The Intricacies of Infertility
By Dr. Erika Aragona, DO
TRANSCRIPT:
Crissy:
We are so excited to sit down once again with Dr. Erika. Dr. Erika always tells it like it is and shares information about really important topics. So thank you for joining us again today. We’ve had previous content, and I highly recommend everybody go check it out, where we talked about periods. We talked about miscarriages, and today we’re talking about infertility. So, Dr. Erica, how does a woman know if she’s infertile? How do you know when it’s time to take the next step and seek medical advice, and that it’s no longer in your hands, that you need additional help?
Usually what we're looking for is 12 calendar months of actively trying to conceive successfully by those measures I just talked about, but not successfully getting pregnant.
Details of Infertility
Dr. Erika Aragona:
Yeah, I love this question. Because it makes me go back to when I was trying to get pregnant. And every month, it was so stressful to take that test, have it be negative and be like, oh, when do I have to see a doctor, and I am a doctor. But it was so stressful. Like I’m doing everything right? I’m eating healthfully, I’m exercising, taking these prenatals. And then nothing. And I had so much stress that trying to conceive was like the worst period of my life in that moment. Because you’re like, Okay, time is ticking. When is it going to happen? The more stress you put on your body, the more difficult it is to get pregnant. So you know, I had to go months before I conceived. And I just kept scratching my head like, do I need to see somebody? Or do I just keep doing what I’m doing?
So I hear this question all the time, also in my practice, and what we normally will look at is how long have you been trying to get pregnant? First and foremost. What are you doing to get pregnant? And how long have you tried? Because believe it or not, not a lot of people realize that they ovulate once a month, right?
So you want to try to conceive every single month. So you have to have sex to get pregnant. And if you’re not sexually active, and using no barriers, like condoms, for example, and timing it with when you think you’d be ovulating, you won’t be successful. So if you have sex the first day of every month, but your periods not till the middle or the end, you might miss your ovulatory window.
So we often will teach women how to know if they’re ovulating. And it’s tricky, I’m going to be honest with you is really difficult, because there’s different things that happen with our bodies. So your basal body temperature can actually go up a little bit when you’re ovulating, but it’s only like a degree or so. So what if you’re sick? What if you’re stressed out? What if you just chugged a cup of coffee like me just know, your temperature is gonna go up, right? So it’s hard because you have to track your temperature every single day. And then so many factors can change. That’s not the most reliable thing. But that can be one of them.
Another one is your cervical mucus can change. And the consistency in the check texture can change. And women will often check that to notice the differences.
Another thing you can do is get an ovulatory tracker. So every month you track your cycles and measure when your period started and stopped to try to get on track. But again, that can fluctuate month by month by just a couple of days, and you might miss your window.
And then finally, there’s actually tests at home that you can take so where you actually can kind of like a pregnancy test, where you would urinate on a home test. But instead of testing for the pregnancy hormone, it tests for the ovulation. So that can be helpful. They’re pricey. So I usually recommend learning the other steps with your doctor at first instead of going out and buying a bunch of those kits, month by month by month.
Okay, but that’s the first step you have to time sex when you are ovulating. And it doesn’t have to be the day of I get that question a lot. Often it can be a couple of days before ovulation because sperm can last and live that long, or a couple of days after ovulation. Because once you ovulate, it’s not over you have a couple of days where that egg is still ready to be fertilized. So that’s one part of fertility.
The next thing is the duration of how long you’ve been trying to conceive. Usually what we’re looking for is 12 calendar months of actively trying to conceive successfully by those measures I just talked about, but not successfully getting pregnant.
Because a lot of the time me included, me totally included. After two months, I’m like “I’m done.” Like everybody says it’s easy to get pregnant. It’s not for me. So I’m gonna go to the doctor. I wouldn’t recommend doing that because most doctors will say you haven’t tried long enough. And we really haven’t.
There’s so many factors that can change. If you ovulate if you don’t stress, illness, infection, hormonal changes, not having intercourse the time that you’re supposed to. There’s so many factors. Women getting off birth control might not ovulate regularly right away. So you need to get that out of your system for a while and then start to track those cycles. So if you jump into your doctor’s office and say I can’t get pregnant, there’s not a lot that we can do, because you haven’t been actively trying for a while.
So usually what we look for is have you successfully implemented those practices for 12 months and not conceived? And if so, and then we’ll start the path for fertility testing and a workup.
Fertility Work-up
Crissy
Thank you so much for breaking all that down. What are the steps in the fertility workup? How does that go?
Dr. Erika Aragona
Yeah, great question also. So the first thing is to test the male partner. It’s easier, and it’s not as much that you have to go through. So having your male partner go to either their primary care doctor or urologist for a semen sample is the first step.
So they would provide a sample to see the sperm successfulness. Essentially, is it moving fast enough is dizzy have a high enough sperm count? Would it make for a successful pregnancy, because if your partner has, you know, a suppressed sperm count, for example, there’s not really a great way to go through all the testing for the woman. If you’ve missed something really easy to fix, by testing with the male first, I shouldn’t say easy to fix, but what I mean by that is, if we do female testing, it’s usually a lot more invasive.
So let me break that down. We’ll start with blood tests, hormone tests, checking for their female dominated hormones, thyroid hormones, things like that. Another thing that we’ll do is a pelvic ultrasound. And that is where a vaginal probe is going into the vagina. The other ultrasound goes on top, kind of like how we do it when you’re pregnant. It’s going to be checking for your anatomy, making sure that your uterus is healthy and could support a natural pregnancy.
After that, if there are certain things found to be abnormal, you are going to have to see an OBGYN or Fertility Specialists where they’re going to do more invasive procedures. Sometimes checking to make sure the fallopian tubes are open. And we’ll be able to support a pregnancy that way with ovulation and fertilization, and then continuing down the pathway of how do we work this up once we find something abnormal, because treatment varies tremendously as well. So it’s a lot more intense for a female workup than a male workup.
So by and large, what I tell patients is you’re trying to conceive awesome, I support you, let’s start prenatals, let’s get a healthy lifestyle. Let’s make sure we know how to successfully have sex when we’re supposed to so that we can maximize your chances of conceiving actually. And if we don’t have success by about a year, then I want you to pursue an additional workup with your partner, and also with you afterwards. And that’s really the first steps.
Cindi
Now, Dr. Aragona, as a Family Medicine Physician, do you start the initial work workups? Or is there somewhere else that they should be looking?
Dr. Erika Aragona
So I do the initial workups. Not every family medicine doctor does. I love women’s health, so like 95% of my patients are female. And I also like to do a lot of OB care. So as long as your family medicine doctor does that in their field. We’re board certified too so we can start up the entire workup with the labs, ordering the imaging, and even doing a pelvic exam and a pap smear. I mean, there’s a lot that we like to start with. And then after that point is when I placed the referral elsewhere. That’s a great question. But make sure that your doctor does it. You can’t just find a family medicine doctor and assume, you know, you want to make sure that you find a doctor who definitely does all of that care.
Crissy
Thank you so much, Dr. Aragona. This was really helpful and we’re really excited to sit down with you and dive into this topic and some of the other ones from previous content in a future episode of Mama Needs a Moment.
Dr. Erika Aragona
Thanks, Crissy. Thanks, Cindi. It was a pleasure as always
Dr. Erika Aragona is a dual board-certified family medicine physician with a focus on preventive medicine and women’s health. In addition to a full time practice, she serves as adjunct faculty at Idaho College of Osteopathic Medicine where she teaches women’s health. She holds an additional degree of a Bachelor of Arts in English, and has used her experience in medical and creative writing to publish a book, A Certain Innocence, as well as author several pieces in national journals including Medscape, The DO, KevinMD and Alpha Phi International. She serves as an expert physician consultant with appearances on national television and social media and writes articles and produces videos for multiple health and wellness companies. Her passion is making medicine cheerful, and with her website, dr-erika.com, she highlights female entrepreneurs as well as discusses positive aspects of medicine.
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