We’re Trying For A Baby

Practical advice from a GP

Reading Time: 7 minutes

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?

Blood tests

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.

Ultrasound scans

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.

Tubal Tests

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.

Laparoscopy

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.

Hysteroscopy

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!

Aisha x

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41 Comments

  • Hm. As a person currently trying to concieve, I feel very distressed by this article. I come away from it with an overwhelming feeling of negativity at something which you have acknowledged is a very stressful time and one in which most couples will not require medical intervention. Yet your article reads like a page from the NHS website with little thought to the emotional impact it is having on the reader or giving them any practicle tips on how to concieve.

    Perhaps consider another title?

    • Hi Samantha. Huge thanks for your comments. The focus of this piece is for those women who *do* end up requiring medical intervention. I’m saddened you feel distressed by it. I am going through my own fertility journey so that was certainly not my intention. Good luck x

  • This is an incredibly negative article and has done nothing to put my mind at ease. There are plenty of things that can be done before reaching the stage of fertility checks, why are none of them mentioned? Why jump straight to fear mongering rather than reminding of the importance of taking folic acid? Why no mention of pre pregnancy checks that can be carried out to put your mind at ease? Of ways to clean up your diet or ways to naturally reduce your stress levels to help your body concentrate on conceiving without the weight of poor mental health bogging it down? There is SO much this article could have said to reassure those TTC, but instead all it’s done is make the whole process even more terrifying, which I can guarantee won’t be helping the stress levels of those readers that are early into the process. Additionally, there is conflicting evidence about how often you should be having sex when TTC,with some claiming that it’s better to have less sex around the time so sperm is ‘saved up’ for the main event. Your writer shouldn’t state her opinion as fact in such instances, the conflicting evidence should be shared despite her personal beliefs about how often one should be having sex.

    • Hi Charlotte. The main focus is for those who do end up requiring medical intervention and what happens when they get to the point of referral. In terms of how often you should be having intercourse, I have used the current guidance from the Royal College of Obstetricians and Gynaecologists, not my opinion/personal beliefs. As a medic asked to write a medical factual piece on the journey from referral I did not include the pre referral checks. I am more than happy to do a pre referral stage piece if you’d like? x

  • This certainly feels unnecessarily negative. I understand being realistic as most people take a while to conceive but I feel like there could be more practical ideas for what to do when TTC e.g. Cutting down caffeine, taking folic acid for a few months before trying, cutting down alcohol, trying to relax about it, keeping time together as a couple but instead it jumps straight to medical intervention which most people really won’t need.
    I understand Aisha wanting to share her expertise as a GP but a lot of couples don’t need doctor’s input in their TTC journey so for it to sound like it’s expected feels a little dangerous and scaremongering.

    • Thank you Jacqui. The main focus of this is for those who end up requiring medical intervention. Huge thanks for reading! X

  • Not that we’re TTC yet but it’s always a big worry of mine (rationally or not!) this was such a reassuring and educational read! Thanks Aisha! Xxx

  • So brilliant to read this. 2018 will be the year I start TTC. I also have PCOS so I’m prepared that it may be a long and difficult process and I’m very much looking forward to reading the rest of this series.

    • Good luck! I have lots of information on PCOS and trying to conceive so when you get there, let me know and I can explain more. x

  • This is so beautifully written! So many articles on TTC/ difficulty conceiving shy away from the practicalities but Dr Davies has explained the investigative procedures in a thorough and easy-to-understand way. I can really tell the care and sensitivity that has gone into writing this piece, thank you.
    Dr Davies, your patients are so lucky to have you!

    • Thank you Sarah! I have tried to be clear but understand some others would have preferred a less medical approach. The subject is so huge it certainly is impossible to fit it into a single piece x

  • Thanks for such an informative and clear article Aisha! We are just at the beginning of our fertility journey, but you have completely answered my personal big vague question of ‘what might be the next steps if all doesn’t go smoothly straight away?’. There’s lots of fluffy advice around about cutting out caffeine etc, but clear, concise, friendly information about a pathway which some of us might go down has taken away some of the fear of not knowing. As someone undergoing tests for PCOS, I found this incredibly helpful!

    • Thank you Bethan. I’m so glad. It’s such an emotive subject and even in these comments there’s a 50/50 split. Huge thanks for your comments x

  • Thank you Aisha for this piece. After TTC for a number of months now I’m always told by those who are aware to ‘relax’ when all I actually think about when thinking we may be having an issue is what we are going to face in the future if there is a problem. I’ve already had a number of tests done and am glad to now know what further tests may be and how invasive/uncomfortable they may be for me or my husband… or even if they’re absolutely nothing to worry about! I look forward to reading more articles about how we can help ourselves along 🙂 x

  • I wouldn’t say this is negative or scary, we are planning g to start to TTC and I hear all the time of people struggling and have started to realise how common it is. Rather than scary, I found this to be matter of fact and reassuring, I now know what to expect and what my plan B would be should we struggle. Thanks Aisha x

    • Thank you so much Cesca. It’s such an emotive topic I’m not surprised opinion is split. Huge thanks for your comments x

  • Thank you so much Aisha. We are planning on starting in the near future and I am concerned as my mum suffered from PCOS and endometriosis. She also had me fairly young and miscarried when I was 6. So I appreciate the factual nature of the article.

  • This is a brilliant article Aisha, as a GP myself I feel it gives a very clear over view of what to expect when attending the GP for fertility. I’ve seen some have found the article negative in the comments but I feel that you’ve explained what can be a very confusing process and that can only be beneficial for any woman who may need fertility investigations.

    • Hi Sarah, and thank you. It is so difficult to write about such an emotive topic and I was disappointed some felt it was too technical and negative. Interestingly lots of women who are at this stage have messaged to say they appreciate an piece written for them. Hope your Christmas period is not as busy as ours! x

  • Thank you Aisha for writing such a clear and well thought out article. I’m discovering that TTC can feel like a lonely and confusing place sometimes with lots of conflicting advice. Its good to read an article that focuses on the practicalities but also highlights the importance of mental health which is something I hadn’t considered before starting the TTC journey x

  • I’m a long way off TTC personally, but on the subject of fertility, I would really like to see a piece on miscarriage. I’ve read lots about the emotional side through the ALL group, but feel that the medical side is not openly discussed. I know its an incredibly difficult subject to write/read about, but would be very imformative too.

    • Yes I agree with Lucy, I am also way off TTC but I think any woman who wants children worries occasionally about the what if! I would love to hear more about miscarriage and the difficult subject of ‘what is normal’ and also pre-TTC advice e.g. Coming off long term contraception etc and realistic timelines

      • Hi Lucy and Meredith! I will certainly pencil in a month where I talk about miscarriage. Reading yours and other comments I will definitely do a piece on what is normal and pre TTC-advice. It is clearly something lots want to read about x

  • Thanks so much for this informative article Aisha. It’s great to have this practical guidance but in a digestible way and in a friendly format: topped and tailed with reassurance and good wishes.

    You mentioned repeated miscarriages a couple of times above but I’d assumed for those there would be e.g. genetic investigations. I’ve had two MCs and have been told that I would be offered early scans for my next pregnancy and further testing after a third MC. Can you offer any further guidance on what to expect? And the most common causes of repeated MCs?

  • Hi Katie. Firstly, my heartfelt condolences on your miscarriages.
    Recurrent miscarriages are managed according to national guidelines and anyone with three or more miscarriages before 10 weeks gestation should be referred.In some areas and for some indications referral is earlier (eg maternal age).
    It is not always possible to determine the exact cause of miscarriage but in those women where no cause is found the prognosis for a future successful pregnancy is high (75%).
    At referral for investigations you are likely to be offered assessment for antiphospholipid antibodies and possibly other immunological abnormalities. If antiphospholipid antibodies are found (basically an autoimmune reason for miscarriage), treatment with aspirin will be considered in future pregnancies and this may protect against miscarriage. You are correct in that there are usually investigations for genetic abnormalities in both partners.If you haven’t had one already then you will have a pelvic ultrasound scan to detect uterine abnormalities.

    I give my patients this leaflet –

    https://www.miscarriageassociation.org.uk/wp-content/uploads/2016/10/Recurrent-Miscarriage.pdf

    Really hope the link works! If not you should be able to copy and paste.

    Wishing you and your partner all the very, very best x

  • Really very interesting and informative read, which I also found kept the experience at the centre. Some topics are so big that they can never meet everyone’s needs but I found this really useful – especially hearing from a GP that one should go and see a GP, rather than feeling like they’d do an internal eye-roll at you. Thanks for this.

  • Aisha, this is wonderful to read.

    Everyone experiences such a different journey and it’s good to know what to expect should it not happen as quickly as planned / previously.

    I was just reading the comments and saw that you mentioned aspirin may be prescribed, this was mentioned to me by my GP when we were talking to her about potentially trying in the new year for our rainbow baby. As you know our little boy Marc was born sleeping.

    What does this aspirin mean and would this be something you would normally expect someone who has suffered a stillbirth to be prescribed? Additionally, there was no known reason for Marc’s death but I wondered how closely I will be monitored should we be lucky to conceive again? Would I be scanned every two weeks like I’ve heard from some other mums?

    I’m scared about the entire pregnancy journey this time round, petrified really, and would love to know how this might be dealt with in terms of how close I’m being monitored? Also would I have an induction date or would it be natural?

    Sorry a hundred million questions!

    Love this article xx

    • Hi Sarah, and huge apologies for taking so long to respond – I didn’t see your message! Aspirin is prescribed in pregnancy for lots of different things, particularly risk factors for pre-eclampsia. So women with high BMIs, or women who have clotting disorders, or those with hypertension my well be prescribed aspirin. There is no specific guideline that mothers who have experienced stillbirth be prescribed aspirin but many obstetricians decide to prescribe.

      With regards to frequency of scans and appointments, that really depends. For some people regular scans acts to increase the anxiety of an already hugely anxiety driven second pregnancy. It’s not usual for scans every couple of weeks, but you may have more scans/appointments in the 3rd trimester. Your obstetrician will decide on an induction date if necessary, but for most women this is slightly earlier that due date – but again, this will depend on what they feel your risj factors are.

      Sending you all my love. And again, huge apologies for a late response! xx

  • Great article! We went private after 6 months of TTC for a fertility MOT as I much prefer working with fact and data to the unknown and advice like “be patient, stop drinking coffee”.

    I’m glad we did as I was diagnosed with PCOS. My GP instantly referred us to a fertility clinic and we’ve cut down what could have become a protracted and increasingly hopeless situation by 6 months.

    I’m so glad to find articles like this (written by medical professionals!) as it’s weirdly all such a mystery what the various procedures/options are when there are fertility problems (which is sad as you say fertility problems are very common).

    Thank you Aisha! I’ll definitely read your next piece on IVF but I’d love to read about the various stages of tests, advice and options before IVF and what to expect. Also anything on PCOS would be amazing.

    Jude x

    • Hi Jude! Sorry, I missed your comment initially! IVF post will be coming very, very soon. Possibly next week. I will certainly discuss PCOS – probably in the piece after IVF. x

  • Hi Aisha, I somehow missed this post before and have just come to it off the back of your invaluable IVF post. This post is really interesting and I’ve bookmarked it for if/when the time comes for me! It’s full of so much useful information in a really non-threatening way, thank you. The only comment I would make is that you haven’t mentioned alcohol anywhere in the article. Given what we now know the evidence is telling us about the impact of alcohol on a developing foetus, and the subsequent developmental and neurobehavioural outcomes, I feel it should be highlighted as strongly as you have highlighted smoking risks. Scottish Government and the NHS here are now strong proponents of the “no alcohol – no risk” advice for mums to be when trying to conceive and during pregnancy, and hopefully the rest of the UK will follow suit. X

    • You’re very right, I haven’t! It wasn’t an intentional oversight. I may do a piece further down the line on the very early parts of TTC so will include folic acid, alcohol, smoking, nutrition etc when I do. It was my first ever blog piece so I learned a lot from writing it. Huge thanks for your comment Janie xx

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