By Pamela Paul
A lot leads up to the decision to get pregnant: thinking, fretting, saving, planning, and best of all—practicing! But when the moment arrives that you and your partner decide it's finally time for your egg to meet his fleet of tiny Michael Phelpsian fertilizers, you want it to happen pronto.
That desire for instant pregnancy-test gratification is what prompts some women to start browsing the fertility websites when that telltale double pink line eludes them during the first few months of trying. And in cyberspace, successful conception seems rarer than a backyard UFO sighting. The offline facts: Female fertility starts to decline at the tender age of 27; by 35, a woman is considered to be "of advanced maternal age," a senior citizen in the maternity ward. Even more troubling: More than 6.1 million people of childbearing age in the United States experience infertility—about 10 percent of the reproductive-age population, according to the Centers for Disease Control and Prevention. And anytime even a fertile couple tries to get pregnant, the chances of success are a mere 20 percent per cycle.
Hearing these stats, it's easy to bug out, but the news isn't really so dire. "It's not as if there's an epidemic of infertility out there," says Victoria Jennings, Ph. D., director of Georgetown University's Institute for Reproductive Health. "Apart from more women trying to get pregnant later in life, there are no data to suggest that the rate of infertility has increased." And even for women in their late thirties and early forties who are having problems, each day brings treatment breakthroughs and an increased understanding of how pregnancy happens.
We know—you're still worried. That's why we've talked to top fertility specialists to get the answers to women's most common questions. Consider this your CliffsNotes on getting knocked up.
When is a woman's most fertile time?
You have only about a six-day window each month to conceive—your most fertile period actually begins five days before ovulation and ends about one day afterward. This is because the sperm (which can survive for more than 100 hours) need to be in the upper part of your fallopian tubes when the egg comes out of the ovary. And conception is more likely to happen when intercourse is before ovulation, not after. The best strategy is to have sex at least every other day during that fertile window.
But here's the rub: It can be hard to know exactly when you ovulate. Even if your menstrual cycle is, say, precisely 27 days every month, ovulation doesn't necessarily take place at the same time each cycle. An OTC ovulation test kit can tell you when you're about to ovulate, but by then you've missed several fertile days. At Georgetown's institute, this baby-making method is recommended for women whose menstrual cycles are usually 26 to 32 days: Have sex every other day from days 8 through 19 of their cycle (day 1 is the first day of your period).
Does having sex in certain positions up the chances of making a baby?
You don't need to switch from reverse cowgirl to missionary: Doctors say sexual position has no effect on fertility. Nor do you have to invert yourself into a headstand once the deed is done. The truth is, sperm have just a few minutes to swim into your cervical mucus, where they hang out and are released into the uterus over the next several days. Elevating your hips on a stack of pillows or hanging upside down at the time of ejaculation will not enhance the chances of that happening.
Are there any symptoms that could indicate getting pregnant will be tough?
Unfortunately, no. "Most of the time, there are no symptoms, and fertility-sapping conditions like ovarian cysts, fibroids, chlamydia, and polycystic ovary syndrome often go undiagnosed until a woman tries to become pregnant," says Louis Weckstein, M.D., medical director of the Reproductive Science Center of the San Francisco Bay Area. "The exception is endometriosis, which can result in significant pain during intercourse or menstruation." If you haven't yet had a checkup with your general physician or ob-gyn to make sure you're healthy and free of STDs, do it now.
Why is a woman's age so freakin' important?
It's the number-one determining factor for fertility. Sure, we hear about 50-year-olds miraculously giving birth after having fertility treatments, but the truth is, even with in vitro fertilization (IVF), the chances of having a child at age 45 are a mere 1 to 2 percent. The reasons: As women get older, their number of healthy eggs dwindles. And around age 35, the system inside the body that causes eggs to be released starts to break down, making ovulation more difficult and less frequent. (Home ovulation tests can tell you if you're rolling out an egg every month.) So while you may have hundreds of thousands of eggs-in-waiting, only a select few will ever mature enough to be pushed out by your ovaries.
Still, today's baby-making technology means that significant numbers of women are conceiving well into their forties. (That 1 to 2 percent figure cited above translates into a decent number of rug rats.) According to the National Center for Health Statistics, between 1990 and 2005, the number of infants born to women ages 35 to 39 rose 52 percent, and the number born to women ages 40 to 44 has doubled since 1981.
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