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Last month, I saw two sets of couples with very similar situations. They were both trying to get pregnant for some time and had already done a variety of treatments. By the time they were sitting in my office, both women were a few days late for their period. They both assumed that they could not get pregnant on their own, and therefore had stopped spending their time and money (and patience!) on those pesky home pregnancy tests.
For those of you still reading, you can probably predict where this story is going… we did a blood test (that was positive), followed by an ultrasound a few weeks later showing a beautiful fetal heartbeat. After a few moments of celebration, both couples asked me the same question – how could this happen after so many months trying without results?
While the answer is different for each patient, taking a look at natural fertility provides some answers. Although natural fertility varies across age groups and populations, the pregnancy rate in any given month (“fecundity”) is between 10 and 20 percent – actually quite low!
Why human reproduction is so inefficient has perplexed scientists and doctors for a long time. There are many reasons for this low rate – genetic errors that occur during egg or sperm development, abnormal fertilization (sperm does not penetrate the egg or does so abnormally), abnormal growth of the embryo before implantation, failure to implant, and miscarriage. Furthermore, couples who are prone to these problems often have subtle abnormalities that often escape detection by the fertility specialist
Here’s the good news – couples that are prone to such errors often overcome the problem with minimal or no fertility treatment! As there are so many steps that need to occur in order to get pregnant, many attempts are often needed --- a true “numbers game.” Treatment can increase the numbers of sperm and egg that are produced in a given month, increasing the chance of pregnancy and speeding up the process.
In today’s demanding world of instant results, we often lose sight of what some couples truly need – a long term approach of both natural attempts and treatment when necessary. I encourage my patients to continue trying during the evaluation and months that they are taking a break from treatment --- and encourage them with stories like these that I see every month.