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Fertility is something many of us don’t think about until the time comes when we are ready to have children. It is a complex process with a number of factors at play all needing to be optimal in order for a successful pregnancy to occur.

In order to conceive it is important for women to be ovulating and producing good quality and quantity of eggs and for men to have healthy sperm. Ovarian reserve decreases with age and the quality of the eggs produced may be suboptimal as you get older.

Together with sperm and egg quality, the anatomical structures such your fallopian tubes and uterus need to be normal to allow the egg and sperm to meet and implant appropriately. Certain conditions may affect this. Finally your hormone levels also need to be adequate in order to sustain a pregnancy.

The length of time it takes to fall pregnant differs in each women. Many factors affect a couple’s chance of conceiving such as; age, general health, reproductive health and how often you are having intercourse.

Data from the National Institute for Health and Care Excellence (NICE) shows 80% of couples (less than 40 years of age, not on oral contraceptive and having regular intercourse) will conceive within 1 year. Of those who do not conceive in the first year, about half will conceive in the second year giving a cumulative pregnancy rate of 90%.

You also need to ensure you are having intercourse regularly so it helps to understand your cycle. Sperm needs to enter the vagina at the time of ovulation. For those with a regular cycle this is normally 12-16 days before your menstrual period starts. It’s advisable to have intercourse every 2-3 days while you are trying to conceive according to NICE and NHS guidance.

Some forms of contraception are known to delay fertility, in most cases this is short lived and it has no effect on long term fertility.

A large study conducted by Yland showed; women who used injectable contraceptives had the longest delay in return of normal fertility (five to eight cycles), followed by users of patch contraceptives (four cycles), users of oral contraceptives and vaginal rings (three cycles), and users of hormonal and copper intrauterine devices and implant contraceptives (two cycles). It is important to take this into account when pregnancy planning.

How to improve your chances of getting pregnant and having a healthy pregnancy?

In order to optimise your chances of falling pregnant, women should maintain a healthy weight, cut down or stop drinking alcohol and stop smoking. Women should take a folic acid supplement of 400mcg daily before they conceive and should remain on this for the first 12 weeks of pregnancy.

This reduces your risk of neural tube defects (spina bifida). You may be advised to be on a higher dose if you are at increased risk due to a family history, underlying medical condition such as diabetes or are on certain medication.

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Men should not exceed the recommended alcohol intake (14 units per week), should stop smoking and maintain a healthy weight. There is an association between elevated scrotal temperature and semen quality.

For both men and women, a number of prescription, over-the-counter and recreational drugs interfere with male and female fertility. If you are concerned you may be at risk you will need to discuss this further with your doctor.

What is infertility?

Infertility is defined by the WHO as a disability and a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility can be due to ovulatory dysfunction, tubal or other anatomical disorders, endometriosis, or unknown causes.

Investigation requires evaluation of reproductive anatomy and physiology. The underlying treatment advised is dependent on the diagnosis but may include medical therapy, surgical therapy, or IVF. The outcome is dependent on age, infertility diagnosis, and treatment plan.

Data on pregnancy rates following assisted fertility from NICE show over 50% of women aged under 40 years will conceive within 6 cycles of intrauterine insemination (IUI), of those who do not conceive within 6 cycles of IUI, about half will do so with a further 6 cycles giving a cumulative pregnancy rate over 75% in this group.

When to see a GP?

You should see your GP if you have been trying to conceive for over a year. If you are 36 years old or over, there is a known clinical cause or predisposing factors for infertility, you should see your GP sooner.

Those individuals with underlying medical condition like diabetes or thyroid problems or those on long term medication should seek advice from their doctor before trying to conceive as there are some medications which could be harmful in pregnancy. If you have any known genetic conditions in your family you should also discuss this with your doctor before trying to conceive.

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