Trying to Conceive Naturally: What Are The Next Steps?

An NPN reader asks our natural parenting mentors:

My husband and I conceived our first child on the first month we tried. I was an avid “fertility awareness method” follower, so I was tracking my temperature and mucous. That is out of the window now, as I do not sleep and wake regularly enough, but I still know when my period is coming. I was and still am extremely regular.

My son is now one month shy of three years old, so we conceived him almost four years ago. I am thirty-seven-years-old. Last July, we tried and conceived again after only one month. I had a miscarriage at nine weeks. My midwife told us we could try again when my period came back as I was otherwise healthy and there was no apparent reason for the miscarriage. I had my next cycle exactly one month later. We have spent the last eight months TTC. I just peed on a stick this morning with no joy. I had been using the “ovulating on day fourteen rule” and we were “trying” for a few days before and after that day. For the last two months we used an ovulation kit, and it turns out that I am ovulating on day ten (at least for these last two months), so we adjusted our “trying” days.

My question is at what point do we look into the next step. And what might that next step be? I know by the ovulation kit that my luteinizing hormone (LH) is at least spiking, but I guess I may not actually be ovulating? Should we get husband checked for his count/motility?

I feel like since we had such an easy time of it twice before that I do not want to overreact, but I also want to conceive as soon as possible. We are not super stressed about it, but I am not getting any younger.

Other info about us is that I am still nursing my almost three-year-old and have been the whole time, though we are only nursing three times a day, and I do not know how much he is even getting. He was nursing much more when we conceived the second time including one night nursing, so I do not think that is to blame. He still wakes us once a night to come into our bed, but this is not a stressful event, just a wake up for me. Also, I am probably eating more chocolate and exercising a whole lot less than when we conceived our son.

I would love any thoughts or advice.

Here’s what our natural parenting mentors had to say:

Donielle: I would highly recommend charting again, either on paper or with a website that uses the sympto-thermal method. This way you will know for sure whether or not you are ovulating and you will be able to see if you have any luteal phase problems that might be preventing pregnancy. It is actually very normal that a woman does not follow the “day fourteen” rule, so knowing exactly when you ovulate is a wonderful thing! It is also important to notice signs of change in cervical fluid, since sperm can live in this fluid for up to five days, meaning intercourse before ovulation is more important than after. After ovulation, if the sperm are already in there waiting, they have a better chance of meeting the egg before it deteriorates too much. Unfortunately, the older a woman gets, the faster the egg deteriorates. So once you begin to experience the “egg white” cervical fluid, it is time to get busy.

Any amount of nursing can also prevent ovulation, even if you are regularly experiencing menses. Now, this is not true for every woman! Some women I know begin ovulating while breastfeeding, but my own personal experience has been quite different. I did not ovulate at all, even when my daughter was nursing just once per day. The issue is that breastfeeding can raise the hormone prolactin, which suppresses the needed progesterone. Some women have had good luck with taking the herb vitex to help lower the prolactin in the body and balance the estrogen and progesterone. It is not a quick fix for most as it can take a few months, or up to a year, to fully work in the body.

You also mentioned chocolate. I hate to break it to you, but sugar is one of the biggest dampers on fertility. When your body is constantly working to bring down the blood sugar levels, the production of insulin (a hormone) takes precedence over the production of the reproductive hormones. So cutting out sugar can make a huge difference in your hormone levels.

Nutrition is also extremely important in fertility, sometimes even though we think we are eating “healthy” we are not getting the nutrients that we really need. Good fats like butter, coconut oil, extra virgin olive oil, and walnut oil are important to include in any diet as fat is needed to produce hormones. In fact, cholesterol is needed to produce progesterone! A variety of produce each day (and lots of it!) along with grassfed meats, pastured eggs, organic/whole dairy, and whole grains will help to keep your body both healthy and strong as well as provide nutrients for proper egg development and hormone production.

The steps I take each time we try to conceive:

  • Gentle cleansing of my body as well as my husband’s. Even while nursing you can do some light “detoxification” by supporting you body’s natural systems.
  • Focus on eating a “fertility diet”, full of good fats, fresh produce, and organic animal products.
  • Make sure I keep at least light exercise in my daily life. With little ones at home it can be harder to fit it in, but even a short walk around the block can help keep you strong and keep your circulation moving as well. There are also some really good fertility yoga DVDs. I happen to use Bend, Breathe, Conceive.

Getting tested is not always a bad thing. If you find that even after making some changes and waiting a few cycles you are still not pregnant, you should be able to easily get tests done for both of you. Hormone tests are important for both man and woman, as well as vitamin D tests. The man should also get his sperm tested. Once you know if there is a problem and what the issue is, you can continue to treat it naturally most of the time by tweaking herbs and nutrition.

Arpita: First of all, I want to say my heart goes out to you. No one understands the pain of wanting children and being unable to have them unless they have been there.

My first piece of advice would be to absolutely go to your family doctor with your husband and let them know your trying to conceive history, and the fact that you want to move forward with some investigation. Some general practitioners will ask you to wait until one year of trying. However, most will at least start investigating an issue after six months of trying. While it is fabulous that you did not have any issues before, that does not mean that either your or your husband’s medical conditions have not changed. Any good doctor should realize this. The first thing any doctor will request is to send your husband for a Sperm Analysis (SA), mainly because it is much easier, faster, and cheaper to determine if the issue is with the man. They will ask him not to have sex or ejaculate for four days, and then he will give a sample. They will check his sample for sperm count, as well as sperm morphology, motility, and mobility. This basically means how many swimmers there are, what percentage are properly shaped, and what percentage are effectively picking up the attraction to the egg and swimming to her.

Now, on to you. The doctor might or might not be willing to prescribe you Clomid while they send your husband’s sample out. From talking to other couples, this really seems to be 50/50. Some doctors (like mine) will happily write you a prescription as soon as you breathe the word baby, whereas others want to wait and really see what is going on. From what I have gathered (and this is completely just my perception from three years of trying and talking to other couples who have tried for a long time), the Clomid is so mild and such a small step when it comes to fertility that most doctors have no problem prescribing this.

If you are not familiar with it, Clomid is a tablet you take orally for five days, and it simply triggers the LH in your body and makes you ovulate on a specific day. Normally you will take Clomid on days two to seven of your cycle and then you will ovulate anywhere between cycle days (CD) ten to sixteen, and you are supposed to “try” every other day starting with CD eight until eighteen. The reason a lot of doctors will recommend this even if there is no issue with ovulation, is that it simply helps the couple time intercourse perfectly with when we know you will for sure ovulate. I have also (not personally) seen amazing results with Clomid in combination with acupuncture.

In response to your question about ovulation prediction kits (OPKs), yes you can get a positive OPK and not ovulate that month. You mentioned that you are ovulating on CD ten. This would mean you are getting your positive OPK on or around CD eight, as the OPK will tell you twenty-four to thirty-six hours before you are actually going to ovulate. Also, something you may want to look at is if your cycles are exactly a month. While the period of ovulation can vary quite a bit from woman to woman, and even for the same woman month to month, one thing that does not vary much is the luteal phase, which is the time from ovulation to when your period comes. This is almost always fourteen days, sixteen being the absolute max for a woman who does in fact ovulate.

For instance, when we first started trying my cycles were thirty-six days and I was ovulating on CD twenty-two. Now my cycles are a little shorter at around thirty days, and I ovulate on CD fifteen or sixteen. Sometimes I will have a fourteen day Luteal Phase, and sometimes it will be fifteen days. SO, if you are having roughly thirty-day cycles, then it is possible your body is gearing up for ovulation around CD ten, and giving you all sorts of signs like egg white cervical mucous, ovulation cramping, tender breasts, etc. and still be a few days or more away from actually ovulating. For me, I will always get fertile cervical mucus (CM) about a week before I actually ovulate, and literally as soon as I do ovulate, the fertile CM is gone. From talking with friends of mine who were also trying to conceive for years and had similar cycles, I have learned this is quite common for fertile CM and ovulation to not line up. Something you may want to try is Pre-Seed. This was recommended to me by my family doctor. I tried it, and my husband and I actually still use it simply because we do really like it. The only downside is that it is really only sold either online or in sex-shops since it is a personal lubricant. However, it is the only personal lubricant on the market that does not harm or block sperm. Other lubricants make it impossible for sperm to swim through.

Regarding breastfeeding, I would continue to breastfeed as you are. As long as your cycles have returned and are regular, there should be no indication of breastfeeding interfering with your fertility at all!!

Here are some websites that may be helpful.

What Is a Semen Analysis?

What Is Ovulation Detection?

When Should We Consider a Fertility Evaluation, and What Is Involved?

Lani Michelle: The current recommendation is to have an infertility evaluation after one year of unsuccessfully trying naturally for women under thirty-five and after six months for women over thirty-five. So I would say that you are right around the time to start think about seeing someone.

The next step would be to contact your midwife and have an appointment with them and ask for a referral to see a reproductive endocrinologist (RE). I would also suggest researching RE in the area. Look at the stats at different clinics and read reviews of them. Depending on your location you may be limited to one that is closest to you.

Your midwife might do some blood work, have an ultrasound, and check your husband’s sperm. She could also order a hysterosalpingogram (HSG) to make sure your tubes are open and the uterus looks normal. She could also do a hysterscopy to look at the uterus to make sure there is no scar tissue or anything left from your miscarriage. It can’t hurt to have your husband checked, and by all means, it is the easiest test there is for infertility.

From experience, you do not want an OB/GYN treating you for infertility. You want to see a specialist rather than waste months with someone just trying basic things. Some OB/GYNs or midwives like to try things before sending you to a specialist, because they have nothing to lose. You are always racing the clock, so it may not be in your best interest to wait.

If you have an LH surge, then you should be ovulating. Also, if your periods are around twenty-eight to thirty-two days, they are probably ovulatory cycles.

You are not overreacting. If you are not ready to see an RE, I would suggest the following:

  • Have you husband’s sperm checked.
  • Have all your blood work checked. Have them do what they call “Day Three Labs.” Your midwife should know what this is. It checks different hormone levels. Have them check you prolactin and vitamin D level. This can be a basic way of seeing if everything is ok.
  • I would also have the two tests listed above done. They are relativity painless, just a little more uncomfortable then a pap smear.

If all of that comes back normal, at least you know that everything is fine and you can keep trying for a few more months without wondering if some thing is wrong. If things come back not as great as you would like, then you can take steps to fix any issues.

I would not worry about your diet too much. I am sure if you are breastfeeding, in general, you eat pretty healthy. Some REs might want you to stop breastfeeding.


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