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From Consultation to Conception: Helping Couples Become Parents


By Michelle Brubaker   |   February 14, 2013

About 15 percent of couples nationwide have trouble conceiving, and as more men and women delay family planning, that number continues to rise.

“Human bodies were designed to have children in our early twenties when we are the most fertile, but a change in our culture and lifestyle is resulting in couples waiting until they are in their thirties to have a baby,” said Michael Hsieh, MD, male fertility specialist in the division of urology at University of California, San Diego Health System.

Sanjay Agarwal, MD, director of fertility services in the department of reproductive medicine at UC San Diego Health, said if a woman is under 35 and not pregnant after a year or over 35 and not pregnant after six months, the couple should seek medical help.

“Don’t hesitate to see a professional. With new technologies and advancements in fertility treatments, most couples have a good chance of having a baby before turning 40 years old,” said Agarwal, clinical professor at UC San Diego School of Medicine.

“We see patients come in for the first time frustrated and ready to give up, but our goal as fertility specialists is to give realistic hope and help couples become parents,” said Hsieh, assistant professor at UC San Diego School of Medicine.


Dr. Mike Hsieh offers advice for men who may be facing infertility issues.

Both men and women can face a variety of common fertility issues, including the blockage of fallopian tubes, problems with ovulation, female age, defective sperm, hormones and stress.

“An important piece of advice for couples struggling to conceive is to try not to stress about timed intercourse.  A woman’s chance of conceiving is increased with intercourse during the fertile window, which spans from five to six days before ovulation to one day after ovulation,” said Agarwal. “Couples feel pressure from family, friends and society to reproduce, so it’s important to educate patients on the impact of stress on fertility.”

Agarwal recommends couples trying to conceive have intercourse at least two days per week during the fertile window and without increasing stress.

“It should be a mutually enjoyable time for couples and not sex on demand,” said Agarwal. “Sadly, I’ve seen couples separate over this issue.”

Hsieh said it’s also important to end the stereotype that women are the root of fertility issues.

“The take home is it’s not always the woman’s medical issue. Couples could spend years trying to find out what’s wrong with the woman when really it’s a medical issue with the man, which results in valuable time lost in diagnosing the problem,” said Hsieh.  “With my couples, I would say it’s about 50/50 when identifying fertility issues between men and women.”

UC San Diego Health has fertility specialists focused on and dedicated to the diagnosis and treatment of both men and women.

“It’s a balanced approach where we can treat the couple simultaneously, optimizing their fertility chances,” said Hsieh.

Treatment options range from medications, artificial insemination, microscopic surgery and in-vitro fertilization (IVF).

“Our medical team works closely with each couple to develop a personalized treatment plan, depending on their needs and wishes,” said Agarwal.

Both Hsieh and Agarwal advise couples to make non-medical lifestyle changes that can also increase the chances of fertility.

A patient should limit caffeine intake, not smoke or drink excessively and watch general health issues like weight, diabetes and high blood pressure. Men should also avoid hot tubs and saunas and not take any growth hormones to boost testosterone.


Dr. Sanjay Agarwal eloquently describes what women should do to increase their chances of getting pregnant.

“Hormones to increase testosterone levels are actually counterproductive and can kill the male’s sperm count,” said Hsieh. “It takes at least six months to recover the sperm count to appropriate levels.”

Both fertility specialists said with encouragement and appropriate guidance and information, many patients can conceive on their own.

“In our field, I usually get to deliver good news to patients and watch the pure joy it brings them,” said Agarwal. “This is such a thrill both professionally and personally.”

From the first consultation to conception, Agarwal and Hsieh said they feel privileged to work with couples on such a personal level and help them enter the next chapter in their lives.

“It’s very rewarding as a fertility specialist to go through this journey with couples. As a father of a toddler, my work now has an even deeper meaning, and I can relate to my patients in a new way” said Hsieh.  “With today’s medical knowledge and advancements, having a baby is more possible than ever before.”

To learn more about UC San Diego Health’s fertility program, please visit:

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