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Enhancing Fertility: What Works?

For millions of women who would like to become mothers, the best Mothers' Day present of all would be a positive pregnancy test. In their efforts to conceive, these women and their partners have heard about every possible intervention, from taking aspirin, to having massages, to highly invasive (and extremely expensive) medical interventions. What really works? Dr. Donnica separates the facts from the misconceptions regarding the non-invasive techniques that have been shown in medical studies to increase the likelihood of conception.

Most books and articles about fertility discuss it in terms of "infertility". Rather than discussing tips to increase the likelihood of conception in the first place, most articles focus on how to intervene once a couple has been diagnosed as "infertile". This is often a traumatic label meaning that a couple has been not yet conceived after one year of unprotected, "well-timed" intercourse, or that a woman has been unable to carry a pregnancy resulting in a live birth. In the general population, one out of seven couples-10% of the reproductive age population--would be considered "infertile" with this definition.

It seems as though infertility has been steadily increasing over time, and it is. According to the National Center for Health Statistics, approximately 6.1 million women in the United States are now infertile, compared with 4.9 million in 1988. The most common reason for this is the tendency for women to delay childbearing. The ability to become pregnant peaks in a woman's mid-twenties and decreases as she ages. By age 35, this becomes a fertility factor; by age 43 this becomes significant. In addition, the incidence of miscarriages increases with increasing age, especially over age 35. But the perception and awareness of infertility-and the fear of infertility-has become much more of an issue than the medical statistics to support it. Along with women's increased ability to control and delay pregnancy until they're "ready" to become mothers comes a psychologic factor that you're "ready" the day that you finally decide it's time! This releases a sense of urgency, pressure, and second doubts about whether you've waited too long, exacerbated by the tremendous media attention over the past 10 years to advanced medical technologies and interventions which produced medical miracles from octuplets, to grandmothers acting as "surrogates" carrying their daughters babies to term, to a pregnant 63 year old. In the general population, one out of seven couples--10% of the reproductive age population--would be considered "infertile" with this definition. It is also estimated that and one out of every three couples in their late thirties has infertility.

These pressures have contributed to many couples entering the infertility evaluation process sooner than clinically necessary. While I do recommend that all women consult their physicians for a preconception visit prior to pregnancy, this does not mean that women need to start taking fertility drugs a month or two after going off birth control pills just because they want to accelerate their pregnancy! We recommend folic acid and prenatal vitamins for all women trying to conceive; fertility drugs should not be perceived as pregnancy vitamins!

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 One in five couples who have a complete infertility evaluation are diagnosed with unexplained infertility - no specific cause is identified. 


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