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Getting pregnant is supposed to be an intimate experience with your partner. For infertile couples, however, reproduction becomes a complex choreography of hormones, physiology and exquisite timing that frustrates millions of wanna-be parents.

It may appear that everybody but you is getting pregnant without effort. Appearances can be deceiving. Conception often requires deliberate resourcefulness and as much information about your fertility as you can gather.

This is why the pharmacist usually stocks shelves full of thermometers, test kits and monitors all designed to pinpoint the days of the month intercourse is most likely to result in pregnancy.

These scientifically developed tools that let you know when the small window of peak fertility opens each month—when a woman’s hormones have done their work, when her ovary is ready to release an ovum and then travel to the fallopian tube. It is important to determine the 12 or so hours out of her cycle when conditions make that egg receptive to union with one strong, long-distance swimmer of a sperm.

Fertility predictor aids take a whole lot of the guesswork out of baby-making. But there are a few caveats:

First, know what you’re doing. Read the instructions and follow them. Any questions about procedure, interpreting results, call the 800 number help line every manufacturer provides. The last things you want to squander are money and time.

Second, if it’s been a year of unprotected sex (3-6 months for the 35-and-over crowd) without a pregnancy, skip everything else and head to your doctor for basic infertility workups. It’s imperative that both partners - men and women - rule out conditions that compromise reproduction and require medical attention or intervention.

Third, distinguish between home fertility tests and predictors. For example, there is an at-home semen check. But it only identifies one of the three main causes of male infertility, and that is the concentration of sperm in a semen sample. It does not reveal whether or not the sperm possess those qualities that make for fertility (e.g., motility and shape). A few below par results, though, should be an incentive to have a professional medical analysis.

Aside from that, fertility predictors, used judiciously, come in handy. They range in sophistication and user-friendliness but, ultimately, they’re designed to help identify the surge in hormones that signals a woman’s body is ripe for conception. They can be invaluable, if you know what you’re doing.

Intimate Relations: You and Your Body

Even the most advanced over-the-counter fertility predictor isn’t going to pay off unless you get very familiar with your individual menstrual cycles. It’s basic knowledge that helps you use the kits most efficiently—not too early or too late to detect the all-crucial surge. Guessing or relying on what magazines say is the road to nowhere.

• Mark the length of your menstrual cycle beginning with the first day of your period on a calendar. Check for a regular pattern. Bear in mind that regular is a relative word. Some women are like clockwork—every 28 days. Others vary, some between 23 and 30 days, or ever 35 days. This variation is their normal pattern. Plan on charting several months for an accurate read.
• Pay attention to the regularly occurring symptoms of premenstrual syndrome. For example, heightened moodiness, depression or irritability two days before your period is a useful marker. Same for mid-cycle cramping.
• Stretching cervical mucus (“Spinnbarkheit” to the congnoscenti). This requires some bravado. Reach in, touch the cervix and pull out mucus. When it’s elastic enough to stretch three inches between your fingers without breaking, it’s a sign of imminent ovulation. If you’re going to rely on this method, training by a health care professional is recommended.

A Few Bucks and The BBTs

The most basic over-the-counter aid is a thermometer to measure a woman’s basal body temperature (BBT). It is by far the least expensive and unquestionably the most labor intensive. It demands rigid discipline and unwavering consistency. Any change in behavior will compromise the results. And, take special note, it is best regarded as a retrospective indicator of fertility. Here’s why and how it works.

BBT is the body’s core temperature and accurate only when taken every morning, before getting out of bed for any reason (that includes the 2 am bathroom run) or doing anything (not even sipping latte in bed). BBT usually registers somewhere between 97.2 and 97.6 degrees during the first half of the menstrual cycle. With ovulation, the body produces progesterone, which causes that core temperature to spike one-half to one degree. You don’t get much warning. BBT can rise right at or just after ovulation and remain elevated until the beginning of the next cycle. But BBT can vary by as much as half-a-degree from day to day. You’re looking for a sustained rise.

The downside is, BBT doesn’t tell you when ovulation is about to occur, only that is has. However, mapping BBT gives you pretty good hindsight that could assist you in beaming in on your fertile time.

Homing In On Hormones: Predictor Kits and Monitors

The Kit Club:

The most dependable home predictor kits, to date, measure luteinizing hormone (LH), the brain’s message to the ovary to release an egg, found in urine.

There are several on the market, prices ranging from $18-to-$25 for brand name kits and $14-to-$20 for private labels. They are popular - 2.9 million sold during a recent 12-month period, according to market research numbers. The Centers for Disease Control reports that each year, just over 1 million of the 3 million women trying to conceive will buy an over-the-counter aid.

The kits have a 2-year shelf life. By the time they reach the point of purchase, there’s usually between 18 and 20 months remaining. Retailers, generally, will not buy kits with less than 12 months. Check the expiration date because efficacy diminishes after that.

Brand name or private label, the ovulation predictors use the same technology. They detect the amounts of the luteinizing hormone that collects on a dipstick held in the urine stream. Typically, the kits come with a five-day supply of sticks and are brand specific, not interchangeable (although you can use leftovers from one month for the next it you stick with the same manufacturer).

They work by comparing the color intensity of your test against the manufacturer’s reference line. In some medical conditions such as PCOS and menopause, LH, is always present in the urine, and will show up. You’re watching for the color to deepen over the days until the color of your test line is at least as intense as the control line. Bingo. That’s the surge. Ovulation will happen within 24-48 hours. (If you’re not sure, retest the same day, within 12 hours.)

That means the clock starts ticking the moment you get a positive reading, not that ovulation will occur for a day-and-a-half, a common misinterpretation. When there’s evidence of the surge, have sex, even if you’ve had intercourse the night before.

Do not complicate things. Don’t improvise. And don’t be desperate to find the surge. Perform the test at the same time every day. Hold the stick in the urine stream for exactly the amount of time the manufacturer recommends. Longer is not better. It will taint the test. Do not wait any longer than directed, typically 3-to-5 minutes, to read those results or they won’t mean a thing.

Monitor Yourself

There are no compelling reasons to ante up the extra dollars for a monitor if you get consistent readings in your ovulation predictor tests. But if you have irregular cycles, or you have trouble interpreting home ovulation kits, the monitors may provide the help you need and justify the expense. About 180,000 of these small electronic devices have been sold in the last 18 months. They’re easy to use and because they read the results for you, they alleviate some tension about making mistakes. They also give you a heads up by registering increases in estrogen levels that precede the LH surge by about 3-to-4 days. The rise in the luteinizing hormone is still the lynchpin to coital scheduling, but you’ve leeway to more precisely time intercourse. Simplicity is the big plus.

You turn on the monitor every day. When your period starts, push the menstruation button. During the first use, the monitor will ask for urine testing beginning day 6. The monitor starts storing your individual readings.

It registers three levels of fertility—low, high and peak. At the outset, the low fertility bar will show. It’ll prompt you to keep testing until it detects a rise in estrogen, a high fertility reading, and then the LH surge, peak fertility, usually within 3-to-4 days of the estrogen reading. The monitor is programmed to base calculations on blocks of 10 tests. If a surge is not found, the monitor will ask for another 10 sticks until it finds one.

After the first cycle, the prompts for the second cycle will be tailored to your specifics. Typically, in the first cycle, 60% of women need to do only 10 tests. By the second cycle, that jumps to 80%. The monitor comes with 20 sticks and boxes of 30 are available for about $50. So it can become a pricey proposition. But it reduces the margin of error - the only thing you can do wrong is to get too much or too little urine on the stick or forget to do the urine tests when asked for by the monitor.

Not In The Mood?

True, synchronizing intercourse with hormone levels can dampen the thrill of intimacy. But it’s key. Sperm can swim to the uterus within 15 minutes of coitus. But it’s uterine contractions that get them to the fallopian tubes. Before ovulation, the uterus contracts from the cervix up, pulsing the sperm to their final destination. After ovulation, the progesterone the body releases stops the uterine contractions. Ergo, timing is everything. The egg is not fertilizable 24 hours after ovulation.

Pregnancy Tests

These are nice easy kits. But don’t jump the gun on at-home pregnancy tests. Eagerness for conception provokes lots of couples to pour hard-earned cash into these tests too early. Wait until you’ve missed a period before you test. Unfortunately, one in three conceptions will naturally abort, usually before a period. Test too soon and might there be a positive result that doesn’t fulfill the promise. Sometimes there will be false positives when women taking drugs to stimulate ovulation still have trace elements in their blood. Patience, so hard to come by, may be your best friend.

Regardless of which over-the-counter aid you go with, it’s not a magic bullet. Using it once or a dozen times doesn’t guarantee conception. It just makes you smarter and relieves the anxiety around timing. Under the best circumstances, achieving pregnancy is stressful when you’re both feeling ripe for parenthood.

Get the support you need from your doctor. And contact The American Fertility Association at (888) 917-3777 or visit our website at http://www.americaninfertility.org with all your questions and worries. We know how you feel and we’re here to help.

Prepared by:
By Lawrence Grunfeld, MD
With The American Fertility Association