What The Fertility Experts Want You To Know About Getting Pregnant

How long does it take the average couple to fall pregnant?

“It’s crucial to understand that every couple’s fertility journey is different, and many factors come into play when you’re trying to conceive, including age, the couple’s general and reproductive health, their lifestyle, and how often they have sex. On average, in over 80% of couples who engage in regular (every two to three days) unprotected sex, the woman will become pregnant within 12 months. After this time, half of the women who have not yet fallen pregnant will go on to become pregnant in the following 12 months. It is not clear how age affects fertility in men, but the belief that women’s fertility somehow drops dramatically after they turn 35 is now being challenged. The latest research indicates the decline in the number and quality of a woman’s eggs is much more gradual and slower than once thought.” – Lesley Gilchrist, registered midwife & co-founder of My Expert Midwife

How long should you try for before seeking extra support?

“Throughout the UK, GPs will commonly diagnose a couple with infertility when they have not managed to get pregnant after a year of trying. A GP will expect couples to try for 12 months before seeking assessment if the woman is under 36 years old and for six months if she is older than 36. But couples should visit their GP sooner if they know or suspect they have medical factors that may cause fertility issues, or if they have been trying for six months via donor or partner insemination at home.” – Lesley

“I look at two things when I’m assessing a couple – age and time spent trying. And what I mean by ‘trying’ is ‘really trying’ – having lots of sex, changing lifestyle and taking the right supplements. If you’re 35 and after six months nothing has happened then think about having some tests. Infertility is usually diagnosed when a couple hasn’t managed to conceive after a year of trying. However, I don’t like the word ‘infertile’ and don’t use it in my clinic. Nobody can tell you that you can or can’t get pregnant. This is just an added label women have to bear.” – Zita West, founder of The Zita West Clinic

Should your GP be your first port of call?

“Yes, unless you opt for private care. After an initial assessment, and possibly tests, your GP will refer you to a fertility specialist at an NHS hospital or fertility clinic for further tests and assessment. The availability of NHS-funded fertility treatments, as well as waiting times for treatment, vary across the UK. Currently, waiting lists can be very long in some areas, usually at least six months.” – Lesley

What are some of the initial tests that will be done?

“At the very minimum, you should have a full hormone panel done between days two to five of your cycle, covering FSH, LH, oestrogen, prolactin, TSH, SHBG and testosterone, as well as a standalone progesterone test around six to seven days after ovulation. It can also be helpful to get your levels of vitamins D and B tested as well as CRP (an inflammation marker), and a transvaginal scan to check for uterine abnormalities such as fibroids, polyps, or conditions that affect the uterine lining such as adenomyosis. An expert should also look to rule out hormonal imbalances that may be affecting ovulation, such as thyroid disorders, high testosterone, or polycystic ovary syndrome (PCOS), which can affect egg quality and the uterine lining.” – Rachel Sherriff, fertility acupuncturist & founder of The Fertility Suite  

“Your GP should also recommend a full semen analysis to establish the health and motility of the sperm, as well as sperm count, and a screening for sexually transmitted diseases, as some can directly impact male fertility. An examination of the testicles and penis will also rule out any lumps, deformities or potential abnormalities.” – Lesley 

What are some of the most common problems discovered?

“In approximately 30% of couples who struggle to conceive, there are issues relating to male fertility. These range from erectile or ejaculation dysfunction, to low sperm count, suboptimal sperm health (their morphology – shape – and/or their motility), blockages in the male reproductive system, and prostate problems. In another 30% of couples struggling to get pregnant, the issues are related to female fertility and can include ovulatory problems, conditions affecting the uterus (like endometriosis), PCOS and blocked fallopian tubes. A combination of fertility issues affecting both the man and the woman (for example, a low sperm count and issues with ovulation) is reported in 20% of couples who struggle to have a baby, while for the remaining 20% of cases, the causes of infertility is unknown.” – Lesley

“Often, the male side of things is under investigated and more emphasis is placed on the woman. In around 40% of couples struggling to conceive, the man will have an undiagnosed varicocele. The World Health Organisation (WHO) now recommends a sperm DNA fragmentation test should be included as part of the standard fertility mark-up. An inability to conceive could also come down to an undiagnosed thyroid condition. Low levels of thyroid hormones can hinder ovulation and increase miscarriage risks, but symptoms can overlap with other conditions or can be considered ‘normal’, such as tiredness, sluggish bowels or dry skin. Therefore, women fail to get the diagnosis or treatment they need to optimise their hormones for fertility.” – Rachel 

Do you have any advice for finding a reputable fertility clinic?

“If you have a diagnosed condition or think you know why you aren’t conceiving, then a good starting point is to find a clinic or consultant that specialises in this area. Arrange to visit the clinic or have a phone call with one of the nurses – lots of clinics now offer open days or free calls to enable you to make an informed decision. Find a clinic that doesn’t just sell you IVF as the first-line treatment. IVF isn’t a guaranteed success and for many couples there are other steps that can be taken first. Ask the clinic whether there is anything else that can be done before you start IVF to optimise your chances. Avoid clinics that offer a ‘standard’ protocol that doesn’t take into account your unique clinical picture.” – Rachel 

What are some of the steps you can take before IVF?

“If you are having problems with ovulation or irregular cycles, ovulation stimulation is a sensible first step. However, this is only appropriate if your partner has good quality sperm and your fallopian tubes are clear. You can usually take ovulation stimulation drugs for up to six cycles, during which time we would usually provide you with some fertility awareness coaching (in order to make sure you have optimally timed sex – you might be surprised at how many couples do not) and also monitor you closely to check that the drug is having the desired effect. This would involve having a number of scans and a blood test for progesterone to confirm that ovulation is occurring. Most women will ovulate with the use of these drugs and many will conceive. However, there are situations where ovulation may not occur despite the use of ovulation-boosting drugs.” – Zita 

What are your options after this?

“If ovulation induction methods haven’t worked after six cycles, IUI is an option. In IUI, the male partner provides a sperm sample and we then separate fast-moving sperm from more sluggish or non-moving sperm. The fast-moving sperm are then placed into a woman’s womb close to the time of ovulation. Success rates for IUI are lower than that of IVF, but the procedure is much quicker and less expensive, and depending on your individual circumstances, can sometimes be done without fertility drugs to boost egg production though, as you would expect, this reduces the success rate further.” – Zita