Fertility
Advice before you start to try for a baby
Rubella
Most teenage girls in Europe ad USA received a vaccine against German Measles or Rubella, when they were either babies, or as a teenager. The vaccine may not have been given in other countries. Unfortunately for some, the vaccine does not guarantee life long immunity from this virus. Infection during pregnancy can cause severe developmental problems in the baby so it makes sense to check with a simple blood test whether you are immune or not before you become pregnant. A single shot vaccine is all that is required if you are not immune and then you need to simply wait for 1 month before you try for pregnancy.
Sex
It should come as no surprise, but sex is essential if you want to become pregnant, and it needs to happen more than once a month! A woman with regular periods will usually ovulate fourteen days before a period is due (for most women this is around day 14, counting day 1 as the first day of a period). Recommendations vary but personally I advise having sex twice a week throughout the cycle and then starting 1-2 days before anticipated ovulation, have sex once a day for 5 days. Having sex more than once daily is detrimental as it dilutes the sperm, but saving up the sperm for 6 days or more reduces their swimming capacity!
Genital infection
A history of pelvic infection (PID), Chlamydia or recurrent discharge can be associated with problems becoming pregnant, and sometimes with early miscarriage. It is a good idea to discuss any concerns about infection with your Doctor before you start to try for pregnancy. A routine infection screen for both yourself and your partner is sensible, especially if either of you have had problems in the past.
Your medical history
Some serious medical problems are associated with problems becoming pregnant, and many chronic problems can complicate pregnancy. You should discuss any concerns with your Doctor who will advise you how any ongoing conditions or serious past medical problems might affect you in pregnancy. A history of blood clots, autoimmune diseases, heart complaints, high blood pressure, kidney problems, bowel disturbance and cancer in particular should prompt a specialist opinion.
Family history
A family history of diabetes, early menopause, immune problems, or any genetic conditions should be discussed with your Doctor before you try for pregnancy.
Periods
A regular period (every 27-32 days) usually means that ovulation occurs monthly. Periods that come less often or more frequently may reflect a gynaecological problem associated with decreased fertility that requires special treatment, and if this is the case you should come for a consultation before you try for pregnancy. Heavy periods may be associated with conditions such as fibroids in the womb that in turn can affect fertility. Light periods are rarely cause for concern, but a change in your normal pattern may indicate a problem.
Sperm issues
One third of couples experience a delay in conception because of poor sperm quality. A sperm test assesses not only the number of sperm but also how normal they look, how they swim, and whether the supporting fluid is healthy. No specific cause for low sperm quality is detected in most cases, but a history of infection, trauma or surgery to the area, and certain medications may suggest that a problem is likely.
Sperm take 90 days to form and the count can naturally vary in some men quite dramatically over time, but smoking, alcohol, being overweight, and working in a sedentary job all take a toll. Adopting a healthier lifestyle can significantly improve sperm quality, and certain vitamins have been scientifically proven to help too if you take them regularly.
A history of testicular, groin or penile injury, infection or disease, and any problems with impotence should be assessed by a fertility specialist or andrologist. Home fertility kits are fairly inaccurate, and should not be relied on. A formal semen analysis is the best assessment of male fertility.
Sperm take 90 days to form and the count can naturally vary in some men quite dramatically over time, but smoking, alcohol, being overweight, and working in a sedentary job all take a toll. Adopting a healthier lifestyle can significantly improve sperm quality, and certain vitamins have been scientifically proven to help too if you take them regularly.
A history of testicular, groin or penile injury, infection or disease, and any problems with impotence should be assessed by a fertility specialist or andrologist. Home fertility kits are fairly inaccurate, and should not be relied on. A formal semen analysis is the best assessment of male fertility.
Diet and weight
‘You are what you eat’...it is true! The body is a machine that works best when provided with a healthy balanced diet including plenty of fruit, vegetables and protein. The ovary needs relatively large amounts of vitamins and minerals to produce healthy eggs and manufacture the hormones that are so important in the early stages of pregnancy. Pollution, smoking and excess alcohol cause oxidative stress that needs to be balanced with additional antioxidant vitamins. I recommend specific prenatal supplements for both men and women, but of course also adopting a healthy lifestyle is crucial.
Missed and hurried meals, and work stress mean that the body often doesn’t absorb the best from the food we eat. Eating too much sugar upsets the blood glucose and insulin balance that in turn can affect ovarian function.
Obesity is often associated with irregular ovulation, and hormone imbalances that make it more difficult to conceive and increase the risk of miscarriage, apart from the difficulties during pregnancy and delivery that can happen, so it makes sense to try and lose some weight before becoming pregnant if you are overweight. Being too slim is also a problem. A fertile woman needs to have a minimum amount of body fat for effective reproduction, so even if your periods are regular, putting on a few pounds can help some very thin women. The same is true of athletes. A history of anorexia or bulimia, especially if associated with missed periods may be important.
Missed and hurried meals, and work stress mean that the body often doesn’t absorb the best from the food we eat. Eating too much sugar upsets the blood glucose and insulin balance that in turn can affect ovarian function.
Obesity is often associated with irregular ovulation, and hormone imbalances that make it more difficult to conceive and increase the risk of miscarriage, apart from the difficulties during pregnancy and delivery that can happen, so it makes sense to try and lose some weight before becoming pregnant if you are overweight. Being too slim is also a problem. A fertile woman needs to have a minimum amount of body fat for effective reproduction, so even if your periods are regular, putting on a few pounds can help some very thin women. The same is true of athletes. A history of anorexia or bulimia, especially if associated with missed periods may be important.
Stress
There is good scientific evidence that stress is associated with delayed conception. We have all heard stories about the couple who tried for months, and conceived ‘without trying’ during their long overdue 2 week holiday. Stress affects people in different ways, sometimes producing physical symptoms such as fatigue, hair loss, and irritable bowel syndrome, and other times causing depression and low libido. There is no magic way to take it away. It is a part of our lives, but minimising stress and assessing how best to deal with it is very beneficial. It might mean cutting back on long work hours, saying no to the boss occasionally, and replacing the bottle of wine after work by a brisk walk and a massage, but it will benefit both of you in the long run.
Smoking, drinking and drugs
There are over 200 potential cancer causing agents in tobacco smoke, so it should come as no surprise that it really is very bad for both men and women when it comes to getting pregnant and staying healthy when pregnant. TODAY is the time to STOP!!!! Even ‘social’ smoking can reduce sperm quality and cause occasional impotence in men. In women it lowers hormone levels, resulting in reduced fertility. Smoking ages not just your skin, but your ovaries as well, and it increases the risk of ectopic pregnancy by affecting the way your fallopian tubes work. Need I say more?!
Many of us enjoy a drink when out with friends or to help us relax after a long day at work, but alcohol in large quantities lowers female and particularly male fertility. You boys might feel great after 10 pints down the pub, and have recovered 12 hours later after a greasy fry up and some re-hydration, but unfortunately your sperm can remain hung-over for up to 2 months after a heavy session, so keep to the recommended government limit of 15-20 units, and spread them out over the week. Large amounts of alcohol lower oestrogen levels in women and may reduce fertility. I recommend sticking to 3-4 glasses of wine (or the equivalent) per week whilst you try for pregnancy.
I have lost track of the number of times men have justified their frequent cannabis use on the basis that Bob Marley had lots of children. Sperm stay stoned for a long time, and they become too laid back to go looking for an egg man, so stopping cannabis before trying for pregnancy is best. Cocaine together with all uppers, downers and injectable recreational drugs is extremely detrimental to both male and female fertility, and of course to pregnancy. Don’t be afraid to ask for specialist advice if you need help to stop.
Many of us enjoy a drink when out with friends or to help us relax after a long day at work, but alcohol in large quantities lowers female and particularly male fertility. You boys might feel great after 10 pints down the pub, and have recovered 12 hours later after a greasy fry up and some re-hydration, but unfortunately your sperm can remain hung-over for up to 2 months after a heavy session, so keep to the recommended government limit of 15-20 units, and spread them out over the week. Large amounts of alcohol lower oestrogen levels in women and may reduce fertility. I recommend sticking to 3-4 glasses of wine (or the equivalent) per week whilst you try for pregnancy.
I have lost track of the number of times men have justified their frequent cannabis use on the basis that Bob Marley had lots of children. Sperm stay stoned for a long time, and they become too laid back to go looking for an egg man, so stopping cannabis before trying for pregnancy is best. Cocaine together with all uppers, downers and injectable recreational drugs is extremely detrimental to both male and female fertility, and of course to pregnancy. Don’t be afraid to ask for specialist advice if you need help to stop.
Exercise
Regular exercise makes you feel and look good, keeps you healthy, and improves your libido. It also ensures that you are less likely to gain too much weight during pregnancy, can cope with the physical strain of pregnancy better, and are more likely to spring back quickly afterwards into your normal jeans. There is a healthy maximum however. Training for over an hour per day has been shown to lower fertility, and possibly increase the risk of miscarriage. This usually relates to a low percentage body fat, so if this is you take things down a notch, and ensure that your weight is within a healthy range for your height.
Men benefit from exercise in the same way, but if you are trying for pregnancy give the gym jacuzzi and sauna a miss as they heat the testicles too much, and keep cycling to 30 minutes at a time for the same reason. The use of body building supplements can be very detrimental to fertility. This applies not only to the use of anabolic steroids but also to creatinine, and some of the other ‘natural’ enhancers. Ask a specialist for advise if you have any cause for concern.
Men benefit from exercise in the same way, but if you are trying for pregnancy give the gym jacuzzi and sauna a miss as they heat the testicles too much, and keep cycling to 30 minutes at a time for the same reason. The use of body building supplements can be very detrimental to fertility. This applies not only to the use of anabolic steroids but also to creatinine, and some of the other ‘natural’ enhancers. Ask a specialist for advise if you have any cause for concern.
When to seek help
You should seek help if you:- Have been trying for pregnancy for 12 months or more
- Are a female over 40, even if you haven’t started to try
- Have previously been told that you need help to become pregnant, or that becoming pregnant might be difficult
- Have had a serious medical illness that is known to affect fertility and/or pregnancy
- Are single, but serious about having a baby
- Are in a same sex relationship
- Are worried, or simply prefer to be tested to check things out before you start
What things I might ask about
- Your ages
- How long you have been together
- How long you have been trying
- Whether you have been pregnant before, and whether your partner has fathered any pregnancies in the past
- Your periods
- Whether you have an idea when you ovulate • Any gynaecological problems
- Any genital infections, testicular lumps, hernias or groin surgery as a child
- Any general medical problems
- How much you both drink
- How much you both smoke
- Your weight and heights
- Any exercise you both do
- What you both do for a living (certain jobs can be a associated with a higher chance of fertility problems)
- Relevant family history
- Medications and supplements that you take regularly
- Any complementary therapies that you are currently having
What investigations I might recommend
- A sperm test
- An ultrasound scan (performed by myself at the consulting rooms). Ultrasound scans are routinely performed vaginally, as this provides the best image of the womb and ovaries.
- A test to check if your fallopian tubes are open. Sometimes this is an x-ray test called a hysterosalpingogram, but you might need an operation called a laparoscopy and dye test and hysteroscopy if I suspect there are problems
- A hormone check, usually done during your period. This tells me how old your ovaries are compared with you, and gives an idea what treatments might suit you best
- A test to ensure you are immune to Rubella (german measles)