Trying to Get Pregnant
For most couples trying to have a baby, the chances of achieving a pregnancy are 60% after 4 months, 75% after 6 months, and 90% after 1 year of trying.
There may be a subfertility issue if a couple fails to get pregnant after 1-2 years of trying.
![](https://anthonysiow.com/wp-content/uploads/2022/11/Cumulative-Preg-Rate-Causes-of-Infertility-AnthonySiow-1024x508.jpg)
Subfertility affects 10-15% of couples.
In 30% of cases, a male factor is found, while in 40% of cases, a female factor is contributory. In some 20% of cases, the reason for subfertility remains unexplained.
Couples Who Can't Get Pregnant After One Year
It is advisable to see a gynaecologist if you can't get pregnant after trying for one year.
If you are 35 years or older or have irregular and painful menstrual cycles, you should see a gynaecologist earlier.
Subfertility Investigations
Ovulation Testing
❖ Urine Ovulation Test Kits, checking 2-3 days before ovulation.
❖ Blood Progesterone level (>30nmol/L), taken 7 days after ovulation, confirms ovulation.
![](https://anthonysiow.com/wp-content/uploads/2022/11/Ovulation-Testing-AnthonySiow-1024x985.jpg)
Tubal Patency Testing
❖ Checking that the fallopian tubes are not blocked by Ultrasound or X-ray.
❖ Checking that the fallopian tubes are not blocked AND looking for other causes of subfertility (eg. Endometriosis, Pelvic Adhesions) by Single Incision Laparoscopic Keyhole Surgery. This is a day surgery procedure that has the added benefit of surgically treating conditions to improve fertility.
![](https://anthonysiow.com/wp-content/uploads/2022/11/Tubal-Patency-Tests-1024x602.jpg)
![](https://anthonysiow.com/wp-content/uploads/2022/11/Tubal-Patency-Laparoscopy-Hydrotubation-AnthonySiow.com_-1024x431.jpg)
Sperm Analysis Testing
![](http://anthonysiow.com/wp-content/uploads/2018/03/SPERM-ANALYSIS-1024x292.png)
Total Sperm Count and Sperm Motility are more important factors than Sperm Morphology.
At least 20 million sperms with 50% motility are needed for the Intra-Uterine Insemination procedure.
Facts in Trying to Get Pregnant
❖ Age of the woman is an important consideration. The chance of pregnancy drops after age 37 and there is an associated increased risk of miscarriage.
![](https://anthonysiow.com/wp-content/uploads/2022/11/Pregnancy-Miscarriage-Rates-AMH-Levels-AnthonySiow-1024x787.jpg)
❖ Frequency of intercourse. 37% got pregnant from daily intercourse, 33% from every other day, and 15% from once a week. This was the result of 221 fertile couples planning to conceive (Wilcox NEJM 1995).
❖ Timing of intercourse. Pregnancy was highest with intercourse beginning 2 days before ovulation. The chances of pregnancy from one act of intercourse are 3.4% at 4 days before ovulation, 9.4% at 2 days before ovulation, and 8.0% on ovulation day itself.
❖ Vaginal Secretion. The probability of pregnancy was highest when the vaginal secretion was slippery and clear. This usually occurs 2 days before ovulation (Scarpa EuJOGRepBio 2006).
❖ Temperature & Urine Ovulation Kit. Measuring basal body temperature and using Ovulation Kit is good. However, studies show that vaginal secretion is a better gauge. This was the result of 782 couples planning to conceive (Bigelow HumRepro 2004).
![](https://anthonysiow.com/wp-content/uploads/2018/03/Trying-to-get-Pregnant-Chart-e1550222880965.jpg)
Diet and Lifestyle for Pregnancy
❖ Keep a BMI between 20 and 30.
❖ Start exercising.
❖ Start taking folic acid 400 mcg daily.
❖ Stop smoking and reduce alcohol intake. Smoking reduces pregnancy by 60%, and Alcohol of >2 drinks/day reduces pregnancy by 45%.
❖ Caffeine of 1-2 cups a day has no impact on pregnancy. Caffeine of >5 cups a day can reduce pregnancy by 45%.
❖ Take 2 or more servings of seafood a week to increase your pregnancy chances. This was seen in 501 couples in the LIFE Study (Longitudinal Investigation of Fertility & Environment). Couples taking seafood had a 61% higher chance of pregnancy. It is thought that the omega-3 in fish and shellfish improves sperm quality, ovulation function and embryo development (Gaskins JClinEndoMetab 2018).
Treatment for Subfertility
❖ Oral Medication (Clomid / Letrozole) or Fertility Injections to improve Ovulation
❖ Surgery to remove Ovarian Cysts or Restore Tubal Function.
❖ Supplements (Profertil) and a healthy diet to improve sperm quality.
❖ Intra-Uterine Sperm Insemination or Assisted Reproductive Techniques like IVF and ICSI may be required for some couples.
![](https://anthonysiow.com/wp-content/uploads/2022/11/IUI-IVF-ICSI-1024x347.jpg)