Trying to Get Pregnant
For most couples trying to have a baby, 60% will conceive after 4 months, 75% after 6 months and 90% after 1 year.
There may be a subfertility issue if a couple fails to get pregnant after 1-2 years of trying.
Subfertility affects 10-15% of couples.
In 30% of cases, a male factor is the reason while in 40% of cases, a female factor is the cause. In 20% of cases, the cause of subfertility remains unexplained.
Investigation for subfertility is usually done after 1 year of trying to get pregnant.
If there is advanced maternal age, irregular menstrual cycles or bothersome menstrual cramps, then these investigation may be done earlier.
The basic subfertility investigations are:-
1. Ovulation Function,
2. Tubal Function and
3. Sperm Analysis.
❖ 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.
❖ 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.
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.
❖ Frequency : 37% got pregnant from daily intercourse, 33% from every other day and 15% from once a week. This was result from 221 fertile couples planning to conceive (Wilcox NEJM 1995).
❖ Timing : For a menstrual cycle of 28days, the chances of pregnancy from a single act of intercouse is 3.4% (Day 8), 9.4% (Day 12) and 8.0% (Day 14). Pregnancy was highest with intercourse beginning 2 days before ovulation.
❖ 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 are good. However studies show that vaginal secretion is a better guage. This was result from 782 couples planning to conceive (Bigelow HumRepro 2004).
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%, 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.