Congratulations! You’ve carefully mapped out your future and have decided it’s time to add to your family. Sometimes, though, “deciding” to have a baby isn’t as simple as it sounds. Many people are able to celebrate a positive pregnancy test within a month or two of trying. Other couples aren’t so lucky. It often comes as quite a surprise when conceiving a child isn’t as easy as you thought it would be! So how do you know when you’re considered infertile, and when is it time to seek help? To start, let’s define infertility.

What is infertility?

Infertility is the inability to conceive after one full year of well-timed, unprotected intercourse. (If you’re over 35, shorten that time period to six months.) It is also defined as being unable to carry a pregnancy to term: i.e., getting pregnant but suffering multiple miscarriages. Infertility is a medical problem. A popular misconception holds that it is a “woman’s issue,” but that is far from true: according to RESOLVE (The National Infertility Association), approximately 35% of problems stem from the man (male factor), another 35% from the woman (female factor), and the rest is either due to factors from both partners, or falls under the elusive “unexplained” category.

What is “well-timed” intercourse?

A woman is most fertile only once per month: around the time of ovulation. In order to conceive, sperm has to be present to unite with the egg, which means that only intercourse within the timeframe of ovulation will produce an embryo. You can have sex ten times a day, but if it’s not close to ovulation, it won’t do a thing.

How can I tell when I’m ovulating?

The first day of your menstrual period – of regular flow, not just spotting – is considered cycle day 1. Ovulation occurs somewhere close to the middle of your cycle, so if you have a “normal” 28-day cycle, you should ovulate on approximately cycle day 14. However, the term “normal” is used loosely when it comes to cycle lengths. There are many women who do NOT have 28-day cycles, and for those women, ovulation can occur either earlier or later than cycle day 14. If your cycle is generally about 34 days long, for example, you probably ovulate on cycle day 20 or so, not on day 14. So if you’ve been timing your intercourse around cycle day 14, and you have a cycle that is longer than 28 days, you’re missing your fertile window. Your period comes two weeks after ovulation has occurred, whatever your cycle length.

There are several ways to determine when you’re most fertile. One of the easiest methods is to use an ovulation predictor kit (also called OPK). These are tests that look and act very similar to pregnancy tests and are usually found in the same aisle at the store. Like pregnancy tests, you urinate on a stick to determine the results. Right before ovulation occurs, your body sends out a surge of luteinizing hormone, or LH. If the OPK detects an LH surge in your urine, it will be positive – you’re about to ovulate, so let the baby-making begin! If the test is negative, just wait a few days and try again.

Charting your basal body temperature is another way of tracking your ovulation patterns. Every morning at the same time, before getting out of bed, take your temperature using a basal body temperature – or BBT – thermometer (which are readily available at drugstores). After ovulation has occurred, extra progesterone in your system causes your temperature to increase, where it holds steady at the higher temperature until your period starts, then drops again. You can plot each morning’s temperature on a graph, or a BBT chart, and be able to see on which day you ovulated by looking for the temperature “spike.” This doesn’t predict ovulation in advance, but after charting for a few months, it can be a very useful tool in determining your own personal patterns and planning accordingly.

Checking the cervix and/or cervical mucus is another way of determining when ovulation is approaching, although it is a method that doesn’t appeal to everyone. The cervix is the “mouth” of the uterus and can be felt by inserting a (clean!) finger into the vagina. That mass of tissue you feel at your fingertip is the cervix. When you’re not close to your fertile time, it will be low and easy to reach, and feel firm, like the tip of your nose. Its opening, called the os, will be closed tightly. However, as ovulation approaches, the cervix rises higher which may make it more difficult to reach. It also softens, and will feel more like your lip than your nose. The os will be open, and you’ll be able to feel it as a slight indentation. Another clue is your cervical mucus: if it is clear and slippery and looks very much like egg white, it is fertile mucus and signals impending ovulation.

How often should we have sex around the time of ovulation?

Sperm are able to live in a woman’s reproductive tract for up to 48 hours. Around the time of ovulation, it’s important to have intercourse at least every other day. If you ovulate on cycle day 14, for example, you’d want to have sex on cycle days 10, 12, 14, and 16 in order to maximize your chances.

What can I do to maximize our chances of conception?

A healthy lifestyle is a good start. Minimize drinking, and quit smoking. Eat a balanced diet and enjoy moderate exercise. Men should follow the same guidelines, with a few extras: wear boxer shorts instead of tight-fitting underwear to allow plenty of circulation to the testicles for good sperm production. Men should steer clear of hot tubs and wear a protective cup when playing sports or riding a bicycle. It’s a good idea not to use any douches or lubricants; in the conception game, “au natural” is always best. After sex, don’t get out of bed immediately – sperm needs time to travel up the vaginal canal and through the cervix in order to do its job. If possible, just go to sleep and don’t get up until the next morning! You can also prop your behind up with a pillow to assist gravity, although it’s not necessary. And one more tip for both partners: be sure to keep even scheduled intercourse fun and stimulating.

We’ve done all this, and we’re still not pregnant. Should we seek medical help? Who do we turn to?

If you’re sure you’ve done your best to maximize your chances, and you’re still not pregnant after a year of trying (or six months if you’re over 35), it’s time to consult a medical professional. You could begin by seeing your regular OB/GYN, but the majority of infertility sufferers say they wish they had gone straight to an RE instead. An RE is a reproductive endocrinologist, a doctor who deals exclusively with infertility. OB/GYNs do see infertility patients, but they are generally not as experienced in that particular field as an RE. Most RE clinics are also open seven days a week, which can be advantageous, because ovulation doesn’t only occur on Monday through Friday! You can find a reputable RE in your area in several ways: ask your doctor to recommend someone, look in the yellow pages, go to the website for the American Society of Reproductive Medicine (www.asrm.org) or call 888-623-0744 for a physician referral list produced by RESOLVE. It is worth your valuable time and money to go to someone who can get straight to the root of the problem.

So what’s next? What can we expect for our first visit?

For your first visit to a reproductive specialist, try to schedule it during the first week of your cycle, within a week after starting your period – preferably, cycle day 3. Cycle day 3 is the perfect time for testing baseline hormone levels. Most doctors will also do a screening of both partners for hepatitis, AIDS, and other diseases. He or she will also ask many questions about your cycle history, so it may be helpful to keep track of cycle lengths and approximate ovulation dates for several months beforehand. Bring any pertinent medical records with you. For your husband, a semen analysis will be scheduled to check the quality, quantity and overall health of his sperm.

Ideally, you won’t need to see a doctor in order to conceive. It takes even normal, fertile couples up to a full year to get pregnant, so if it doesn’t happen immediately, try not to worry. Sometimes it’s as simple as faulty timing, or just a lack of knowledge about what it takes to make a baby. If it turns out that you do need medical assistance in order to have a baby, expect a lot of investment, both financial and emotional. You will be poked, you will be prodded, you will go to lengths you never thought possible – but the end result, your very own bundle of joy, is truly worth everything you’ll go through.