Trying to Conceive? When Do You Need to Ask for Help?
How are you today? I’m feeling super excited! Why?
Because I’ve got a wonderful special guest here today for you, the fabulous Chloe Quinn, MSN, RN, WHNP-BC, aka, guru behind the top rated online course, The Pregnancy Prep!
Chloe is a wealth of all things fertility, prenatal, pregnancy, and postpartum. I’m delighted to have her share her wisdom with you today. Please join me in welcoming Chloe below!
Trying to Conceive? When do You Need to Ask for Help?
Chloe Quinn, MSN, RN, WHNP-BC
I know you’ve have been trying to conceive for months. You’ve been marking your phone app appropriately and counting the days until ovulation. You’ve been having sex frequently and eating just right. You’ve read 3-4 blogs and talked to your closest friends. But after months of this, you still haven’t seen those infamous two pink lines. You met your doctor and they encouraged you to keep trying, to take your prenatal vitamins and to worry less. You try so hard to worry less, but that is so much easier said than done. You wonder if your worrying is slowing down your potential to fertilize an egg every month, you wonder if something is wrong with your partner and you wonder… you wonder if you’ve waited too long. You blame yourself, your weight, your period, your food and your lifestyle. You think about this everyday at work and you wish you could devote more time to trying. You wonder when your day will come, when will you have good news to give, and how you will tell your partner.
I hear you, I know you, we are the same, nothing is wrong with you for thinking these things and no, you haven’t gone crazy over this. This is so important to you.
My name is Chloe Quinn and I’m a nurse practitioner in OB/GYN. I dabbled in the infertility realm after my career as a labor and delivery nurse, and knew I had to have a larger role in women’s lives. I became a board-certified women’s health nurse practitioner and I love all of it; the good, the bad, the pain, the beauty… and I want to help you get through all of it too. Desiring to procreate is fundamental to our species. It is the strongest urge we have and it is what our bodies were created to accomplish. It is so important to us as women and as human beings. It is not a necessity, no, but the desire is so strong and it should never be diminished.
When I spoke with Elizabeth, I just knew I had to collaborate with her. Her story is powerful, her fortitude is strong and her knowledge on fertility and food is vast. Just like you, I want to learn the ways to protect female fertility through food and nourishment. Good building blocks are important when looking forward to growing a tiny human being. But, I also want you to know when to seek the care of a medical professional after you’ve tried to do all you can on your own.
As a medical professional, I see women everyday who plan on waiting to have a family well into their thirties. Whether it is because of career growth, marriage or the desire for independence, it is becoming more and more normal to wait. Typically, at 35 years of age, our fertility starts to slow down on its path to menopause. This is the natural rhythm of life. But occasionally difficulties achieving pregnancy can occur much earlier. If you have been having unprotected intercourse for 1 year without becoming pregnant and you are under 35 years of age, you should seek out the help of a medical professional. If you are over 35 years old, you should seek help sooner, at about 6 months. You’re chance of becoming pregnant is roughly 87% during the course of 1 year between 27 – 35 years old.¹ This only slightly diminishes to 82% after 35 years old but incrementally decreases as the years progress. ¹
Before you seek help
Keep track of your ovulatory cycles by plugging in the days of your period into a nifty fertility tracker (there are plenty, go for one you like and is free). Next, buy ovulation predictor kits and use them every day once your period ends, particularly in the morning. Write down your findings. Also, check your cervical mucus for color and consistency. When your cervical mucus is clear and sticky like egg whites, you are most likely ovulating. Does your predicted ovulation day (from your app) match your cervical mucus and ovulation predictor kit findings? If so, please have sex. However, it is most advantageous to have unprotected intercourse everyday the six days prior to and including your anticipated ovulation day. This comprises your “fertility window”. After 6 months to a year of attempting this and you are not pregnant, please make a fertility appointment with your practitioner.
So what does “help” really look like?
When women come to me to worked up for infertility, they usually are stressed and concerned and want everything possible done. Unfortunately, we don’t have a good measure of fertility, but there are some levels we can evaluate.
Thyroid Stimulating Hormone (TSH)
The thyroid determines metabolism and circadian rhythm of our bodies. Your period can be directly affected by an abnormal TSH level. This is incredibly easy to treat if it is found that you have a slow thyroid (hypothyroidism), elevated TSH level or subclinical hypothyroidism. Frequently a low dose of synthetic T4 is given even in those that have a relatively normal TSH level for all other circumstances.
Prolactin is a hormone produced in great quantity when producing milk or during lactation. When you are lactating, you usually will not have a period. This is called amenorrhea. Prolactin levels can be falsely elevated and cause amenorrhea if you have abnormal secretions from your nipples or if you have a pituitary tumor (causing more of this hormone to be created). This is easy to test for, but is best done when there has been no nipple stimulation or heavy protein meal for at least 24 hours.
Follicle Stimulating Hormone (FSH)
This hormone comes from the pituitary gland in the brain and is sent to the ovaries to encourage them to produce estrogen. This may be very high if the ovaries are not producing enough estrogen. If you are nearing menopause, FSH will be high and estrogen will be low.
Tested to help determine is premature ovarian failure is at fault.
Anti-Mullerian Hormone (AMH)
This is most likely the most popular test to have done and is consistently being requested in women concerned about fertility. AMH levels give us an idea about ovarian reserve. Depending on age your number may be higher or lower, but typically we are looking for anything above 1 and lower than 8 based on age. (More on my experience with AMH levels, here.)
Testosterone levels should be low in a female, however in women with polycystic ovarian syndrome (PCOS), levels may be abnormally high. There are a couple different types of testosterone that may be tested.
There are also physical tests we can perform to evaluate your reproductive organs and your partner’s sperm count. These tests include:
This is a elaborate ultrasound done with contrast dye that is pushed through the cervix into the uterus. This dye will be seen spilling out of the follicular tubes and will aid in the determination if the uterus and the tubes are patent. You want patent (open) tubes because this means that an egg and sperm can freely float through the tubes to meet each other. Different diseases can cause those tubes to be occluded like endometriosis, chlamydia, history of ectopic pregnancies or pelvic inflammatory disease.
This test is similar to the HSG but it uses only saline to visualize the interior of the uterus for polyps and fibroids. These findings can impede the implantation of an embryo and will make it difficult to achieve or maintain pregnancy.
Done vaginally to visualize the uterus and the ovaries. This is an imaging test to rule out fibroids, adenomyosis, ovarian cysts and a more-than-normal number of follicles.
This test involves a man to wait to ejaculate about 3-5 days into a specimen cup to either be immediately brought to an appropriate testing site or to be done at the testing site. It needs to be kept warm and tested as quickly as possible for factors like speed, motility, sperm count, shape and function. (More on the report cards of infertility and our experience, here.)
These tests obviously take some time to have done and get the results. Your medical provider may do some of these tests or additional tests. Many of the tests need to be done at specific times of your cycle for accuracy and prevention of the disruption of a natural pregnancy. Some of these tests can be crampy and painful. Occasionally, these tests may be normal, in which case the diagnosis of unexplained infertility may be given.
Even though you may be scared to have these tests done or to be diagnosed with infertility, time is of the essence. If you suspect that you may have infertility, it is best to contact your medical provider so that testing might begin. This is not intended to be personal medical advice, but instead, general education. Please contact your medical provider for all of your medical care.
I wish you the best and many fertile years ahead,
Chloe Quinn, MSN, RN, WHNP-BC
Obstetrics and Gynecology Nurse Practitioner at Yale & Founder of The Pregnancy Prep, online childbirth course intending to help women through every step of their reproductive journey and empowering them to have beautiful births in the hospital setting.
¹Dunson, D. B., Baird, D. D., & Colombo, B. (2004). Increased Infertility With Age in Men and Women. Obstetrics & Gynecology,103(1), 51-56. doi:10.1097/01.aog.0000100153.24061.45