Gynaecology

The Science of Women

Trying to Get Pregnant


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For most couples trying to have a baby, 60% will conceive after 3 months, 75% after 6 months, 85% after 1 year and 95% after 2 years.

If a couple fails to get pregnancy after 1-2 years, investigation for subfertility is usually done.
If there is advanced maternal age or irregular menstrual cycles, these tests will be done earlier.

Subfertility affects 10-15% of couples. In 35% of cases, a male factor is the reason; in 45% of cases, a female factor and in the remaining 20%, no reason can be found. The basic tests are Ovulation Function, Tubal Function and Sperm Analysis. Additional tests may be needed if there are menstrual irregularity or severe menstrual cramps.

 

Ovulation Function

❖ Urine Ovulation Test Kits between 12th to 16th day of the menstrual cycle
❖ Blood Progesterone level around the 21th day of the menstrual cycle. Levels > 30nmol/L is a positive test.

 

 

Tubal Function

❖ Ultrasound Hydrotubation
❖ Xray Hysterosalpingography
❖ Laparoscopic Hydrotubation and Hysteroscopy. This is day surgery procedure under general anesthesia. Though it is a surgical investigation, it has the added benefits of performing treatment at Hydrotubation to improve fertility.

 

 

 

Sperm Analysis

 

Facts in Trying to Get Pregnant

Frequency : 37% got pregnant from daily intercourse, 33% from alternate days and 15% from once a week. This was result from 221 fertile couples planning to conceive (Wilcox NEJM 1995).
Timing : The probability of pregnancy from intercourse on Day 8 was 3.2%, on Day 12 was 9.4%. Pregnancy was highest with intercourse beginning 2 days before ovulation.
Cervical Mucus : The probability of pregnancy was highest when the mucus was slippery and clear. This usually occurs 2-3 days before ovulation (Scarpa EuJOGRepBio 2006).
Temperature & Urine Ovulation Kit : Cervical mucus increased the chance of pregnancy as good as or better than measuring basal body temperature of using urine ovulation test kits. This was result from 782 planning to conceive (Bigelow HumRepro 2004).

 

 

Diet and Lifestyle for Pregnancy

❖ Keep a BMI between 20 and 34.
❖ Start exercising.
❖ Start taking folic acid 400 mcg daily.
❖ Stop smoking and reduce alcohol intake. Smoking reduces pregnancy by 60%, 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 it thought that the omega-3 in fish and shellfish improves sperm quality, ovulation function and embryo development (Gaskins JClinEndoMetab 2018).

 

Treatment for Infertility

❖ Ovulation function can be restored with Clomid / Letrozole or Fertility Injections
❖ Tubal Surgery may be needed if tubal blockage is present.
❖ Sperm quality may improve with lifestyle changes, exercise, healthy diet and supplements (Profertil).
❖ In cases where no apparent reason for subfertility is found, Intra-Uterine Sperm Insemination has been shown to improve pregnancy chances.
❖ Assisted Reproductive Technique like IVF and ICSI may be required for some couples who are still unable to get pregnant.