Get Your OB On Board: Time Is (Almost) Everything

Being in the right place at the right time can make a difference in your life. It's true for getting pregnant, too. And your OB/Gyn knows how key timing is to pregnancy and delivery.

Does your OB also know how time impacts your ability to get pregnant? If he or she doesn't, you should.

At Houston Fertility Center, I've heard from many new patients their personal reports of months, and sometimes years, full of worry that something is wrong -- all the while being told by their primary care physicians that the best thing to do is de-stress and have patience. Nothing's wrong. Relax and you'll be pregnant in time.

It's true that stress can be a fertility factor, since it wreaks havoc on your hormones, which can result in lessened fertility. But many patients have health conditions that might easily be diagnosed and treated so that conception and pregnancy can occur -- stress or no stress. (And if stress really is your primary fertility problem, there are plenty of recommended steps you can take to change that.)

There's one factor in the fertility equation that treatment can't do much, if anything, about: time and your age. And there's nothing that has a greater impact on your chances for pregnancy.

While we have incredible medical technology that can help women get pregnant all the way into their 40's, the natural fact is that women's fertility levels decline significantly as they get older. That means the older you are when you're trying to conceive, the more effort it may take. It also means your chances of conception get smaller.

Age and time are so important to fertility, experts recommend you consult a reproductive specialist if:

you haven't become pregnant after a year of trying and you're a woman who's younger than 35 years

or

you haven't become pregnant after 6 months if you're 35 to 39 years old.

And women who are 39 years or older should seriously consider talking to a specialist as soon as getting pregnant is a goal.

The American Society for Reproductive Medicine explains details of the age-fertility connection in their related booklet.

Besides the reproductive change that every female body goes through (and that actually begins long before most of us are aware of), many infertility-causing conditions are silent -- no symptoms to cause you concern, all the while the condition becomes a growing barrier to your body conceiving a pregnancy. If you have one of these barriers, which includes structural conditions, trauma, or infections, your own baseline fertility will quite possibly become worse over time.

If you've heard "Everything's fine," a little too often from your OB/Gyn, there's no harm in seeking a second opinion. You might benefit from some easy, inexpensive blood testing or semen analysis, or like some patients learn, it may only take a thorough medical history and brief educational tips on optimizing your trying-to-conceive efforts.

More of my thoughts about timing and conception:

Trying to Get Pregnant After 30 - Time to Panic? - a blogpost about how moving along with your plans is good, but stressing out about it defeats your purpose

Timing Is Everything: When You Want a Baby Later - a newsletter article on using ART to delay conception

a quick intro to Fertility & The Mind-Body Connection

~ Dr. Sonja Kristiansen MD

Is Your OB On Board With Baby-Making?

When questions about getting pregnant arise, most women first turn to their OB/Gyn. You probably even rely on your OB/Gyn as your primary care physician, especially if you have health insurance. Patients typically count on their OB/Gyns to alert them when it's time to see a fertility specialist.

Unfortunately, though, a lot of woman also find that their OB's may not act very quickly when the patient expresses more than just fleeting thoughts but worries about getting pregnant.

That's why I and many of my colleagues spend at least some of our time educating other physicians about the differences in fertility levels and about how those differences may show up in their otherwise healthy patients.

If you're not yet a fertility patient (and you may never have to be!), here are a few related basic points to look into and discuss with your OB/Gyn if your goal is conception:

How long have you been trying to conceive?

Do you know when your most fertile times are each month, based on your cycle?

Do you have any family members who had trouble getting pregnant?

And if you're in your mid-30's or older and are still thinking "maybe someday"... it's time to discuss plans now with your physician, even if you don't plan on putting it into action immediately.

Knowing when to seek care from a fertility specialist can really make the difference between having a baby or not. If your OB/Gyn doesn't know what to look for or doesn't ask you the above questions, start the ball rolling yourself.

How Do Fertility Patients Feel About Donor Anonymity?

I work in a medical field that is ripe with controversy at times. There's nothing casual about helping people try to create life. But I try to avoid bringing a sense of alarm to my patients, even when the news headlines are worrisome. I do think there's a place for staying updated, though, when the news is about laws that may find their way into how I practice reproductive endocrinology and how my patients' treatments will be impacted.

The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.

Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.

The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.

This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.

~ Dr. Sonja Kristiansen MD

Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?