Many couples I meet are hoping to conceive or may have taken many months to conceive their baby, and each of these situations brings with it a degree of anxiety. There are many statistics such as, 84% of women conceive in the 1st year, 1 in 6 couples seek fertility advice, and the average time to conceive is 12 months. These statements are not helpful if you have been quietly hoping to have a baby for 18 months. 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.
If a woman has not had a baby previously, advice may be via an NHS fertility clinic. If she already has a child, a couple 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. Before this, 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. Making sure pre-existing medical conditions, such as diabetes or hypertension are stable, is also important prior to conception. A woman should take a folic acid supplement, 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, causing a gap in the spine).
Initial tests are important, but the nurse or doctor should sensitively ask 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.
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. A smear test should be in date and the woman have had her rubella vaccination. A history of periods and their regularity (or not) should be 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.
Sperm is assessed by either the man producing a sample at home and delivering it to the clinic within an hour, or providing the sample at the clinic. The amount of sperm (concentration), the percentage of swimming sperm (progressive motility) and occasionally the sperm shape are assessed. A history of previous pelvic surgery, infections or injuries should be taken.
Clinicians really do appreciate the sensitive nature of the situation and the tests involved. We aim to make the process as smooth as possible, whilst providing information throughout a couple’s journey.