It seems that the modern availability of too-much information and technology has produced some complex perceptions among women regarding fertility. Many come to believe that they will be unable to conceive despite no actual experience with infertility and equal numbers believe that the advent of reproductive technologies will allow them to conceive at any point in life regardless of biologic limitations. Both situations cloud the long-standing truth that up until the mid-30s age range, about 85% of women will conceive (and have a live birth) within one year of simply trying the old-fashioned way – unprotected intercourse during peak fertility. On the flip side and despite that we see women having babies much later in life than in past generations, the percentage of women that will naturally produce a live birth within one year of trying at age 40 decreases to about 45%.
Some common situations which cause women to doubt their fertility are irregular or absent periods, a family history (i.e., a sister or a mother with known fertility problems), a history of unprotected intercourse that did not result in an unintended pregnancy, chronic disease, a belief that the male partner is infertile, the choice to have intercourse during lower fertile times in the menstrual cycle or current breastfeeding. If you’ve experienced any of these, please know that we almost never consider a couple to suffer sub-fertility or infertility until they have actually tried to conceive with at least ovulation tracking and timed intercourse for one year (usually a shorter time period for older women) and that fertility issues are just as likely to be of male origin as of female origin (meaning that if you haven’t conceived in one partnership, don’t assume that you will not conceive in a different relationship). This common misperception of low fertility leads to many unintended and unwanted pregnancies.
Another area in need of more public health education is in the use of prenatal vitamins, specifically folic acid or folate. Prenatal vitamins are great for many reasons but one of the most important (and the one that has been repeatedly proven in research) is the role of folic acid in preventing spinal cord malformations (like spina bifida) in the baby. In order to be most effective, folic acid must be taken in the months prior to conception. By the time you have your first prenatal visit with your provider (which is when so many women begin taking prenatal vitamins), the baby’s spinal cord is well into its growth and abnormalities — if they’re to be — have already developed. This is not to say that you shouldn’t start the vitamins if you didn’t get them on board early, just to say that when thinking about pregnancy, the first thing to do is get on some vitamins. Better yet, if you are a women of reproductive age, even if you’re not planning a pregnancy, get on vitamins anyway!
Anyone who has already had children can tell you that there is no “perfect” time to have a baby. Life will always be too long on obligations and too short on money but having your meticulous plans thrown into chaos is one of the many amusing frustrations of parenthood. The best preparation that you can do is to get on the same page as your partner about your hopes and dreams and make a plan that has loose borders, room for change and a dose of humor. If you’re over the age of 35, you’ll need to modify “someday” into a more specific time frame for childbearing; our current reproductive technologies are fabulous but they are not guaranteed and they are certainly not without heartache and significant costs.
If you are not ready to have a child, there are so many reliable birth control options available to you and many are newly available in the past several years so forget what you thought you knew, get into your clinic for a chat and find a method that that suits you! If birth control is not an option for religious or cultural reasons, carefully implemented “natural family planning” can be a great option when done correctly and consistently. Your provider can help you get started or there are many reliable ‘apps’ and computer programs to help with this.
If, on the other hand, it seems that children are even remotely on the radar, it’s a perfect time to meet with your obstetrician or midwife for a complete physical, a review of your history and family history and to get some pointers on tracking your ovulation cycles. Working (always) to arrive at or maintain a healthy weight and starting a daily prenatal vitamin should also be on the short-list. Most of all, try to enjoy some surprise and spontaneity in the process. If you don’t conceive after some time (again, usually one year), we at Physicians and Midwives Collaborative Practice will be right there for you to investigate and help in every way possible so try not to become stressed if your friends become pregnant before you. With just a bit of forethought in a healthy partnership, an understanding of your menstrual cycle and some faith in your body, it’s very likely that you will have a healthy baby in a time frame that somehow turns out to be just the perfect time to meet your baby.