Planning for pregnancy
In our instant-gratification world, conceiving a baby is still something that often requires patience, optimism and a lot of waiting.
And when you think about all the requirements for a successful pregnancy, its not surprising that such a complex event often takes a while to come off, particularly when there is such a short window of time for the egg to be fertilised.
Many health professionals now suggest that women who are over 35 seek help if they have not conceived after six months of unprotected sex, although for those under 35 who have no known health problems, waiting for twelve months before seeking medical help is still the current recommendation.
The average age of a first-time mother in Australia is now just over 30 years, by which time peak fertility has already passed. Even so, an estimated 90 percent of women fall pregnant within 18 months of having regular intercourse near the time they ovulate.
Most couples trying to conceive will be successful in the first twelve months ; and for many couples, changing their lovemaking practices to initiate pregnancy (rather than avoid it) can be exciting and liberating, so its quite fun to have a long and luxurious stretch of time to pursue that goal of conception.
But other couples have reported that when pregnancy doesnt happen straight away, (though we know that this only happens in a quarter of the population even at peak fertility), they have felt stressed and pressured about sex.
It can be frustrating when you have made the decision to have a baby to then wait, with seemingly very little control, as month after month the arrival of a period signals dashed hopes.
Another problem is that disappointment when you dont fall pregnant particularly if you expect it to happen immediately – can actually do you a disservice, as the resulting stress can hamper fertility further.
Good news – natural conception
Most couples that have difficulty conceiving on their own do eventually end up falling pregnant. These days there are many options available to couples who are struggling to conceive.
There are many common, treatable conditions that lead to short-term infertility (also known as sub-fertility). In fact, in 80 percent of couples with infertility, there is a proven, medical cause.
If you think you may have fertility problems, the first stop should be your family doctor, who can begin some tests.
Next Steps – fertility specialist
You may want to ask your GP to refer you and your partner to a fertility professional. Some experts suggest asking for an infertility specialist with CREI qualifications (that is, postgraduate training in Reproductive Endocrinology and Infertility); which means they may be more up-to-date with the latest investigations and treatments.
Alternatively, many large public hospitals in Australia have fertility clinics and you can call these clinics direct to make an appointment.
Tests and Causes of infertility
The specialist will take a including a detailed case history and often a range of tests will be done, including an internal examination for women, blood tests for both partners and a semen test for men. If none of these tests identify an area for treatment, further tests are done.
Men account for about forty percent of fertility problems and semen testing is less invasive than many tests on women, so initial investigations will often start with a male partner.
Some of the common causes for male infertility include abnormalities in his sperm (perhaps there is a low number of sperm or they have poor motility thats their ability to swim or there are problems with their shape); or that a man is producing antibodies to his own sperm; or has erectile dysfunction.
Women also account for around 40 percent of all fertility problems. If you havent already done so, you will be asked to fill in some temperature charts to pinpoint the timing ovulation timing, a post-coital test will examine cervical mucus several hours after intercourse and a laparoscopy may be suggested, where a womans uterus and fallopian tubes are examined under general anaesthetic.
There are numerous causes of female infertility. Some of the most common include pelvic inflammatory disease, endometriosis, uterine fibroids and polyps and polycystic ovary syndrome. Stress can also be a contributing factor.
In around 20 percent of cases of infertility, no cause can be established.
Staying positive when conceiving becomes a problem
Some couples prefer not to use the term infertile, because it has such negative connotations. But the definition of infertile refers to a couple who have not conceived after 12 months of regular unprotected sexual intercourse. It might help to think of infertility as a medical definition rather than a lifelong condition.
About fifteen percent of Australian couples who are of reproductive age have a fertility problem but most dont talk about it, which can make you feel very isolated. It can be helpful to join a support group such as ACCESS, the Australian National Infertility Network.
The road to conception can be heartbreaking when a couple experiences so many obstacles and there is now increasing evidence that infertility often has a profound psychological impact, putting a huge strain on individuals and on relationships.
A German study in 1999 found that women unsuccessful in conceiving had clinical depression rates similar to women with cancer or heart disease.
There is strong evidence to suggest that relationship counselling in these circumstances can help to ease the considerable stress that couples with fertility problems may be experiencing.By Fran Molloy journalist and mum of 4