It’s been six months - should we consult an expert?

This is a very common question – when to seek advice when trying to conceive? This really depends on a couple’s circumstances and most importantly the woman’s age. Fertility starts to drop when a woman reaches mid 30’s. So as a guide, seeking medical advice after 9-12 months of trying if aged under 35 and after 6 months if 35 or older is sensible. This assumes that a woman has a regular menstrual cycle and that the couple have good health.

If your cycle is not regular it is important to see your doctor to check if you are ovulating or not. It is not uncommon if your cycles are irregular to have eggs in the ovaries that are not maturing and therefore not being released regularly. If your cycle is regular, you most likely will be ovulating each month. Some women notice changes in their body around ovulation time, such as vaginal discharge changes or mild pelvic discomfort. Urine ovulation test kits can be bought to confirm ovulation. The test detects a hormone surge the day prior to ovulation, helping to time intercourse.

If you or your partner have any ongoing medical issues it is important to see your GP for a check-up to check if any medicine taking is suitable to continue during pregnancy.

The woman needs to take folic acid, at least 500mcg a day, starting ideally 3 months before starting to conceive. This helps the babies’ spine and skull to form properly.

If you are experiencing a delay in falling pregnant the first step is to consult with your GP. At your consultation the GP may arrange fertility tests for the two of you or refer you to a fertility specialist.

What will the fertility tests involve?

Common tests include a timed blood test to check you are ovulating. Other baseline fertility blood tests check your blood group, blood count and for infection immunity. There is a useful “egg count” blood test. A hormone from the ovaries called Anti Mullerian hormone (AMH) rises proportionally to your egg count. A higher AMH level indicates more eggs are stored in your ovaries whilst a lower level indicates less eggs are present. The level purely reflects the egg count and gives no indication regarding egg quality or chances of falling pregnant. A way to understand the test is to equate it to a car’s petrol tank. The car drives along normally whether the tank is full or nearly empty. Only when it runs out of petrol (you run out of eggs) you cannot drive (fall pregnant). Egg quality is related to a woman’s age as you are born with all your eggs as a baby, so as you get older so do the eggs. This clinically makes it more difficult to fall pregnant from your mid 30’s onwards. Egg quality can also be affected by your general health, any medical conditions and smoking status.

A pelvic ultrasound checks the uterus shape and for growths such as polyps or fibroids and for any ovarian cysts.

What about my male partner?

The man needs to produce a sperm sample for testing. One third of the time, a delay in falling pregnant is due to sperm abnormalities. The semen sample is checked for sperm numbers, motility (sperm swimming) and morphology (sperm shape). Sperm are produced continuously and fluctuations in numbers occur so any abnormal result should be followed up with a repeat test at least 6 weeks later.

Timing your sexual intercourse

The correct timing of sexual intercourse will help you efficiently fall pregnant. Ideally intercourse should start 4 days prior to the expected ovulation day and continue every second day until after ovulation. Based on your menstrual cycle or LH urine ovulation testing results, the estimated ovulation day can be decided and intercourse continue for 2-3 days afterwards to provide some leeway.

If you have not fallen pregnant after 6-12 months of trying, or earlier if needed, your GP will refer you to a fertility specialist. Here at Create Health we specialise in fertility treatment and will individualise your care and advice based on your circumstances, needs, and wishes.

Your Create Health fertility specialist will take a thorough history from you and your partner, arrange appropriate tests, and discuss with you the best plan for your unique situation.

Treatment options at Create Health

Treatment options are individualised for each couple. Some couples require menstrual cycle monitoring and advice regarding timing of intercourse. Women who do not ovulate regularly require medicines to initiate ovulation. Tablets taken for 5 days a month or daily hormone injections can kick start ovulation for the month they are used.

If physical pelvic abnormalities are present, minimally invasive surgery (key-hole surgery) is used. A laparoscopy involves inserting a very thin camera through the umbilicus to check the pelvis whilst a hysteroscopy involves inserting a thin camera to check the internal uterine cavity. These procedures treat any physical conditions that may affect fertility, such as endometriosis, or to check fallopian tube patency.

Create Health doctors also arrange more focused treatments such as sperm insemination (IUI) or IVF.

Insemination is used for unexplained infertility or as an adjunct to ovulation induction treatments. Sperm is prepared by fertility scientists (embryologists) then the sperm is inserted into the uterine cavity, similar to having a PAP smear.

IVF is an efficient method to treat infertility. The IVF cycle complements and boosts the natural menstrual cycle. Daily small injections are used for approximately 10 days, making a number of eggs mature during the cycle. The eggs are then collected with a vaginal ultrasound probe under a light anaesthetic. The IVF scientists prepare the eggs and fertilise them with the male’s sperm. The embryos are cultured for 5 days in incubators which are kept in a controlled environment and the best embryo is selected. The selected embryo will then be transferred back into the uterus with a thin vaginal catheter tube. Ten days later a pregnancy test is performed to confirm if a pregnancy has been achieved.

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