Half of Fertile Couples Have Problems : The Wanted Pregnancy: Not as Easy as It Seems

It was with great expectations that Barbara Johnson tossed out the last of her birth-control pills.

She and her husband happily began planning for the baby’s arrival nine months hence. After all, they had read that half of all American pregnancies are unwanted “accidents.” How simple it should be for those who want a child?

Convinced that conception would follow almost instantaneously the act of unprotected sex, the couple made no other adjustments. They made love on the weekends. A month passed. Nothing happened.

In the second month, they conceived a new plan: sex every 24 hours, no excuses, no exceptions. To her astonishment and anguish, Johnson awoke with menstrual cramps on the 30th day.

Visited a Doctor

At the end of six months, dejected and certain of permanent infertility, the couple decided that it was time to see a doctor.

He reassured them that they had no physical problems. He told them to begin again, relax, be patient and go to bed when it felt comfortable, beginning 10 days after Johnson’s next period.

“We never imagined it would be so tough,” Johnson said. “After visiting the doctor, we saw how far off base we had gone in trying to do a simple thing.”

She missed her next period. The baby was a girl.

The Johnsons are not unique.

Fertility experts say about half of all fertile couples have enough trouble conceiving a child that they end up consulting a professional.

“With all the focus on contraception and unwanted pregnancy, there’s this myth out there that we’re very fertile,” said Candice McKinnon, who teaches classes in fertility awareness at Planned Parenthood in San Rafael, Calif.

‘We’re All Shocked’

“When women reach the point where they decide to have a child, and it doesn’t happen right away, we’re all shocked.”

Lini Bodian, fertility consultant to Planned Parenthood, said, “We have so many women calling here after only three or four months of trying. We tell them not to worry and call back if nothing happens in eight or nine months.”

Of 100 women having unprotected sex for the first time, 15 will conceive the first month, 70 more within a year and five more by the end of the second year, doctors said. About 10% of American couples will remain infertile. Conception time is cut about in half for subsequent pregnancies.

Last year, of the 55 million American women of reproductive age, 6 million became pregnant, said Dr. Luella Klein, president of the American College of Obstetricians and Gynecologists. Of these, 2.7 million planned the conception.

Although the total national birth rate has been climbing steadily--3.29 million births were reported in 1972, 3.68 million in 1982--the most dramatic increase has occurred among women over 30, said officials at the National Center for Health Statistics in Hyattsville, Md.

The number of babies born to mothers in the 30-to-34 age group soared during the decade, from 375,001 to 605,273.

Home Test Kits

The surge in baby making has spawned a lucrative home pregnancy test market. In 1984, women spent $40 million on the $8 to $12 kits, which are 96% accurate in detecting pregnancy as early as three days after a missed period.

“Why some women become pregnant with ease and others have to work at it remains a mystery,” said Dr. John Jarrett II, assistant professor of obstetrics and gynecology at the Indiana University School of Medicine.

Factors include age, anxiety, past abortions in later stages of pregnancy, long-term use of contraceptives and unusually irregular menstrual cycles.

A woman’s most fertile period is between ages 20 and 24, doctors said, and a first conception becomes more difficult after age 30. A Yale University study of 40 childless women found that the time it takes to conceive at age 35 and older lengthens from an average of six months to more than two years.

As the biological clock ticks away, anxiety may increase.

“For nearly four years we’d been on a strict schedule of abstinence-performance, and I can testify that it had not been anything like a picnic,” said Jola Osborne of London. “When I hit 30, the worry turned to panic. The pregnancy was as celebrated in our household as the royal wedding.”

Greatest Problem

Surprising as it may be in this day of mass communication and explicit education, misinformation was judged the greatest problem by several experts.

In addition to the misconception that failure to conceive in the first few months means permanent infertility, several obstetrician-gynecologists said, many couples know very little about the cycles of the woman’s body--the best and worst times to engage in intercourse to encourage pregnancy.

So far as is known, 92% of all conceptions take place between days 10 and 16, counting the first day of the last period as day 1.

Jarrett recommends having sex every other day, beginning with day 10 of the cycle through day 18.

“If you have intercourse every day, it can decrease the sperm count and, thus, the chances of pregnancy,” he said.

Ordinarily about 30 million sperm must be produced for a chance of penetrating and fertilizing the egg, because less than 200 will reach the egg. Sperm survive 48 hours; the egg, 24. Each month, there is a single day when the life-spawning union may occur.

1 Egg Each Month

One egg, or ovum, is normally produced in the ovaries each month. It is released, during ovulation, by the ovary and moves into the Fallopian tube, a thin, flexible structure leading to the uterus.

Sperm moving through the uterus into the Fallopian tube meets the egg, and fertilization takes place. The fertilized egg, or embryo, continues on to the uterus, where it develops in the uterine wall.

“It’s that one time, unlike all the others, and for no apparent reason, the sperm penetrates the ovum, and everything changes,” said gynecologist Robert Epstein of San Francisco.

For Deborah, who asked her last name not be used, that magic moment occurred so unexpectedly that even her doctors were surprised.

“I was recovering from a miscarriage, which doctors said would take time. Two weeks later, I got pregnant. For the first two months, the doctors thought I was still reacting to the old pregnancy.”

Ramona Shewl of San Francisco, who had been trying for a baby for a year, said she “was sick for four months, taking aspirin and eating lots of hot soup for what I thought was stomach flu, which turned out to be a pregnancy.”

Ovulation Check

To help identify the ovulation time, women can use basal body thermometers, which show the minute temperature changes that occur at ovulation, or a method of analyzing increased mucus discharge that precedes ovulation.

“There aren’t very many books on this subject, and it is very time-consuming to teach a woman how to identify her cycle, so we began fertility awareness classes in 1980,” McKinnon of Planned Parenthood said.

Women who have been using contraceptives should give their bodies at least one month to return to normal, doctors said. Users of the intrauterine device or the pill should wait between three to four months before trying for a baby.

To determine the outcome, women can choose from a variety of tests.

Of 11 home pregnancy tests on the market, the newest is the Advance Pregnancy Test, the first to feature a “color stick,” which, when tested with a woman’s first morning urine sample, turns blue if she is pregnant. Results, available in 30 minutes, can be obtained as early as three days after a missed period.

The test uses monoclonal antibodies--very specific proteins that only respond to a specific foreign substance, in this case, the hormone HCG, or human chorionic gonadotropin, which is produced during pregnancy.

‘Tests Are Important’

Another color-change test is the E.P.T. Plus, which takes two hours and can first be used nine days after a missed period. The other nine tests indicate pregnancy by forming a ring on the bottom of the test tube.

“I think home pregnancy tests are important because the woman may be reluctant to go to a doctor until she is surer of her pregnancy, and the earlier she knows, the better,” Jarrett said.

“Care during the beginning stages of pregnancy is crucial because most fetal development, including the heart, lungs, brain and organ systems, occurs within the first 8 to 10 weeks.”

As soon as she knows she will be a mother, said Epstein, “she can abstain from tobacco, alcohol, drugs, caffeine, aspirin and other things that may harm the fetus.”

Doctors use three types of pregnancy tests. A slide test takes two minutes and can detect pregnancy five days after a missed period. A tube test takes up to two hours and can detect pregnancy from three to nine days after a missed period. A blood serum test for HCG provides results as early as one week before a missed period; it is expensive and may take up to 24 hours.

Ancient Tests

Pregnancy tests date to 1350 BC. In ancient Egypt a woman drank a mixture of pounded watermelon and the milk of a woman who had borne a son. If she vomited, she was considered pregnant.

Later in Greece, Hippocrates suggested that a woman be given honey and water before sleeping. If her stomach swelled during the night, she was pronounced pregnant. In the 13th and 14th centuries, physicians believed that a woman was pregnant if milk floated in her urine.

The first truly scientific pregnancy test was the famous “rabbit test,” introduced in 1927 and still in use a generation ago. Doctors inoculated a rabbit with a woman’s urine. If the HCG hormone were present, it would cause blood to accumulate in the animal’s ovaries.