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A Question Of Conception

Jan 16, 2008
You may think that starting a family should be the easiest thing in the world but for many couples the joy of expecting a baby does not come as quickly as they hoped. It is a worrying time and poses many medical and lifestyle questions you might have never previously contemplated. In this article I've offered comprehensive answers to six frequently asked questions.

How long should we try to conceive before seeking medical advice?

This really depends on you and your partner's health. It is always worth seeing your GP before starting to try. Your GP will ensure that you have been immunised against German measles (Rubella), and discuss lifestyle changes that you may need to make to maximise your chances and ensure that you will be as healthy as possible through pregnancy. Your GP will also be able to gather information about you and your partner and decide if you should be referred early on to a gynaecologist.

Generally as long as you and your partner are in good health, then you should try for about one year before seeking medical help. This is because most couples (80%) will fall pregnant within the first year, and 95% within two years without any medical intervention.

What sort of investigations should we expect to have done after one year?

After one year of trying, it is worth looking into why there maybe a delay. Your GP should be able to organise the basic investigations for you and your partner. The most important tests are a blood test to check that you are ovulating, and that your partner's semen analysis is normal.

The ovulation blood test is best done 7 days before your next period starts. If you have a 28 day cycle then this means that the test is done on day 21. Commercially available urine tests are available and these will detect ovulation (again in 28 day cycle, ovulation should happen around day 14).

The male partner is normally given instructions as to producing the sample. To standardise the test most laboratories advise three days of abstinence from ejaculation. Most fertility centres have rooms where men can produce samples. Should this not be the case, it is best to bring in the sample as quickly as possible. Also try and keep the container as close to body temperature as possible.

My partner is not keen on having a semen test, does it matter?

Yes it does matter. We know that about 30% of all subfertility is due to there being a major problem on the male side. Slightly reduced semen measurements are thought to be contributory in another 15% of cases. It is very important that your partner's semen is checked very early on in your investigations.

My periods are irregular, does that mean I will never be able to get pregnant?

An irregular cycle is when a woman has a cycle length of more than 35 days. The vast majority of women with irregular periods will fall pregnant. The most common cause of irregular periods is polycystic ovarian syndrome. This condition affects 20% of women, and is normally effectively treatable by weight control and medication.

An irregular cycle often means that ovulation (egg production) is not occurring on a regular basis. However, ovulation can occur occasionally. This explains why women with irregular periods can still conceive without medical aid, but the length of time they need to try is longer than in those women with regular cycles. If medication is required to make you ovulate then the treatment is best monitored by ultrasound.

I am 37 and am worried that I will not be able to conceive.

It is well publicised that the ability to fall pregnant decreases with age. This is because a woman is born with all the eggs she will ever have. The eggs of a 37 year old woman are 37 years old and unfortunately 'new' eggs cannot be made. These more mature eggs are less likely to produce a pregnancy, and if a pregnancy does arise then the chances of a miscarriage or a chromosomal abnormality in the pregnancy increase. A woman will go through the menopause when the vast majority of the eggs are used.A blood hormone test on day2 or 3 of your menstrual cycle can provide further information as to your chances.

When population studies are looked at, they do show that women after the age of 37 demonstrate a clear fall in the chances of falling pregnant. It is difficult to establish your individual chance without taking other factors into account, however most women aged 37-39 fall pregnant, it may just take longer than if you were younger.

We have been using hormonal contraception (the pill) for a long time, I have heard that it can cause a decrease in my fertility

The combined oral contraception does not cause infertility. Many women are concerned about a delay in fertility after stopping contraception. There are many different types of contraception and in the majority of cases (including the pill) fertility returns to the age related level quite soon after stopping.

It is worth remembering that the pill is prescribed for many reasons other than contraception. These include irregular, painful or heavy periods. These symptoms may be parts of a wider problem such as polycystic ovarian syndrome or endometriosis that are associated with a decrease in fertility. The pill often masks the symptoms, and once the pill is stopped the symptoms and the underlying problem will return. If your periods are very different from how they were before starting the pill then you should see your GP or gynaecologist.

If you are anxious that you are taking too long to conceive don't be embarrassed to ask your GP questions relating to your specific circumstances and remember - you and your partner are in this together!
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