits before you know they are EXPENSIVE! Especially when you're doing this for months and months at a time. So due to cost I decided to go with some strips to test for the whole 30 days because they were cheaper than the wands and digitals.

First Option: Strips. This is a picture of the strips (not mine but you get the idea, thank you to whoever posted all of these images, they are a perfect representation of what you can expect), as you can see they look like pregnancy tests with 1 to 2 lines. The problem with the strips is that they can be really hard to read because the second line can be faint or dark and kind of come and go which makes it hard to say whether it's positive for the surge or not. What I did was keep every single day and compare them next to one another, by doing this you are much better able to see a trend in the lines and accurately detect the TRUE surge. I recommend writing the date on them to keep track. This picture shows someone using them twice a day, which is also a good thing because you could be missing your window by 12+ hours if you are only testing once a day, keep that in mind.


Next option: Wands. These are what you normally find at the store, they look exactly like a pregnancy test in fact if you aren't reading carefully you can mix the two up easily. I kept using the strips daily but would also use the wands on occasion to see if I would get a better picture of the LH surge. The wands are pricier than the strips and they really don't give you a better impression of what's going on, as you can see from this picture. If anything they seem to be less sensitive at detecting things, in my opinion and after a month or two of these I stopped using them. My advice, skip the wands.






Lastly: DIGITALS. After a couple of months I had an idea when my surge was, in general, so I decided to REALLY confirm things by adding the digital tests to the mix. I would still test with the strips daily but during the week I was expecting the surge I would also take the digital tests. It was the most foolproof method I could think of and we were starting to get very frustrated, anxious, and desperate. The digital tests are even more expensive, which is why I don't recommend using them as a daily option, unless you want to and then you'd have no guessing. Even among the digitals I tried I decided my favorite were the SMILEY FACE ones and I swear by these to this day. They are a wand but show a digital picture of either a smiley face or a plain circle with no face. There is no mistaking these, no interpreting a faint line, just like pregnancy tests the digital are as clear as it gets. When you pull out the stick you can see the same 2 lines that the strips and wands have but these tests take the guesswork out of it for you. And outside of the clarity the little smiley face that pops up is a reminder to be happy about this, instead of looking at things as a science experiment which is how it feels. Can't hurt right?


Ovulation kits are a great way to start getting to know your cycle and taking charge of your fertility but they aren't the end all, be all. The next easiest thing to do is a daily temperature reading. Your Basal Body Temperature is the fancy name. Basically you take your temp every single day immediately after you wake up and record it. Ideally, you will see 2 main changes in temperature throughout your entire cycle, lower at the beginning and jumping up later on. This jump occurs AFTER your body has ovulated. You will see a 3rd jump if you end up pregnant and implantation has occured.  These jumps are subtle, we're talking 2/10's of a degree to 1 degree in most cases. This is the simple version and I recommend keeping it simple, it is an additional tool to use in your efforts and gives you a better picture of how your body is operating. There is a catch however, these temps must be PRECISE, which means you need to take your temperature at the SAME time every single day. There are measures to adjust the reading with calculations and I will tell you this clouds things, the best way is to get a routine set up, wake up at the same time every day, take your temp immediately after you wake up and keep it simple. You need to record the temp to the 1/10th degree, so a digital thermometer is the way to go. Also keep in mind that a falsely high reading can skew everything so be careful in what you record: 97.52 should be recorded as 97.5 and 97.68 should be recorded as 97.6.

The take away: "A dip in temperature followed by a rise (at least 2/10's of a degree) higher than all temps the previous six days and staying at or beyond this level for at least 3 consecutive days shows that ovulation has occurred"

However, these temps show you when you have already ovulated, meaning you should've already hit the sheets. After a few months you can hopefully see a pattern and time things appropriately but there are other indicators of the cycle. Cervical mucus, I'm not going to lie, I hate talking about this because let's be honest it's not a great visual to say the least mmmkay. So I'll leave it to the experts with this short explanation, "Directly prior to ovulation, cervical mucus should be abundant. Fertile cervical mucus is characterized by a transparent appearance - and it may look and feel like raw egg white and stretch between your fingers without breaking (see fig 1). This stretchiness is called Spinnbarkeit and indicates that ovulation is likely imminent. Fertile CM will be thin, slippery (like lubricant), stretchy and translucent. Typically, fertile-quality cervical fluids will appear a few days prior to and during ovulation. Following ovulation, the quality of CM will change again due to sudden decrease in estrogen and increase of progesterone."


Bottom line you should be paying attention to it to add that much more knowledge to the picture. Which brings me to the last point of trying to conceive tools. Cycle charting helps you keep track of all of these changes. Fertility Friend, your key to the crazy world of cycle charting! It's a website that you input all of this information into and it keeps track of everything for you. You can input temps, body changes, mucus changes, you name it. And with all of this data you finally start to see the exact picture of your body's cycle which gives you a basis for the best odds of conceiving. Not only does this help you in your efforts it is also a HUGE resource for your OB and/or fertility docs if you continue to be unsuccessful, it gives them a wealth of knowledge to help you. A great great great tool!




Stay Tuned for Part II which delves into the options and testing available for those who are unsuccessful after ALL of this.






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