A Question Of Conception
Author: Net Callidus

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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