1 in 6 couples in the UK experience some problems in achieving a pregnancy naturally. At our Fertility Clinic, you will see a consultant gynaecologist who specialises in providing Fertility care.
Problems getting pregnant - what is delayed conception and what can cause it?
Age is the most important factor governing female fertility and the success of fertility treatment. All women are born with a fixed number of eggs in the ovaries at birth - the female body makes no new eggs after birth. As the quantity and quality of eggs declines with time, women will find it harder to conceive naturally, and unfortunately the risk of miscarriage will also increase with age.
Amongst women aged under 30, 8 in 10 (80%) will conceive naturally after one year of trying, with the success rate increasing to 90% after 18 months of trying. As a result of this, many women will talk to their GP if they have not become pregnant after 12 to 18 months of trying. All GPs have regional and national guidelines that set out what the first level investigations should be for the couple, and also when to refer the couple on for more specialist treatment.
There are some situations that will need an earlier referral for specialist care, such as when a woman is over 35 OR if she has a significant past medical history such as pelvic infection, endometriosis or irregular/infrequent periods. Likewise, men with certain types of significant past medical history such as surgery/injury to the testes, cancer treatment, diabetes should see their GP. The GP will be able to refer them for investigations, which will include semen analysis.
The most common clinical causes of delayed conception (infertility) are:
- Not ovulating (releasing an egg) regularly, which can sometimes be caused by polycystic ovary syndrome
- Sexually-transmitted diseases, such as Chlamydia, causing damage to the Fallopian tube(s). Chlamydia can also affect male fertility.
- Male factors (men with a poor quality/quantity of semen).
About one-third of physical causes are found in women, one-third in men; whilst one-fifth of the time in both men and women. Unfortunately, this means that in about one-fifth of the cases, no specific reasons can be identified.
A Healthy Body
Recent research has shown that delaying trying to start a family and also unhealthy lifestyles are significant contributing factors that affect a couple’s prospects of having a family. Being overweight (especially those with large waist measurement - over 94cm/37 inches for men; 80cm/31.5 inches for women), not taking enough exercise, smoking, drinking too much alcohol, and use of recreational drugs or anabolic steroids are well recognised factors affecting both male and female fertility.
Weight is a serious issue in the UK today, with nearly one third of women in the UK age between 20 and 50 are classified as obese with BMI over 30kg/m2. It has been known for many years that obese pregnant women have much higher risks of have problems once they are pregnant and also having a poorer pregnancy outcome compared with normal weight pregnant women, including the following.
- Twice the risk of having a baby with spinal bifida (neural tube defect)
- 2 or three times greater risk of developing high blood pressure in pregnancy
- 2 or three times greater risk of developing diabetes, which further causes more pregnancy complications
- Twice the risk of needing interventions such as having to have labour induced or needing a Caesarean section
- Higher risk in developing blood clots
Sadly the same risks mentioned above will also increase risk of stillbirth and so national guidelines on pre-pregnancy and pregnancy weight management have been written to help women know what changes can help to improve pregnancy outcomes. Overweight women with polycystic ovary syndrome can find it particularly hard to lose weight.
At the other end of the scale, women who go into a pregnancy underweight (BMI less than 18.5 kg/m2) can be at higher risk of premature delivery and/or having a small baby, so getting to a healthy body weight is an incredibly important step when planning a pregnancy.
A Healthy Mind
There is a lot of evidence that infertility can have a very negative effect on mental well-being. While the couples perhaps understandably focus on the physical causes of infertility, its psychological impact is often overlooked, which can include anxiety and depression. Although research suggests that a higher proportion of women than men say that struggling to start a family is the worst experience in their life, the reality of infertility is hard on both men and women. It can lead to low self-esteem and a sense of having no control in the face of such uncertainty. Some people experience isolation because they feel a need to avoiding social interaction with friends and family members who are pregnant or have children, and in some cases this can also lead to anxiety-related sexual dysfunction and marital disharmony.
These are complex problems for couples experiencing delayed conception and require a holistic (whole person) approach in order to improve both physical and emotional well-being, while attempting to achieve the ultimate goal of a successful pregnancy, with or without fertility treatment.
How can the Fertility Assessment Clinic help you?
The Fertility Assessment Clinic is a Fertility Consultant-led service that offers a holistic approach for those experiencing delayed conception.
This will include some investigations and tests which can tell you what your fertility potential is in relation to your age, and whilst we cannot predict when or whether you will conceive naturally, where there are no obvious barriers to conceiving naturally found, we can offer you that reassurance. If the tests suggest there may be a problem, we can discuss further appropriate investigations/treatment with you.
Where there are lifestyle changes that will greatly improve your chances of conceiving naturally, we can discuss these with you and provide some tailored advice from a specialist dietitian, to give you every chance of taking control of your fertility journey.
At the clinic, you will see a consultant gynaecologist who specialises in providing Fertility care. The doctor will discuss your medical history with you and will also carry out the following:
- Trans-vaginal Ultrasound - an internal ultrasound scan to look at the ovaries and the uterus
- Vaginal swab - to exclude any potential infection that might have an impact on fertility
- A basic female hormone test
- Discussion as need be around any further female investigations that may be required eg assessing whether the Fallopian tubes are open or not
- Discussion around and if need be arrangement of a sperm test
- Discussion about lifestyle factors
- Providing written information/online information
- Onward referral for lifestyle change support if necessary
We will generally review patients three weeks after their first appointment, depending on what type of tests being initiated in the first consultation. At the review appointment, we provide feedback on test results and discuss what these will mean going forward. We would also give couples advice on what if any further investigations would be needed and also their best course of action in terms of fertility treatments which may be appropriate.
Who is suitable?
- Anyone with history of delayed conception - i.e. not pregnant after 12 - 18 months of trying
- Anyone who wants advice regarding fertility treatment including same sex female couples and single women
- Any man who wants to discuss fertility issues
If you would like to book an appointment or require further information on the available options, please do not hesitate to contact our private patient booking team via our online enquiry form.
Alternatively, email Kingsbridge Private Hospital