where is my baby bump?
February 11, 2013 12:59 PM   Subscribe

Trying to get preggos AND also trying to be patient. But, would like to prepare just in case. When should I go in to a doctor to discuss fertility, and who/what kind of a doc should I discuss this with? (OB/GYN? A reproductive specialist?)

My awesome husband and I have been trying for baby number one for a few months. I'm 31, he's 33. I'm trying not to get obsessed, but you know the the deal.

In September we stopped using birth control ( I wasn't on anything hormonal, just used condoms). Perhaps the first couple months, I don't think we were timing sex right at all, so let's say, we've been trying for about 4 months or so.

I think I've gotten to know my cycle at this point pretty well. We've been having sex a few times each month around my ovulation. I've been using those little test strips to see when I'm ovulating, and reading Taking Charge of Your Fertility.

I'm also using Vitex (small dosage every day) and I recently started going to acupuncture (for general health/stress reduction, but the person I'm seeing is awesome, into fertility, and knows I'd like to get pregnant. At this point, she does not feel like I have anything to worry about just yet... She said it took her 2 years!) I don't want it to take 2 years, but I also know this kind of thing has it's own timing.

Good news: My cycle super regular (every 28-29 days) and I've never had any major health problems at all. I'm in pretty good health- I'm not a health nut, but I eat well, my lifestyle is pretty balanced, I drink but lightly, I eat a lot of kale, etc. I don't take any medications and I hardly every get sick, knock on wood. My husband, besides liking a few beers sometimes, is also he's in good health. (And he's awesome, supportive, and willing to jump on board in any way.) Plus we have decent insurance for the first time, so we have more options.

Bad new: well none really, but just feel anxious about the process.

What would be the first steps if we did decide to seek out a medial professional? What questions should I ask, and what tests would I take? I know it's been far less than a year, but also, I'd like to know what the process would look like- can they do preliminary tests to make sure everything is up to code for trying? (hormone levels, etc?)

I don't have a regular OB/GYN right now, so I need to get one anyway. I'm just trying to get a feel of what I should look for if we do seek out any kind of treatment, with who- what questions should I ask an OB/GYN etc...

Also, it's fine to tell me to be patient, but I'd like to know what this whole process might look like.

Or just say: 'Take Care of Yourself, get a check up, have sex."

Anyway, thanks in advance!
posted by Rocket26 to Health & Fitness (21 answers total) 4 users marked this as a favorite
What my OB told me was to see an RE (reproductive endocrinologist) after 1 year of trying if you're under 35, after 6 months of trying if you're over 35. This can be just for testing on you and your partner (the problem could just as easily be sperm-related), so you know what you're dealing with - seeing an RE doesn't mean you're dealing with infertility or need to take extreme measures.
posted by Mchelly at 1:04 PM on February 11, 2013

Are you insured? Does your health insurance include conception assistance? If so, that might be the first place to look for providers.
posted by Burhanistan at 1:04 PM on February 11, 2013 [1 favorite]

Yes, sure, try to be patient. I'm a firm believer that less stress and good sex are more likely to make babies. I'm also a firm believer that if you really want a baby it's hard to be aware of anything else after about four months and that makes the above less stress and good sex harder to accomplish, so it's kind of swimming up stream.

Having said that, it is always appropriate to see your ob/gyn when you're getting ready to try to conceive. They will get you on prenatal vitamins. They will clear your pap and make sure you don't have anything going on (I had BV and didn't know it; who knows how that could have mucked things up. Or maybe not. Whatever). Plus, if you don't have an ob, you should look for one, so when you do get pregnant you have someone to go to. If you don't really like the first one you see find another one.

What kinds of things you want to ask your OB depends on what you want to know. Regarding fertility: how long does the doctor want you to try before they refer you to a specialist? What kind of specialist? Will they try some stuff at this office first? There are lots and lots of things they'll do if they think there's an issue, but starting with a general exam, with a pap and bloodwork, is a great start.

things that matter more after you are pregnant: Do you want one who is friendly to midwives/doulas? Which hospital do you want to deliver from (or not a hospital)? Does it matter to you if that hospital has a NICU? What does the doctor do if you end up high risk? What kind of c-section rate do they have? What's their general philosophy towards pregnancy and birth? Do they work with a specialist if something goes awry (like, maybe gestational diabetes).
posted by dpx.mfx at 1:06 PM on February 11, 2013

Do you really know your cycle? Or you just think so? I'm asking because if you're following the advice in Taking Charge of Your Fertility, you should know the exact day of the ovulation.

Also, some anecdata based on several couples I know: the more you're anxious, the harder it gets.

And yes, it can take a while (2 years seems to be some magic "start seeking medical help" cutoff point). But if you're worried, I'd start with a preliminary check with your OB/GYN right away. Just to rule out things like cysts etc. (Remember to take your basal temperature charts with you.)
posted by gakiko at 1:08 PM on February 11, 2013 [1 favorite]

Are you on prenatal vitamins already? You should be taking those a few months before you get pregnant, ideally (according to my OB who asked me to hold off on getting pregnant until I'd vitamin'd up for a couple months.)
posted by fingersandtoes at 1:08 PM on February 11, 2013 [2 favorites]

You're taking prenatals, right? Those are far more important than woo woo herbs. You don't need an ob-gyn to get them. You can buy them at any drug store, or even on amazon.

If you have a primary care doctor, that's the best place to start. But if your periods are regular and you know what your cycles are like, you really should just chill about it for a few months more. My doctor is pretty common-sensical, and her advice was "when things are sticky and wet down there, get to it."
posted by PhoBWanKenobi at 1:09 PM on February 11, 2013 [2 favorites]

Yes, I am taking prenatals. Also, Vitex isn't really a woowoo herb: it gently support hormones and cycles, I've become literally like clockwork since I started taking them. Just saying.
posted by Rocket26 at 1:12 PM on February 11, 2013

Everyone says it takes time and to be patient, but it's not like you accumulate extra bonus points toward fertility by putting off a doctor's visit. Since you don't presently have an ob/gyn, now is a great time to establish a relationship with one. I think the first step is make an appointment and talk about your reproductive health!

I think you should start charting your cycle according to Taking Charge of Your Fertility (temperature, cervical mucus, the works). That way, if and when you need to see a reproductive endocrinologist, you would have data to present and that may speed up the process.
posted by stowaway at 1:25 PM on February 11, 2013 [4 favorites]

Don't forget about your husband. From what I understand, sperm testing is often a first step if a couple is having trouble conceiving.
posted by ThePinkSuperhero at 1:31 PM on February 11, 2013

Mrs Segundus and I were in your age bracket when we started and conception took us 15-18 months both times, with no medical/other intervention/special timing/special activity, if that helps. My sperm count had previously been measured as normal, and Mrs S had no problems. Both normal pregnancies, healthy normal (special) babies. Of course YMMV.
posted by Segundus at 1:33 PM on February 11, 2013

Like others said, you don't neet infertility counseling, but do should get a preconception checkup. There's probably nothing the OB will tell you that you don't already know, but a checkup is a good idea.

Also, whether you get pregnant relatively soon or need medical intervention of any kind, you're going to want a doctor you trust and feel comfortable with. Before you really need anything is good time to find one.
posted by Mr.Know-it-some at 1:40 PM on February 11, 2013 [4 favorites]

My recommendation is to do all the stuff you can do without having a little one. Take weird vacations, go to romantic places, enjoy outings with your friends.

You're young and there's nothing to get all freaked out about just yet, but my girlfriend's daughter had a baby this weekend and let me tell you, that's it for grown up stuff for a while.

So while you and your husband are enjoying your couple time, just keep the baby thing at a dull ebb. Nothing sucks the fun out of your relationship faster than thinking of your husband as a sperm donor.

Steer clear of the Baby Gap, and Babies R Us and the Baby section of Target

Soon enough you'll be pregnant, and have morning sickness, and weird food issues, and be uncomfortable. And exhausted.

Knowing that you used this conception time as a way of getting closer to your husband and of enjoying your time without kids will help you get through the rough times once you're on the road to parenthood.
posted by Ruthless Bunny at 2:01 PM on February 11, 2013 [16 favorites]

Ah, I wish I could like your answer 800 times @Ruthless Bunny. Some days you gotta hear something like that...
posted by Rocket26 at 2:11 PM on February 11, 2013 [1 favorite]

Wikipedia sez It is recommended that Vitex agnus-castus be avoided during pregnancy
posted by kmennie at 2:39 PM on February 11, 2013 [1 favorite]

I would not worry just yet.

But, to answer the question - do not go to an OB/GYN for advice on fertility. Go to a reproductive endocrinologist who specializes in fertility issues.

Don't rely on people who say "you have enough time, it's too early, just relax and be patient." Focus on results. (Another reason I think Vitex is not warranted right now.)

I first contacted my health provider when I was 29 about a "pre-conception checkup". She sneered at me, rolling her eyes, telling me I had plenty of time and that I was worrying about nothing. I slunk out of there feeling deeply neurotic and ashamed.

Then, after about a year and a half of trying, I approached my OB/GYN about why I wasn't getting pregnant. I went through some unnecessary and painful tests (HSGs suck), only to be told it was "unexplained infertility". I sought out a regular endocrinologist, who also couldn't explain what was happening.

None of these health providers knew how to interpret what my RE was able to figure out within two sessions: I had diminished ovarian reserve, also known as premature ovarian failure. He was able to diagnose this using a blood test and the same CT scans my OB/GYN had ordered years before. In fact, he seemed shocked that she had missed it (they're in the same medical group). "You can clearly see your ovaries shrinking!" he told me.

My OB/GYN was hung up on the idea of regular 28 day cycles with a 14th-day ovulation (something that the "Taking Charge of Your Fertility" book will explain is not actually common for everyone). I was ovulating, but very late. The endocrinologist, having ruled out polycystic ovary syndrome (I'm overweight), couldn't figure out any other cause.

It is unlikely that I will ever have genetically-related children, in part because I wasted time seeing people who were not specialists in fertility.

After six months of trying, go ahead and find a RE, and get all the basic tests run, including a sperm analysis. Please, don't waste time with an ob/gyn.

Right now - buy Toni Weschler's book ("Taking Charge of Your Fertility").
posted by mitschlag at 3:06 PM on February 11, 2013 [3 favorites]

Have more sex, more often, throughout the month, even when you're not officially ovulating. A few times a month when ovulating is not enough, and once it "takes" you'll have time for even less. And enjoy it.
posted by croutonsupafreak at 3:14 PM on February 11, 2013 [1 favorite]

In case you use lube, many of them can be hostile toward sperm. This lube is designed for people who also are trying to conceive.

Also, you should be trying to have sex every 1-2 days after the end of your period up through ovulation. The 5 days before your expected ovulation are prime time for trying to conceive. You want viable sperm already up in the fallopian tube when the egg drops.

If you do end up getting more medical evaluation for fertility, please don't forget to have your husband checked as well. Male fertility issues are also fairly prevalent.
posted by quince at 3:59 PM on February 11, 2013 [1 favorite]

Anecdota: I did the pre-conception checkup with my doctor, assumed I would get pregnant within a month (because it had been beaten into my brain since I was 16 that unprotected sex always = pregnancy), and started assuming around 6 months later it was never going to happen. Went to see my OB, she gave me some suggestions and ran some bloodwork and told me to try another 6 months before we moved to the next step.

Thing is, I was about 5 days pregnant during that appointment. So, yeah, same as others have said: this length of time is totally normal, but never fun.

Second case: a good friend had been trying to get pregnant for 2 years, had gone through fertility treatment, and was about to start on IVF. And then she went on vacation, and then she & hubby got pregnant randomly all on their own. I honestly, truly believe it helped her to just stop worrying about it and to go on vacation and just enjoy being with her spouse.
posted by bibbit at 8:43 PM on February 11, 2013 [1 favorite]

I'm a day late, but two things that helped me get pregnant pretty quickly at 36 were Fertility Friend (to help confirm ovulation) and the Clearblue Fertility Monitor because it's easier to pee on a stick once a day than the several times a day that ovulation sticks require (that said, I used the ovulation sticks, too, after I started getting highs on the fertility monitor. I was very thorough).

As someone stated above, an RE won't see you until it's been a year of trying since you are under 35, but it is definitely worth getting a preconception checkup with an OB - if anything for the fact that it makes you an established patient and allows you to get in earlier once you are pregnant.
posted by echo0720 at 12:25 PM on February 12, 2013

My experience is that a doctor won't take your conception concerns seriously unless you've been trying for a year (if you're under 35). I personally would not start worrying just yet.

If you do eventually decide to seek professional help, I also recommend seeing an RE rather than an OBGYN. Your insurance might not cover it, but some have free consultations. They can tell you what tests you should get, and you can bring those to your OB or General Practioner, who might be able to order the tests so that it is covered.

Finally, it is a big pet peeve of mine when people dismiss what could be a valid medical concern by telling you to relax or go on vacation. I'm sure they mean well, but they really don't know that. The human body is complicated. I hope things work out for you soon. If it takes awhile or you need help, it's not your fault for not thinking positively.

Good Luck!
posted by pizzazz at 12:57 PM on February 13, 2013 [1 favorite]

You're only having sex several times a ... MONTH? Well that's the first thing to work on. Up that to several times a week, if not day (though admittedly, that can be hard to manage nowadays.) But remember, any given time, you have a fairly low chance of conceiving, like 2% by some estimates, assuming everything is normal, so a few times a month is not good odds. And of course, you can get pregnant at any time, not just when you're ovulating. So have more sex! Lots of it, all the time! And have fun!
posted by catatethebird at 8:59 PM on February 13, 2013 [1 favorite]

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