Difficulties getting pregnant
For some couples the road to parenthood isn’t always straightforward and becoming pregnant can prove a lot more difficult than they’d ever anticipated. The National Institute for Health and Care Excellence (NICE) estimate that one in seven UK couples are affected by infertility.
Fertility difficulties can affect the healthiest and most physically fit couples and can cause distress, anxiety and tension in even the most solid couple relationships. A new study has recently suggested that nearly half of all couples who fail to conceive after a year of trying for a baby, do not seek help for fear of being labelled ‘infertile’. Worries over the financial expense associated with fertility treatments and couples’ failing to realise there may be a problem with their fertility, are also stopping individuals from seeking specialist advice.
If you have been trying for a baby for some time and have not succeeded in becoming pregnant, it is important that you and your partner see your doctor for advice and possible referral to a fertility specialist.
How long should we allow before seeking help?
It is generally accepted that if you are younger than 35 years-old it is fine to keep trying for a baby for a year before seeking specialist fertility advice. However, if there is no sign of a pregnancy after a year of trying then couples should see a doctor.
This timeframe is reduced for women who are 36 years or older – they are advised to seek specialist fertility advice if they haven’t conceived after six months of trying for a baby.
Similarly, if there are any pre-existing medical conditions or known causes that are likely to cause fertility problems for either you or your partner, it is advised that you seek specialist advice without delay.
Common reasons for difficulty conceiving
There are a number of factors that can impact on men’s and women’s fertility and couple’s ability to have a baby. These include:
Damage to the fallopian tubes eg due to infection
Polycystic ovary syndrome
- Low sperm count
Problems with the vas deferens (the tubes that carry the sperm)
Problems getting an erection
Problems with ejaculation
What investigations might be required?
If couples find that their attempts to conceive are proving unsuccessful, it is important to see a doctor. This can seem embarrassing and some couples may feel awkward sharing problems of such an intimate nature. However, your doctor will be sensitive to your feelings and will offer advice and support, and can ensure that, where indicated, you are referred to a reproductive doctor for specialist tests.
There are a number of tests that are likely to be recommended. These include a range of blood tests to check that the female hormone levels are in the expected range for ovulation. They involve having samples of blood taken at various phases during the menstrual cycle. The hormone levels measured are:
o Luteinising hormone (LH)
o Follicle stimulating hormone (FSH)
Luteinising hormone (LH)
A luteinising hormone (LH) test measures the levels of LH in a sample of blood or urine. LH is produced by the pituitary gland and helps regulate women’s menstrual cycle and egg production. Levels of LH present in the women’s body vary according to the phase of her menstrual cycle – levels increase rapidly just before the egg is released (ovulation) which normally occurs on day 14 of a 28-day cycle. Your doctor may refer to this as an ‘LH surge’.
LH also has an important role in stimulating the production of testosterone which is important for men’s sperm production.
An LH test is undertaken to identify the cause of a couple’s inability to conceive – it helps to evaluate a woman’s egg supply (called ‘ovarian reserve’) and is also used to examine a man’s sperm count. It is also used to check how women are responding to specific medications that are designed to stimulate ovulation.
Follicle stimulating hormone (FSH)
A follicle-stimulating hormone (FSH) test is performed to measure the levels of FSH in a blood sample. This hormone is also produced by the pituitary gland and has an important role in controlling women’s menstrual cycle and the production of eggs by the ovaries. The levels of FSH present in women’s bodies varies during her monthly menstrual cycle. FSH levels are at their highest just before ovulation.
FSH also has an important role in men – controlling the production of sperm. The levels of FSH in men’s bodies normally remain constant.
FSH testing is recommended for both men and women because it can help to identify causes of infertility. These can include using FSH test to evaluate women’s egg supply (ovarian reserve) and to also diagnose a man’s low sperm count.
NB. Luteinizing hormone and follicle-stimulating hormone levels rise and fall together during a woman’s menstrual cycle.
A progesterone test involves taking a sample of blood to measure the amount of progesterone in a woman’s body. Progesterone is a ‘female’ hormone that is produced by the ovaries when the ‘mature’ egg is released from the ovary each month – i.e. at the time of ovulation.
Progesterone has an important role in preparing the ‘endometrium’ – the lining of the uterus (womb) to receive the fertilised egg. However, if the egg is not fertilised by sperm, the woman’s progesterone levels will fall and the womb lining is shed. This results in the menstrual bleeding (period) that occurs each month in non-pregnant pre-menopausal women.
NB. The placenta (afterbirth) also produces high levels of progesterone during pregnancy. The production of progesterone begins towards the end of the first trimester (the first 12 weeks of pregnancy) and continues until the birth of the baby and delivery of the placenta and membranes, after which, levels rapidly fall.
Progesterone levels in pregnant women are around 10 times higher than those found in non-pregnant women.
A progesterone test is recommended because it can help to identify the cause of infertility. Measuring progesterone levels helps to determine whether ovulation is occurring each month. The test is also used to monitor ovarian and placental functioning during pregnancy, and to evaluate how well fertility medications or progesterone treatments are working.
Getting the results
Where the test results come back ‘normal’ and no physical or medical conditions or problems can be identified, couples are likely to be advised to continue having regular sexual intercourse for up to two years (including the length of time they have already been trying). However, your doctor may still refer you for specialist fertility investigations.
Couples may also be given health and lifestyle advice such as, losing weight or gaining weight (if the woman has a low BMI); stopping smoking and stress-relieving strategies, which may include the use of complementary therapies.
In some cases, medication which encourages ovulation may be recommended. Where necessary, your doctor can refer you to a fertility doctor for more specialist investigations and longer term follow-up.
If your doctor decides that it is appropriate for you/your partner to start fertility treatment, the recommended approach will depend on a number of individual factors including the woman’s age and both partner’s medical histories.
Fertility treatments tend to fall into three main categories:
Fertility medication – These tend to be prescribed for women and are designed to help with any ovulation problems. One of the most common fertility medications prescribed is Clomifene
Surgical treatment – This can include surgery to the fallopian tubes if they have become scarred or blocked because of previous infection, or to the uterus (womb).
Assisted conception – Assisted conception can involve:
Intrauterine insemination (IUI) – this treatment tends to be recommended where there are mild problems with the man’s sperm. The procedure involves sperm being placed into the uterus (womb) using a fine catheter (small plastic tube)
In vitro fertilisation (IVF) – this treatment involves the sperm and eggs being mixed together outside of the woman’s body so that fertilisation takes place. The fertilised eggs are then placed back into the woman’s uterus. This form of treatment can be used for more severe sperm problems and in cases where a couple’s inability to conceive is unexplained i.e. no cause can be found.
It is important to note, that many couples who are referred for fertility treatment will actually go on to conceive naturally (without requiring any treatment). Often this will happen before they even get to their clinic appointment – it is thought this happens because couples finally ‘relax’ allowing conception to happen spontaneously.
Recent research undertaken by Greenwich NHS Trust, Imperial College and King’s College London has found that where fertility treatment did not work, one in three women went on to become pregnant naturally. In fact, the researchers state that regardless of the outcome of fertility treatments – whether women conceived or not – there is about a 30% likelihood of conceiving over a six-year period. It was found that 87% of the spontaneous conceptions occurred within two years of completing infertility treatments.
Similarly, almost a quarter of women who had successfully given birth through IVF or other methods also had more children without the need for further treatment.
Support Groups and Organisations
Family Planning Association (FPA) – The sexual health charity. Further information is available at: www.fpa.org.uk
Foresight – The Association for the Promotion of Pre-conceptual Care. Further information is available at: http://www.foresight-preconception.org.uk/
The Foresight Approach has been developed over 5 decades to optimise the chances for people to have a baby, to support the physical, mental and emotional wellbeing of children and young people, and to improve the health and longevity of the elder population.
Further information is available at: www.tommys.org
Tommy’s provide evidence based, expert and user led, accessible pregnancy information to support expectant parents in understanding what they can do to support a healthy pregnancy.