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OK, so you want to have a baby. Your chances of succeeding are excellent: About 85 percent of all couples who try to conceive will do so within one year. (After one year, couples are considered infertile.) Twenty to 22 percent will get pregnant within the first month of trying. There are some obvious rules to this game. The first is that you and your partner need to have sexual intercourse, with the penis in the vagina. The penis must ejaculate inside the vagina, depositing sperm near the cervix, the mouth of the uterus. In addition, intercourse must occur at or around the time of ovulation. There are also a lot of misconceptions and old wives' tales surrounding this issue. For example, it is not necessary for the woman to achieve orgasm in order for conception to occur, according to Paul A. Bergh, M.D., an assistant professor of obstetrics and gynecology in the Division of Reproductive Endocrinology at Mount Sinai Medical Center in New York. Bergh explains that the fallopian tubes, the tubes that carry the egg from the ovary to the uterus, actually draw the sperm inside, coaxing them to unite with the egg. This occurs with or without orgasm, he says. The following tips will help increase your chances of getting pregnant. Also refer to "When and Why to Seek Help" for a list of conditions that should prompt you to see a doctor before your year of trying is over. Good luck!

Get a physical.

Before spending a year trying to get pregnant, it's a good idea to have a thorough physical examination, according to Sanford M. Markham, M.D., an assistant professor of obstetrics and gynecology at Georgetown University Medical Center in Washington, D.C. "Make sure that there aren't any physical problems, such as masses or cysts in the pelvic area," he says. "Your doctor should also treat any low-grade vaginal infections that you might have. He or she should also check for sexually transmitted diseases." Other conditions that can interfere with pregnancy are ovarian cysts, fibroids, and endometriosis, an inflammation of the lining of the uterus, Markham says.

Have sex around the time of ovulation.

The woman's egg is capable of being fertilized for only 24 hours after it is released from the ovary, according to Richard J. Paulson, M.D., an associate professor of obstetrics and gynecology and director of the In Vitro Fertilization Program at the University of Southern California School of Medicine in Los Angeles. The man's sperm can live for between 48 and 72 hours in the woman's reproductive tract. Since sperm and egg must come together for an embryo to be created, a couple must try to have sex at least every 72 hours around the time of ovulation (see Extra! Extra! - "Methods of Ovulation Prediction") in order to hit the mark, Paulson says. "Every 48 hours is even better," he says. However, he adds, the man should not ejaculate more frequently than once in 48 hours, since that may bring his sperm count down too low for fertilization.


Men should ejaculate every two to three days.

Along with the advice to have sex no more often than once every 48 hours, men should also try to ejaculate at least once every two to three days throughout the month, says Bergh. Men need to keep ejaculating to keep up their sperm supply, he adds.

Maintain a healthy lifestyle.

The best way to enhance your chances of getting pregnant is to maintain an all-around healthy lifestyle. This goes for both men and women, says William C. Andrews, M.D., executive director of the American Fertility Society and professor of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk. "A healthy lifestyle will also help ensure the quality of your offspring," Andrews says.

Try to eliminate stress.

"There is little doubt that severe stress will interfere with reproductive function," says Paulson. "At the simplest level, stress will take away your libido. At the extreme, the woman may stop menstruating. Although studies in men are lacking, it is quite likely that a similar effect may occur."

Keep the testicles cool.

Exposure to extreme heat can be the death of sperm--literally. (That's why the testicles are outside of the body--to keep them cool.) Bergh's advice for maintaining the proper temperature is to wear boxer shorts (if you find them comfortable) and to avoid hot tubs and whirlpools. Taxicab and truck drivers will benefit from the use of a beaded seat mat that allows air to circulate. "There was an old Indian fertility ritual where the men used to dip their testicles in cold water," says Bergh. "They had the right idea." Varicose veins in the testicles can also interfere with temperature regulation. If you have these, see a urologist, Bergh suggests.

Take your time in bed.

It's not a bad idea for women to stay lying down for half an hour after sex, to minimize any leakage of sperm from the vagina, says Markham. Although staying in bed for a while may not make a tremendous amount of difference (sperm are strong swimmers), it certainly can't hurt. "Just stay in bed and take it easy," he says.

Try elevating the hips.

Placing a pillow under the woman's hips after intercourse may prevent sperm leakage, says Bergh. Although this is not proven to have any effect, it can do no damage, he says.Don't smoke. Smoking has been shown to lower men's sperm count and to impair fertility in women, according to Paulson. "There is nothing that has been looked at that smoking has not had an impact on," he says. His message is clear--don't do it. Also, if a woman does become pregnant, cigarette smoke--even in the first few days after conception--may be harmful to the developing embryo. So, the sooner you can quit, the better.

Eliminate alcohol and drugs.

Hormones can be thrown out of balance with drug abuse and high alcohol intake, says Paulson. This holds true for men and women. Even marijuana smoking can impair fertility. "Marijuana smoking has been associated with increases in prolactin, a hormone which can cause milk secretion from the breasts of both men and women. This can have deleterious effects upon reproduction," he says.

Eliminate medications.

Many medications, including common over-the-counter analgesics, can impair fertility, according to Markham. "A lot of things can inhibit ovulation and conception," he says. "It can be helpful to eliminate all medications." Be sure to check with your doctor before discontinuing any prescription medication, however.

Avoid lubricants.

Certain gels, liquids, and suppositories for lubricating the vagina may impair the sperm's ability to travel through the woman's reproductive tract and fertilize the egg, according to Markham. He recommends consulting a physician for a list of those that are not detrimental.

Try the missionary position.

This is another old wives' tale that can't do any damage and may do some good, according to Bergh. The missionary position, with the man on top, seems to be a good position for minimizing sperm leakage from the vagina.

Don't ruin your sex life.

One mistake many couples make is worrying so much about being able to conceive that it takes over their lives, says Andrews. "Don't be too mechanistic about it," he warns. "With a reasonable frequency of intercourse, a loving couple will tend to hit the right day. People sometimes make it an ordeal, rather than an expression of love. It can become so stressful that it is counterproductive."







PREMENSTURAL SYNDROM

PREMENSTRUAL SYNDROME - 11 Ways to Ease the Discomforts

You've heard the joke before. A woman flies off the handle at work or at home and everyone around her chimes in with, "It must be that time of the month again." The joke, of course, misses the point that women, at times, actually do get upset by their demanding husbands, whiny kids, and stressful jobs. For some women, however, the joke holds more truth than they'd like to believe. For these women, "that time of the month" really is a period of emotional imbalance, anger, depression, and anxiety. Situations that they normally cope well with suddenly become insurmountable. And the energy and health they enjoy most of the time give way to fatigue, achiness, and weight gain almost overnight. These women have what is known as premenstrual syndrome, or PMS, a condition that has no known cause and no complete cure. But research into the topic has brought about several theories as to what may make some women more vulnerable to PMS. "The two most widely held theories, neither of which has huge support, include an ovarian hormone imbalance of either estrogen or progesterone and a brain hormone change or deficiency," says Harold Zimmer, M.D., an obstetrician and gynecologist in private practice in Bellevue, Washington. Zimmer stresses that no single cause of PMS has ever been proven and that much of the research is contradictory. Whatever the cause, the symptoms can include anxiety, irritability, mood swings, and anger; indeed, these symptoms occur in more than 80 percent of women who suffer from PMS. Other symptoms may include sugar cravings, fatigue, headaches, dizziness, shakiness, abdominal bloating, breast tenderness, and overall swelling. Much less common are depression, memory loss, and feelings of isolation. The symptoms, and their severity, vary from woman to woman. "Symptoms are definitely cyclic, and that is one of the main criteria for diagnosing this condition. And the symptoms generally disappear with the onset of the woman's period," says Phyllis Frey, A.R.N.P., a nurse practitioner at Bellegrove OB-GYN, Inc., in Bellevue, Washington. "It's often the emotional symptoms that bring people in to the doctor," she adds. As for what you can do to relieve the discomfort of PMS, there are several home remedies. And according to Zimmer, the home remedies probably work as well as, or better than, the medical remedies available. Here's what you can try:

Maintain a well-balanced diet.

Include lots of fresh fruits and vegetables, starches, raw seeds and nuts, fish, poultry, and whole grains. "It is just sort of common sense dietary measures," says Zimmer.

Go easy on sugar.

Your cravings for sugar may be strong during this time, but giving in to the sugar craving may make you feel even worse and can intensify your feelings of irritability and anxiety. To make fending off your sugar cravings a little easier, try keeping healthy snacks readily available and keeping sugary foods out of the house--or at least out of your reach. If you can't give up the sweets completely, try eating only small amounts at a time, and opt for things like fruits or apple juice that can help satisfy your sugar craving and provide nutrients.

Eat small, frequent meals.

You don't want to go long periods without food because that can potentially intensify your premenstrual symptoms as well, says Zimmer.

Avoid alcohol.

Both Zimmer and Frey stress that alcohol will only make you feel more depressed and fatigued. Alcohol also depletes the body's stores of B vitamins and minerals and disrupts carbohydrate metabolism. It also disrupts the liver's ability to metabolize hormones, which can lead to higher-than-normal estrogen levels. So if you need to be holding a beverage at that party, try a nonalcoholic cocktail, such as mineral water with a twist of lime or lemon or a dash of bitters.

Cut down on caffeinated beverages.

These include coffee, tea, and colas. Caffeine can intensify anxiety, irritability, and mood swings. It may also increase breast tenderness. Try substituting water-processed decaffeinated coffee; grain-based coffee substitutes such as Pero, Postum, and Caffix; and ginger tea.

Cut the fat.

Eating too much dietary fat can interfere with liver efficiency. And some beef contains small amounts of synthetic estrogens. Too much protein can also increase the body's demand for minerals. Opt for smaller servings of lean meats, fish or seafood, beans, peas, seeds, and nuts. Use more whole grains, rice, vegetables, and fruits to fill out your meals.

Put down the salt shaker.

Table salt and high-sodium foods such as bouillon, commercial salad dressings, catsup, and hot dogs can worsen fluid retention, bloating, and breast tenderness.Practice stress management."Learning to control and reduce your level of stress has a great effect on reducing the symptoms of PMS," says Zimmer. Try joining a stress-management or stress-reduction program at your local hospital or community college; learning biofeedback techniques; meditating; exercising; or doing anything that helps you to relax and cope with stress.Try not to plan big events during your PMS time."I don't like to encourage my patients to plan their lives around their menstrual cycle, but if they have the option of planning a big social event at some time other than their PMS time, it would help them out to do so," says Zimmer. "The increased stress of the event will only make the PMS symptoms worse," he adds.

Exercise aerobically.
"Besides being a great stress reducer, aerobic exercise triggers the release of endorphins (the natural brain opiates) and produces a 'runner's high,'" says Zimmer. "Good forms of aerobic exercise include running, stair-stepping, bicycling, or taking an aerobics class," he continues. "The social environment of a health club can also make you feel better by encouraging you to interact with other people," he adds. He also goes on to say that increasing the pelvic circulation can help to rid the body of some of the bloating associated with PMS. Try to exercise for 20 to 30 minutes at least three times a week. If you are too fatigued to exercise during the actual PMS period, don't. Doing so the rest of the month should help in itself.

Talk it over.

Try to explain to your loved ones and close friends the reason for your erratic behavior. "One of the biggest stresses on a woman during this time is family. And it's not only the stress of feeling bad when she flies off the handle at someone, but also of having to apologize for her behavior later on," says Zimmer. He recommends enlisting the aid of your family and close friends by asking them to understand what the problem is and to realize that when you lash out at them you are not as in control as you would like to be. "If your child is really acting out and yelling at you for something during your PMS time, you might remind him that this is not the best time for him to be getting you angry. Hopefully, he'll see this as his cue to go outside and play," Zimmer explains. "You have to walk a fine line, though, and not begin using PMS as an excuse to be nasty to people," he adds. If the emotional symptoms are causing problems in your relationships, consider getting some counseling from a mental-health professional. Ask your physician to refer you to someone.