‘My period has come again. Why am I not pregnant?’ Many couples seem to assume that the moment they give up using contraception, a pregnancy will result. This may indeed happen but it is not very common. Often it will take three or six months for a normal couple to achieve a pregnancy and some will have to wait a year or more.
Conception depends upon three separate factors and each must be just right for success. Firstly, there must be enough sperm in the man’s semen for effective fertilisation; secondly, the woman must be producing eggs (ova) from her ovaries at regular intervals; and lastly, the semen must get to the inside of the vagina and the sperm must physically be able to swim up into the uterus and Fallopian tubes to meet the egg. Even with these three factors operating normally a couple may have to wait some months for a pregnancy. There are, however, a few things that may obviously be amiss and so here are some clues to these. If any of these problems apply to you, make an appointment to see your GP as tests may be needed to sort out what exactly is wrong:
• If the man has ever had any severe injury, infection or mumps affecting the testicles, the number of sperm may be reduced and fertilisation chances thus diminished.
• Ovulation generally only takes place two weeks before a period. If the woman is having very irregular periods then she is probably ovulating only infrequently.
• Any difficulty with intercourse may mean that semen is not being deposited in the best place for fertilisation, i.e. at the top of the vagina.
• If the woman has ever had infection in the uterus or Fallopian tubes (’salpingitis’), it may mean that the passages necessary for the sperm to get to the egg are blocked. (This does not apply to a history of vaginal discharges like thrush or trichomonas.)
If none of these factors seems to apply to you, wait and apply home treatment. The time you are prepared to wait depends upon you, but if you are keen to achieve a pregnancy and nothing has happened after six months it would be reasonable to make an appointment to see your GP. If a couple are relatively young, many doctors would delay complicated and expensive tests for up to a year, but if a couple are older, and especially if the woman is nearing the end of her reproductive life, there is more urgency about investigation.
This is easy. Relax and enjoy yourselves. There is no need to have sex at a certain time of day or when drunk on champagne, whisky or whatever it is mother- in- law recommends. It is true however that intercourse around the middle of the menstrual cycle – i.e. two weeks before a period is due — is more likely to result in pregnancy.
Here is some special advice for the woman. It is probably best to lie on your back after intercourse for twenty minutes with the knees bent and feet flat on the bed. This ensures that the semen stays at the top of the vagina, near the mouth of the womb and does not run out of the vagina again.
There is also advice for the man. Sperm are produced best if the testicles are kept cooler than body temperature. If you wear tight underpants or jeans the testicles are held up near the warmth of the body and the sperm suffer. So wear boxer- type underpants and avoid tight- fitting trousers. For the same reason avoid very hot baths and showers. Use tepid water and don’t stay in too long. You are then more likely to produce more and better sperm.
What the Doctor Will Do
He will want to see you both. If there is a problem it is rarely confined just to the man or the woman. He will take a history to exclude or identify the kind of difficulties outlined above. He will then examine the genitalia of the man and perform a vaginal examination on the woman. What happens next depends upon the problem. If there appears to be a physical problem, some simple investigations may be requested. A semen sample can be analysed to assess the number and the vigour of the sperm. The woman may be asked to keep a Chart of her temperature upon waking every morning. This can be used to pinpoint times that ovulation occurs as the ‘basal’ temperature is increased by hormonal changes that take place when an egg is released by the ovary. Your doctor may refer you to a hospital clinic for further advice and investigations. If there are psychological difficulties with intercourse, a psychiatrist may be involved.
Routine investigations for the physical causes of infertility can be prolonged and even tedious, so both partners must view the whole process with good humour and patience. Treatment continues after investigation. Sometimes drugs are used – for the man, the woman or even both. Only a very few drugs used to help infertility are associated with the risk of multiple births. You will be told of the risk in the unlikely event of being given such a drug. Sometimes surgery is needed.