Fertility and Conception

By JustMommies staff

Trying to get pregnant? JustMommies spoke with Dr. Sahakian, the Medical Director of the Pacific Fertility Center in Los Angeles. Dr. Sahakian is Board Certified in both Obstetrics/Gynecology and Reproductive Endocrinology/Infertility and is responsible for the births of hundreds of babies all over the world. Read on for the answers to your most pressing questions about fertility and conception.

JustMommies:Talk to us about how age impacts the ability to get pregnant.
Dr. Sahakian:If there are no medical issues with both partners, the most important thing a woman needs to understand is that fecundity (the ability to get pregnant) is very dependant on age. I’m going to give you some odds that might surprise you a little bit, but these are true odds. If you are less than 30 years old, you have a 35% chance of getting pregnant each month. You would think that at such a young age, a man walks by you and you get pregnant. No, there is a 65% chance each month you try that you will not be successful. Now, that same woman, if she was in her 30’s- would have a 25% chance of getting pregnant each month. At 40 years old, it becomes a 10% chance.

JustMommies:Why are the odds so low?
Dr. Sahakian:Many things need to line up in order for you to get pregnant. You have to ovulate, the egg has to be picked up by the tube, the sperm has to reach the egg, it has to fertilize the egg and the embryo has to travel to the uterus and implant. There can be breakdowns in these procedures. Remember, not every egg you produce each month is a genetically healthy egg. At 20 years old, 7 out of 10 eggs will be healthy. There is a chance you will produce an egg one month that will not get you pregnant. It’s very interesting- men make sperm every three months. Women are born with their eggs. As a woman gets older, her eggs get older with her. Therefore, the quality deteriorates. By 50 years old, you will run out of eggs. For somebody that gets pregnant after 35 years old- we recommend they do an amnio to check for the health of the fetus. This is because the risk of chromosomal abnormalities increases with age.

JustMommies:On average, how long should you try to conceive before you seek help?
Dr. Sahakian:Some women are surprised when they do not get pregnant in the first few months of trying. But as you can see, there are many factors that come into play. Timing is crucial, which is why it may take several tries. There is also a major decline in fecundity as you get older. The younger you are, the less you have to worry about how long you try to get pregnant. My general rule of thumb: healthy women who are younger than 30 years old should try for 1 year before seeking medical help. If you are between 30-35 years old ~ give yourself 9 months. If you are 35-40 years old ~ 6 months. There is really no need to seek help earlier if there are no medical concerns. However, if you have any reason to believe that you need to see someone (i.e. due to a sexually transmitted disease or an erectile problem) you should speak with a professional sooner.

JustMommies:Do birth control pills affect your chances of getting pregnant?
Dr. Sahakian:No, there is really no data to suggest that can happen. Now, it might take you 2 to 3 months before you start ovulating again, but it will not affect your future ability to have kids.

JustMommies:When is the best time to get pregnant? Before, during or after ovulation?
Dr. Sahakian:That is the million-dollar question. No one really knows. I’m sure you’ve read on the Internet that the egg survives for 24 hours and the sperm survives for a few days. For me, I believe you have an 8-hour window, maximum of 12 hours to get pregnant. You have to have sperm there when the egg is released, which means you have to time it very accurately. In general, if you cycle at 28 days- you will ovulate at day 14. You can actually calculate your ovulation based on your last 3 or 4 cycles. If you cycle every 30 days- you ovulated 14 days from the start of your period, so you go backwards. If you want to be sure, purchase an ovulation predictor kit and start checking your urine. When the test turns positive, it doesn’t mean you are ovulating right then and there. It means you will ovulate 24-40 hours after the test is positive. The ovulation kit will tell you to check your urine once a day. I recommend you check it twice a day, 12 hours apart. When the test turns positive, have sex 24 hours AND 36 hours later. This is the best time to get pregnant.

JustMommies:If you are having trouble getting pregnant, what options are available?
Dr. Sahakian:You need to speak with your OBGYN. Most gynecologists can deal with basic infertility. You can also go to an infertility specialist. There are four important tests that a doctor will do when you come in.
#1: You have to make sure there is sperm. Believe it or not, half of the time this is the problem. The best type of infertility to have is abnormal sperm count because this is the easiest to fix.
#2: You need to evaluate the eggs. It doesn’t matter if you are only 25 years old. If you can’t get pregnant, the doctor needs to make sure the woman is producing an egg and the quality of the egg is good.
#3: You need to check the tubes. Obviously, egg and sperm have to meet in order for you to get pregnant.
#4: You have to check the uterus, because this is where the embryo grows.

Depending on the test results, there are conventional treatments available which include fertility pills or artificial insemination. Fertility pills will run you about $100 a month. They can work very well if you are somebody who does not have ovulation. There are also other advanced treatments for infertility. In-vitro fertilization (IVF) is popular. In this procedure, eggs are removed from the woman’s body and are fertilized in a glass petri dish using a partner’s or donor sperm. The embryos are subsequently transferred into the woman’s body, in the hope that a pregnancy ensues. In-vitro is expensive because it’s a very high tech procedure. Minimum (with medication) it will run about $10,000. The success rate: Less than 30 years old, after 1 try- you should expect a 50% chance of pregnancy. Within 3 tries, 70-80% chance. Over 30 years old, your chances drop a little. It will be more into a 40% chance. Over 35 years old, it will be more like a 35% chance. For a woman 40-43 years old, it’s about a 15% chance. Over 43 years old, most women will get an egg donor. Egg donation is the growing trend now. Women who are unable to produce healthy eggs, but have a healthy uterus are candidates for egg donation with IVF. As you can see, there are a lot of treatments available to help couples reach their ultimate dream of becoming parents.

For more information on Dr. Sahakian and the Pacific Fertility Center, please visitwww.pfcla.com