Fertility worries: when should you get help?

Most heterosexual couples will get pregnant naturally within a year. But for some, having a baby simply isn’t so straightforward. So at what point should you seek help, if you’re worried about your own fertility? Why do some people struggle to get pregnant, and what can be done? The first port of call is usually your doctor, and Katie Haylor spoke to Cambridge-based GP Sarah Smith, who explained how she approaches patients who are in this situation... 

Sarah - If you’re under 35 years of age, we recommend people try for a baby for two years, and then if you’re over 35, we recommend trying for a year. And then, if nothing’s happening for a couple, do come along and see us and we’ll talk about it and see what can be done.

Katie - When you say “we’ll talk about it,” what kinds of questions might you ask?

Sarah - Sometimes just the lady comes. Sometimes the man might approach us and sometimes the couple comes. So we take a history from both of them and just find out what their lifestyle's like: if they’re leading a healthy lifestyle. We’d find out how long they’ve been trying for and then think about if there’s any past medical problems that might be affecting their fertility; so, for instance, somebody may have had an ovary removed or something, or a testicle removed. And then we’ll move on to perhaps examining them. For the ladies we’ll check their cervix is okay, make sure their menstrual cycle’s regular, and find if they’re having any problems with any heavy bleeding or pain.

Katie - Say someone’s on contraception, obviously they need to come off that in order to get pregnant but how long do they need to be off that contraception for?

Sarah - With the contraceptive pill you can be off it for just one or two months; and women can fall pregnant quite quickly. If you’re on the contraceptive injection it can take longer and we counsel women about that can take up to nine months for your fertility to return to normal after that. If an implant or a coil is removed, again, fertility returns to normal fairly quickly within one to three months.

Katie - So there are certain examinations that you might do on a woman. How about a man?

Sarah - A man as well, we’ll as them about their sperm and we can get them to do a sperm sample and look into the sperm counts, and we can look at the sperm under the microscope to see if they’re swimming well and healthy. If the sperm counts not quite right we can then arrange a repeat sample to see if we get an abnormal sample on two occasions. Actually, 40 percent of couples it’s the male and the female that have problems with their fertility.

Katie - Okay. So having a healthy lifestyle, I’m guessing, is advantageous to getting pregnant. Are there certain specific risk factors?

Sarah - Yeah. It’s a good idea not to smoke. We recommend not drinking any alcohol or keeping it to a minimum. And then cannabis and other recreational drugs, it’s best to avoid them. Because all of those things can affect your egg and sperm quality.

Katie - Okay. So this is for both parties?

Sarah - Yeah. And then the other things: a lot of people are leaving it a bit late in life now, particularly with women having careers, so as your age increases your fertility decreases. And nowadays we're having quite a big problem with obesity and we know that women who are overweight or obese can have more problems conceiving. And, similarly, if ladies are anorexic or too thin they can have problems conceiving as well.

Katie - How are we doing on a national scale?

Sarah - Overall, about one in seven couples will have fertility problems, and, as I said, four in ten couples there is a problem with a man and the woman. And, I guess, around ten to twelve percent of us will have some sort of infertility in Western Europe.

Katie - What does that look like in terms of the future? Do you think things are likely to change?

Sarah - I think we have to be sensible when we’re young. It’s best to have safe sex and to use condoms to prevent sexually transmitted infections because that’s another big thing. If you pick up things like chlamydia and gonorrhea, it can scar your tubes and cause fertility problems. So do practice safe sex and do think about your fertility because simple things like that can help us preserve our fertility for when we do want to start a family.

Katie - So a couple or someone comes to see you; you’ve had a conversation, you do some tests. If they need further help what does that look like? What do you do?

Sarah - The first thing we do is we check the lady’s hormones in the first three to five days of their menstrual cycle. We make sure their FSH and LH hormones are normal to stimulate a normal egg release each month, and then we can get them back about two thirds of the way through the cycle - around day 21 in a lady with a 28 day cycle to check their progesterone levels, to check if they’ve ovulated and produced that egg.

Then we can also send them for an ultrasound scan to check that they’ve got a womb, to check that they’ve got ovaries, and to make sure everything’s nice and normal. We do smear tests to check for any cervical cell problems on the cervix. And then for the man obviously we do the sperm samples.

So we do all of those tests to start with so that that’s ready for the fertility specialist if we need to refer them on. Then the fertility specialist can pick up on that and perhaps arrange further tests for the lady. There’s an X-ray test with dye you can have to check that the fallopian tubes are open. And there’s a little operation you can have with a camera through your belly button, and some blue dye, and they watch the blue dye coming up through the fallopian tubes and out spilling onto the ovaries to check that the tubes are open.