Sunday, July 14, 2024

Fertility Problems

This is an INFORMATION page, verified by physician

If you are looking at this section of the website, you may have experienced a delay in getting pregnant which may be a sign of fertility problems. We know that this can be a frustrating, and emotionally difficult time.

It’s surprising to find out that in fact humans aren’t particularly fertile. For couples experiencing a delay in falling pregnant after using contraception for years, this can feel ironic.

The chance of pregnancy each month for most couples is no higher than 20% or 1 in 5. After 6 months of trying to get pregnant, 60% of couples will be pregnant. But if they carry on having regular intercourse for another 6 months, a further 25% will have fallen pregnant. This means that at the end of 12 months 1 in 6 couples still won’t have conceived.

So how do you know when to keep trying and when to seek medical advice? There are some “red flags” that you should know about that might prompt you to see your GP and ask for referral to a specialist:

  • Irregular periods – keep a note of the date of day 1 of your periods or use a fertility app. If your period cycle is very long (more than 36 days) or varies by more than 5 days month on month, then you may not be releasing an egg every month. Ask your doctor for further investigations or referral to a gynaecologist with an interest in fertility problems.
  • Tubal blockage – your fallopian tubes are the delicate tubes which connect your womb to your ovaries and allow the sperm to find the egg. These are complex structures. They are vulnerable to damage due to infection from conditions such as chlamydia or pelvic inflammatory disease. If you have had an infection in the past your fallopian tubes might have become blocked or damaged. You will need further tests to investigate this.
  • Sperm problems – for roughly 1 in 4 couples struggling to get pregnant there is a male factor involved. Risk factors include surgery as a child to treat a groin hernia or bring the testes down from the groin. This increases the risk of having a low sperm count which can be easily checked out with a semen analysis. Other risk factors include trauma to the testes such as sports injuries or the use of body-building steroids.
  • Maternal age – the chance of conception is strongly linked to the woman’s age. Age reflects the number of eggs remaining in the ovaries. It is known that fertility declines with age. Significant watersheds are 36 years old when fertility starts to decline and 40 years old when the chance of getting pregnant is substantially reduced.

If you think you or your partner have any of the risk factors above you should seek medical advice sooner rather than later. Seek early advice if you have been trying for longer than 6 months and you are older than 35 years. If you are in the younger age group with no risk factors and have been trying for 12 months, then speak to your GP about a fertility referral.

How often should we be having intercourse?

The best general advice for you and your partner is to have a relaxed approach to making love. Rather than restricting intercourse to certain times of the cycle only.

You should try to make love every 2 to 3 days rather than at set times. The best chance of falling pregnant is when intercourse has taken place 1 to 5 days before ovulation. So restricting sex to when the ovulation kits or apps say that you are fertile risks missing the perfect window of opportunity. It also means the sperm in that ejaculate may be too old, have stopped moving and may have lost their potency.

What happens when you visit a fertility specialist?

If you need to see a fertility specialist, they will take a detailed medical history from both you and your partner. They’ll arrange a series of investigations for you both. Sometimes all you need is lifestyle advice and reassurance. Your doctor may suggest: 

  • That you lose (or gain) weight,
  • Take vitamin supplements
  • Make lifestyle changes about your diet, smoking and caffeine intake.

You are likely to need fertility investigations. This can include:

  • A series of blood tests known as a hormone profile,
  • Examination of your fallopian tubes
  • A semen analysis for your partner.

Your doctor may prescribe medication to boost ovulation and regulate irregular periods. Or may recommend onward referral to assisted conception services. Your doctor is also there to provide support for both of you as you go through this challenging stage.

It is fine to ask for an early opinion about fertility matters. But be aware that you may not be offered fertility treatment immediately. Especially if there is a good chance of natural conception based on the specialist’s assessment. This it to protect you from the risks over over-treatment which includes the risk of multiple pregnancy.

The fertility specialist is there to support you in the safest way to get pregnant. They will fully explain every step of the diagnostic and treatment pathway to you.

More Advice on Fertility Problems

It’s also worth checking out help, advice, and any fertility problems posts in our Baby Facebook Group. It allows you to ask questions, gain access to basic advice and share experiences with others facing the same new experiences. You can join here:

about the author

Dr Lisa Joels
Dr Lisa Joels
OBSTETRICIAN & GYNAECOLOGIST - Dr Lisa Joels (MB ChB, MD, FRCOG, FHEA) has 34 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20). These are both University teaching hospitals, each having more than 4,000 deliveries a year and providing tertiary obstetric and neonatal services as well as gynaecological services to their local population. Dr Joels has experience in management of complex obstetric and gynaecological problems including a multi-disciplinary approach and working closely with related specialties such as midwifery, neonatology, paediatrics and anaesthetics. She believes in a woman-centred holistic approach to clinical management and is an advocate for patient choice and shared decision making.

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