“Is it normal to be trying this long and not be pregnant yet or is something wrong?”
This is often the first question a lot of couples ask me and it’s a good question, as once the decision has been made to have a baby, it is perfectly natural for couples to want to get pregnant as quickly as possible and any delay can cause doubts. In order to answer that question, I have to cover several topics which I have listed below and if you have a particular topic in mind, you can click on it in the list to jump directly to that section.
• The Average Couples Chances of Conceiving
• Timing Sex to Maximise the Chance to Conceive
• Psychological Factors
• Maximising Your Fertility
• Is Something Medically Wrong?
• Seeking Professional Help
• When to Seek Professional Help
• Fertility Treatment
The Average Couples Chance of Conceiving
The first thing to consider when you have been trying to conceive for a while and have not yet got pregnant, is what is normal and what is not. Your average couple looking to have children, that is to say a couple who are healthy and between the ages of 20 and 35, have the following chances of getting pregnant:
• Roughly a 20% chance of conceiving every month that they are having unprotected sex
• Roughly an 80% chance of becoming pregnant in the first 12 months of trying. Or to put it another way, 1 in 5 couples don’t get pregnant in the first year
So now you know the average couple’s chances of conceiving, but what can we do about your specific situation.
Timing Sex to Maximise the Chance to Conceive
Having regular sex is vital to getting pregnant, with the recommendation being to have it at least 2 to 3 times a week if you want to conceive. However, it has been my experience that many couples who visit me say they don’t have the opportunity to have sex this regularly. Usually this is because of work, where they are either too tired after a day at work or they or their partner are away a lot on business. It is not just limited to work reasons though, but whatever the cause, not having regular sex is not going to help your chances conceiving.
If you don’t have the opportunity to have sex on a regular basis, then concentrate your efforts on having sex when the woman is at her most fertile.
Women are fertile for about one week every cycle and it is around this time that couples trying to conceive should clear their diary of all other activities and focus on having sex. This window of opportunity is just before ovulation (the release of the egg from her ovary) and immediately after the egg has been released.
Regular Periods and Predicting Fertility
For women with regular periods, it is simple enough to predict when they are likely to ovulate (therefore when the best time for them to have sex is) as ovulation occurs roughly two weeks before the period. For three days before ovulation and three days after, you should have sex every other day.
If you need some help working this out, the NHS provides this useful calculator: NHS Ovulation Calculator
If you would like to know precisely when you are ovulating (which many women do), you can use an ovulation kit as described below in the section on Irregular Periods.
Irregular Periods and Predicting Fertility
Many women have irregular periods, which makes it hard to predict when ovulation will occur. If you fit into this category, or just want to know when you ovulate with more accuracy, then you can use an ovulation kit. Depending on the kit type, these allow you to accurately predict your ovulation by either measuring the hormone levels in your urine or by the salinity (salt content) of your saliva and recording it in a process called “charting”.
Psychological Factors
You may have heard of the term “psychosomatic”. It is when a physical illness or other condition is aggravated or even caused by stress or some other internal mental conflict. You may not even be aware you have it, but it is there at subconscious level potentially influencing your chances of conceiving. Not getting pregnant itself can be a source of stress for some couples. After all, how many couples have you heard of that get pregnant after they gave up trying to conceive?
While there are no specific numbers to show just how much it affects pregnancies, the fact it has been evidenced with other conditions makes the medical profession think that it is a contributing factor towards delays in getting pregnant.
When I suspect that there may be some underlying psychological factor that is at play, I like to ask the question: “Why do you think you think you are not getting pregnant?”
The common responses I get back are:
• I have a lot of stress in my life at the moment
• I had a termination when I was young and now I’m being punished for it
• I’ve been told I have low egg reserves / geriatric eggs / polycystic ovaries
• I have low self-esteem
At best these kinds of thoughts are not helpful to someone trying to conceive and may even be a contributing factor to the delay in getting pregnant.
If you are stressed or believe there is a psychological cause that is stopping you from conceiving, contact your local counselling service. You can find them quite easily by googling “counselling” in your local area or if you live in the UK, visit the NHS website on counselling: NHS Counselling
Maximising Your Fertility
No one is the same, different people have different levels of fertility and this potency can go up and down over time. If you have a low fertility level, it can take you longer to conceive, or if you are on the border line for being fertile, it can stop you from conceiving entirely. Sometimes all couples need is a little boost to their fertility in order for them to conceive.
Your fertility level can be influenced both positively and negatively by your diet, the environment, your work and even they type of hobbies you have. The good news about all these things is that you can influence them and increase the good things, while decreasing the bad.
Studies show that male fertility in general has been on the decline for a while, so doing everything you can to help it is in your best interests. To find out more about how men can increase their fertility level, read the section: How to Boost Fertility in Men.
Women will not only benefit from a boost to their fertility, but will also make sure that when they do get pregnant, the developing baby will have the best possible conditions to grow in. To learn about what women can do to make sure they and their baby are healthy visit the section How to Maximise Fertility in Women.
Is There Something Medically Wrong?
It is best not to look for a specific medical condition to pin the reason on why you are taking time to conceive and it’s also not just necessarily one partner or the other. Plenty of men who have been told they have a low sperm count conceive and plenty of women who have been told they have PCOS also conceive.
However, roughly 10 to 13% of couples do require some form of assistance in conceiving. Approximately 30% of the time there is an issue, the problem can be attributed to the man. 40% of the time it is an issue with the woman, which is not surprising considering they have the more complicated reproductive system. And 30% of the time, no reason can be found in either partner as to why they are not conceiving.
The positive news is that most infertility causes, even unknown ones, respond well to treatment.
Seeking Professional Help
The first professional you should see when you are having problems trying to conceive is your GP (the abbreviation for General Practitioner, also known as a Family Doctor or Physician). This is because at this stage you are unlikely to know which of you might have the problem and the GP has your medical histories and can send you for tests to find out if there is a problem.
Who you see after that is entirely down to the cause of the problem. Whether it be urologist, gynaecologist or some other fertility specialist, your GP will be able to advise you and provide the referral letter.
Even if you think you know what is wrong, I recommend you do not go direct to a specialist without first having seen your GP. There are plenty of stories where one member of a couple has paid for expensive treatments thinking the problem was with them, but it turns out later that their partner was the one with the problem.
When to Seek Professional Help
Though doctors are happy to discuss fertility and conception with you at any stage, most won’t send you for tests until you have been trying to get pregnant for at least a year without success. This is because 80% of healthy couples conceive within the first year, so don’t be too worried if you are the one out of five couples that don’t. However, there are circumstances when you may need to see your doctor sooner than this and I cover this in depth in the section When to Seek Fertility Help, but a brief summary is:
When to see your doctor before trying for a baby
Make a pre-conception appointment to see your doctor before you start trying to get pregnant if either of you have a long term medical condition, are taking prescription medicine, have a genetic disorder or if the woman has not been vaccinated against Rubella.
When to see your doctor after trying for six months
If there is a potential fertility issue with one of you (e.g. previous serious groin injury or endometriosis), the woman in the couple is over 36 years old or has irregular periods, either of you have had surgery near your reproductive organs, or you’ve previously had a sexually transmitted disease – even if it has been treated and cured.
After 12 months of trying for a baby
At 12 months of trying to conceive without success, every couple should visit their doctor if they haven’t had cause to have done so already. To find out more about what to expect from your visit to the GP, you can check out the section: What to Expect When Seeing Your Doctor About Problems Conceiving.
Fertility Treatment
Fertility treatment should never be your first option and should only be sought after you have exhausted all possibilities to get pregnant naturally. Before considering taking this course, make sure you have seen your doctor and they agree that this is your best option forward.
There are three main types of fertility treatment:
1. Medicine that assists fertility
2. Assisted Conception
3. Surgical procedures to correct problems
The type of treatment you will need depends on your specific circumstances. Some may be available on your national healthcare (in the UK it also depends on your location), while others you may have to pay for. Your doctor should be able to provide you with advice on which type is appropriate and how you should go about obtaining it.
If you need to choose a fertility clinic, I have put together a guide to help you make that decision in the section: How to Choose a Fertility Clinic.
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