We’re so happy to introduce A Life Loved contributor Doctor Aisha Davies. With her years of experience as a GP, Aisha will be writing about all sorts of topics for us from general health to fertility and child health. In today’s post, Aisha writes about trying to conceive and the hurdles that might be faced by some couples in those early stages…
Hopefully, following those first conversations with your partner, everything goes smoothly for you and you either conceive or end up adopting soon after. Sadly, however, the journey to becoming a parent is not smooth for everyone, so I’m stealing your Wednesday morning coffee time to chat about trying to conceive – commonly referred to as ‘TTC’ in internet based chatrooms and forums.
When you first start trying, it’s fun. Relaxed, unprotected sex. Fiery, sensual love making. The true closeness you feel with the love of your life. Dreams about who your child may look like, how you may parent, who will reduce hours at work, how you can afford it. As months pass your friends may announce they are pregnant. Your family start asking questions. What was initially an exciting time becomes one full of anxiety, stress and endless and often unhelpful Google searches.
Before we get into the clinical facts of what may happen next, I just want to make clear that if you are struggling to conceive then you are not alone. In the UK, 1 in 7 couples have difficulty conceiving. Trying to conceive can feel like an incredibly isolating time so it is really important that you maintain good mental health as we know that stress can affect our hormones, which in turn may affect our chances of conceiving. More on this in a moment, but for now, let’s look at when you should be talking to your GP and what to expect.
So, what is ‘trying to conceive’?
If a couple are trying for a baby, then I would expect them to be having sex every other day in the week before and the week after expected ovulation.
For some of you, that’s a lot less than normal, but for most of you, that’s a lot more than you’re used to. In a game of chance, you need to play the most hands to get the biggest chance of winning. After all, conception is a miraculous event so the more you have sex the better your chances.
Did you know that in any given month, there is a 20% chance of conception? So if we take 100 couples having regular unprotected sex, just 20 will get pregnant within the first month. 70 will be pregnant within six months, 85 within a year, and 95 within two years. I thought it was worth mentioning this because naturally, once a couple want to conceive, there is an increasing sense of urgency with every passing month. So, whether you are in your first month of trying to conceive or at year two, I’m hoping some of this will be relevant to your journey.
Smoking will affect your fertility and if and when you conceive, you will be encouraged to stop anyway. If your partner smokes, his sperm quality will be affected.
Before we go any further, and I really cannot stress this enough – if you’re reading this and you’re struggling to conceive and you smoke, seek help from your GP to stop. Smoking will affect your fertility and if and when you conceive, you will be encouraged to stop anyway. If your partner smokes, his sperm quality will be affected.
One of the most difficult things whilst you are trying to conceive, is knowing when and if you need to pay a visit to your doctor. As a general practitioner myself, I see plenty of women after they have been trying for years and years to conceive, and long after they should have come to see me, because they were unsure about when we would deem the issue suitable for investigation. I would expect a couple to seek medical advice if, after trying to conceive for 12 months nothing is happening, or miscarriages are recurring. If you are aged over 35, I would recommend a visit to your doctor prior to the 12 month mark – the timeliness of your GP visit may affect referring you onwards for further investigation.
When you see your GP after trying to conceive, ideally you should attend with your partner. A full history will be taken, so you should expect to be asked about your menstrual history, any previous pregnancies, and relevant family history and any previous gynaecological issues. Similarly, your partner may be asked if he has ever had any testicular operations, and if he has ever fathered any children. Your smoking history will be relevant, as will your occupations as this can have an impact on fertility. For example, men working in hot environments, or particularly sedentary jobs, may suffer with poor sperm quality.
Your GP is likely to examine you and arrange some baseline investigations. Women will normally have their hormones checked (at different parts of the cycle) and men may be asked to provide a sperm sample for analysis. A lot of this will depend on your geographical location, as fertility investigations offered by your GP differ throughout the country depending on your postcode. It is also important to remember that no two couples are the same, and therefore not everyone will necessarily have the same investigations carried out.
So, what sort of investigations may you have?
For women who have regular periods, blood tests can be carried out at specific points in the cycle to check that hormones are being released as we would expect. The hormones usually tested for are follicle stimulating hormone (FSH), luteinising hormone (LH), oestrogen and progesterone. Prolactin is another hormone that may be tested. Your GP will be able to explain in more detail.
Some of you may have a diagnosis of Polycystic Ovary Syndrome (PCOS). If you have this condition it may affect your ovulation. You may experience difficulty losing weight, excessive hair growth, and irregular periods. Some hormone tests may point us to this diagnosis, particularly a relatively higher level of testosterone.
A transvaginal ultrasound scan will usually be requested. This will look at the structure of the ovaries, womb and fallopian tubes. The scan will involve a probe being placed in the vagina and is not painful. This scan is usually done to check for any structural reasons that TTC may be difficult such as fibroids or cysts.
A hysterosalpingogram (HSG) is an X ray that looks at the uterus and fallopian tubes. Some women report it being slightly uncomfortable. Dye is injected into the womb and the X ray looks at the dye filling the womb and passing along the fallopian tubes.
The scan is done looking for any obstructions that may be impeding an egg from travelling down the fallopian tubes, or any irregularity in the shape of the uterus.
You may have a Hysterosalpingo-contrast sonography (HyCoSy) instead of a HSG. The difference is that a HyCoSy uses ultrasound and therefore there is no irradiation to the pelvic region.
A laporoscopy is a procedure done under general anaesthetic. It allows a surgeon to have a direct view of the pelvic organs and is the investigation of choice if there is any indication of endometriosis.
Small incisions are made in the abdomen and then the abdomen is filled with gas to give the surgeon more space to see the pelvic organs. A small telescope (a laparoscope) is used to check the organs. The vast majority of women will have this as a day case procedure and therefore be in and out in one day.
A hysteroscopy is the procedure that allows direct inspection of the cavity of the womb. A hysteroscope ( a small telescope) is inserted through the cervix. This is a very valuable investigation for women who have suffered repeated miscarriages or if a HSG test has revealed some irregularity in the womb.
Hopefully I’ve explained the more common investigations you may have in a fertility clinic. Men will generally only have a semen analysis and some blood tests done. If an examination is abnormal they may go on to have some in depth studies including ultrasounds.
Your Mental Health
Of course, just as important as all of this is your mental health. That deep unwavering fear you have that it will never happen. The sense of failure you may have, or the sense that no one can possibly understand what you are going through. Every drink your partner has is getting on your nerves – doesn’t he care? Does he not want this as much as I do? Every single child you see that makes your ovaries squeeze for your own. And every single pregnancy announcement you see that makes you excited for your friends but so, so frustrated and anxious about your own journey.
Amongst all of this, it is incredibly important to keep talking. Your concerns and anxieties do not have to be kept a secret. You may be surprised to find people close to you who have experienced the same thing. Or you just may appreciate a big hug.
Focusing on loving yourself is key. Love yourself enough to nourish your body. Feed it well. Exercise it if you can.
If you’ve never thought about meditation and mindfulness, consider it. The headspace App has really helped me get to grips with mindfulness and I encourage people to explore it if they’re new to the concept.
Perhaps you’re not trying to conceive, but know someone who is? Be there to talk if they need it, but try not to bombard them with endless stories about how someone you know tried for four years and finally conceived. I can guarantee they’d have heard this in almost every conversation they have had on the subject. Your heart is in the right place, of course, but it really doesn’t help them feel any better.
Some people may want to talk about their journey and others may not, but if you know a couple is trying to conceive then a simple question asking how they’re getting on may allow them the space to open up to you. Silence can be deafening and showing your friends and family that you are there for them may be exactly what they need.
This is such a huge topic, and I could type for a long time, but I think I will leave it here for now. Please leave a comment if there are specific questions or blog pieces you would like me to cover. If enough of you would like a certain aspect of fertility covered, or indeed any medical conditions, just let me know and I’ll be happy to help.
My next piece will be about what happens next, including In-vitro Fertilisation (IVF). But for now if you’re TTC, good luck!