If you are struggling to conceive, it can seem as if the whole world is pregnant except you. The reality is that about one in six women has difficulty conceiving, and even women in fertile couples, who are having regular unprotected sex, have only a 20 per cent chance of getting pregnant each month. So, if you have been trying for a few months without success, do not despair.
When to look for help
If you have been trying for a baby without success for 12 months, it is worth talking to your doctor about your concerns. In some cases, it is worth seeking advice after only 6 months, for example if you are over 35 and do not have regular periods; if you or your partner have had a sexually transmitted disease (STD); a pelvic or abdominal injury or surgery; or if there is a tendency to fertility problems in your family.
What happens next?
Your doctor will take a medical history and ask you some questions about your menstrual cycle, how long you have been trying to conceive and your lifestyle. After some preliminary tests, he will probably refer you to a fertility specialist for further investigation.
There is no need to feel upset or embarrassed about talking through your fertility problems: every day, doctors and specialists see people with similar problems, which are a lot more common than you might think. It is important that you and your partner are emotionally prepared for the investigations you may have to go through. Some of the procedures are unpleasant, and waiting for results can be stressful. Remember that you want to have a baby together and there is no need to feel guilty if you discover that one or both of you have fertility problems.
Tests by your doctor
You will be given a smear test and an internal examination and will have to provide urine and blood samples. Tests for hormone levels will show whether you are ovulating. Your blood will also be checked for STDs, as some, such as chlamydia, can affect fertility. Your partner's penis and testes will be examined, and he will be asked to go home and provide a semen sample to be sent to a laboratory for testing.
Tests by a specialist
After these preliminary tests, you may be referred to a fertility specialist, who will carry out further investigations.
These may include:
An ultrasound scan to look closely at your ovaries. A biopsy, which will involve removing a tiny part of the endometrium. This procedure can be performed either with or without a iocal anaesthetic. The sample will then be checked in the laboratory to see whether it is becoming thick and spongy enough after ovulation to allow a fertilized egg to implant.
There are two main tests used for checking the correct functioning of the Fallopian tubes.
A hysterosalpingogram (HSG) involves injecting dye into the uterus, using a catheter passed through the cervix, so the fluid's progress up through your Fallopian tubes can be seen on an X-ray. There is no need for a general anaesthetic.
A laparoscopy and dye is performed under general anaesthetic and involves a telescope being passed through a small incision in your umbilicus (belly button). This enables the specialist to view your entire pelvis and reproductive organs. Dye can then be passed through the Fallopian tubes.
Common causes of female infertility
Problems with ovulation A fine balance of different hormones is needed for the various stages of ovulation (the maturing and release of the egg) to occur. If any of these hormones is absent or not present in the right levels, ovulation may not happen.The ovaries may also be damaged, perhaps as a side-effect of radiotherapy or as a result of surgery or an infection.
Polycystic ovary syndrome (PCOS) Usually the eggs in the ovaries develop inside follicles until one is mature enough to be released. With PCOS, the follicles become cysts, so that the eggs cannot mature.
Endometriosis This condition occurs when the cells that normally make up the endometrium (the lining of the uterus) grow elsewhere inside a woman's body. They then bleed every month when she has her period, causing internal organs to become glued together with the blood and endometrial tissue.
The symptoms of endometriosis include painful and heavy periods. It can affect fertility if the ovaries, Fallopian tubes or uterus become damaged.
Damaged Fallopian tubes Damage or blockage by scar tissue can be caused by a previous ectopic pregnancy, by an infection such as chlamydia or by endometriosis.
Fibroids These benign tumours grow inside the uterus and do not usually affect fertility. Sometimes, however, they can press against the Fallopian tubes or interfere with the implanting of a fertilized egg. They can be removed surgically, if deemed necessary.
Low sperm count This can range from none to a lower than average number; the normal range is 35 to 200 million per millilitre of semen.
Abnormal sperm The sperm may not be properly formed.
Bad sperm motility The sperm are neither fast nor agile enough.
Failure to ejaculate Some men suffer from retrograde ejaculation, where the semen goes backwards into the bladder during sex rather than into the vagina.
Blocked vas deferens The tubes that transport sperm from the testicles to the seminal vesicles ready for ejaculation may become blocked because of a defect or an infection.
Testicular failure Undescended testicles, that is, where the testicle is in the abdomen not the scrotum, injury to the testicles, chemotherapy, mumps after puberty or injury can all damage sperm production.