Introduction
The average time for a couple to conceive is 12 months, but this fact is not helpful if you have quietly been trying for longer than this. Anxiety about what might be wrong can make matters worse. One of the hardest things to do might be explaining to your GP that you have been hoping to conceive without success. It is such a personal and private matter; it is no wonder that couples sometimes delay this call.
Pre-conception advice
It is very important to optimise both partner’s health by looking at lifestyle. Stopping smoking, eating healthily, reducing, or stopping alcohol and having a healthy BMI really do make a difference. Pre-existing medical conditions, such as diabetes or hypertension are stable should be stable. A woman should take a folic acid supplement 400mcg a day, which helps to reduce the chance of the baby being affected by spina bifida (when a baby’s spine and spinal cord does not develop properly in the womb). If you have diabetes, epilepsy, sickle cell anaemia or thalassaemia an increased dose of 5mg is recommended. Also, if either partner has a neural tube defect, or has had a baby previously with one or there is a family history. If a woman’s BMI is over 30, you should ask her GP to prescribe the 5mg dose.
Whilst initial tests are important, the nurse or doctor should sensitively ask you if there are any problems with intercourse. Timing of intercourse should be every 2-3 days throughout the cycle. This regular but relaxed approach can help to reduce the stress so often described by couples. I often say once a week isn’t enough, every day is too often, and every other day is a bit too regimented. Reducing the stress of timing intercourse is so important. This regular but relaxed approach is good even if you have irregular periods or there is a sperm problem.
Female investigations
If you haven’t had a baby before, advice may be via an NHS fertility clinic. Sometimes these can have a longer wait and you might have some initial tests privately. If you already have a child, you will likely need to access a private fertility service. The process of assessment will be very similar as there are several physiological areas to check.
Female fertility tests include checking the anatomy of the uterus, the lining and ovaries with an ultrasound scan. Assessing hormones such as ovarian hormones (FSH and LH), thyroid function, and progesterone to see if a woman is ovulating. Sometimes AMH (anti-mullerian hormone) is assessed to check ovarian reserve. A smear test should be in date, and you should check you have had 2 dosed of MMR (rubella vaccination). This will ensure you don’t catch rubella once pregnant and pass on the infection to your unborn baby. A history of periods and their regularity (or not) is taken, and if there have been any pelvic infections such as chlamydia. An assessment of fallopian tube patency can take place with an outpatient procedure such as HyCoSy or hysterosalpingogram. If the fluid passes through, then the tubes are open.
Male investigations
Sperm is assessed by either the man producing a sample at home and delivering it to the clinic to be checked or providing the sample at a clinic. The amount of sperm (concentration), the percentage of swimming sperm (progressive motility) and occasionally the sperm shape are assessed. Asking about previous pelvic surgery, infections or injuries is important to see if there is an increased risk of sperm problems.
Conclusion
Clinicians really do appreciate the sensitive nature of the situation and the tests involved and the high stress levels these questions and investigations can bring. We aim to make the process as smooth as possible, whilst providing information throughout your journey.