Q: I’m 40 and happily married. My husband and I have been trying to conceive for 2 years but no pregnancy yet. We’re pretty sure we don’t want to get into anything drastically high-tech or expensive but are certainly open to natural fertility enhancement. Any ideas?

A: My first (and only) child, a beautiful girl, was born in 1998 when I was 42. So I’m happy to help on this topic! First, you say there has been no pregnancy yet. Does that mean you’ve never missed a period? So-called “luteal phase insufficiency (a fancy way to say not enough progesterone during the 2 weeks after ovulation) is a common cause of early miscarriage, which may seem like a normal, or slightly heavy, period. If your menses are irregular, or you’re not sure when you are ovulating, that’s the first order of business. You can get ovulation detection kits in any drugstore. You want to attempt conception as close to ovulation as possible, because the egg only lives 12-24 hours (less hearty in older women). The sperm, however, can live 3-5 days, so if you aim for just BEFORE ovulation, that’s best. This requires becoming very familiar with your ovulation pattern. One of the best authors on natural fertility is Toni Weschler. Jeannine Parvati-Baker (from the hippy days) also has some wonderful books on the subject. About 40% of the time infertility is the woman’s “problem”, about 40% is the man’s “problem” and 20% is both. The preferred form of birth control in Japan is hot-tubbing. That’s why you see Japanese business men in magazines or movies having their meetings in hot-tubs. Immersing the testicles in hot (104 F) water for 45 minutes three days in a row effectively knocks back the sperm motility for 3 weeks. So, if you WANT to get pregnant, make sure your man is not heating up his testicles! If you know you are ovulating and your guy has had his sperm checked out by donating a fresh sample to the local laboratory, taking Vitamin A may be all you need. Healthy ovaries are bright yellow in color from the high quantity of Vitamin A in the tissue. I would recommend 25,000 IUs of Vit A daily for 2-3 months. Extremely high (500,000 IU) levels of Vitamin A are dangerous to a potential fetus, but no danger with 25,000 IUs. Also, ladies, please make sure you have at least 20% body fat. Another nice, inexpensive, supplement to soften the ovary walls and enhance ovulation is phosphatidyl choline (available at any health food store). Take 1500 mg daily for 2-3 months. In addition, B vitamins are helpful for strengthening the DNA (genetic information) of both sperm and egg, particularly Vitamin B1. Find a multi B that has at least 50 mg of B1 and take 4-5 daily for 1-2 months. Yes, your urine will turn bright yellow! That’s OK. Occasionally there’s a configuration problem where the opening of the womb (the “os”) doesn’t line up perfectly with the vaginal opening. If you have ever been told on a pelvic exam that your uterus is “retroflexed” or “anteverted” those are variations of normal, so not to worry. However, having sex “doggy style” will improve the line of trajectory. Sometimes, rarely, there are auto-immune incompatabilities that cause the vaginal secretions to “neutralize” the sperm or the ejaculate to cause vaginal irritation. You’ll need a specialist to help sort out these problems.< Possibly artificial insemination (where the sperm is placed in the uterus with a catheter, bypassing the vaginal secretions) is what you need. This is not high tech. Many lesbian couples “do it” with a turkey baster very successfully. One final word for today: I personally believe completing a liver cleansing diet for 2 weeks and drinking plenty of pomegranate juice helped me conceive in my 40s. Pomegranates contain the highest amount of estrogen-like compounds in any known fruit; this beautiful fruit is an ancient Greek symbol of fertility. I love the POM juices and though they’re spendy, it’s a lot less expensive than some fertility techniques, and very tasty to boot! Aim to drink one quart per week – both of you! Good luck!