Trying to Conceive – Overview
Welcome to our new blog series on Trying to Conceive.
In medical parlance technically known as Subfertility or Infertility but I try to steer away from those terms as they sound really negative.
In the coming weeks, we will be posting several blogs on various aspects of this rather complicated subject.
Bearing a child is a really wonderful thing. I know, I have 2 (so far). Conversely, struggling to get pregnant is a very worrying and frustrating experience. I also know. My second child did not come easy.
So you are probably here reading this because you are planning to start a family or you have been trying but have been facing some challenges. Hopefully we can help you shed some light on this.
Let us also bear in mind that fertility and conception are extremely complicated bodily processes and until now, even with all our advances in modern medicine, much of it still remains shrouded in mystery.
This means there is only so much we can do and the rest is in the hands of God (or fate or luck depending on your belief system).
This also means that there is a lot of pseudo-science out there and unscrupulous people capitalizing on your worries to sell fake or semi-proven cures. Please do not fall victim to this.
Right, let’s get to it. So you have been trying to get pregnant for a while now with not much success. You really do not want to see a doctor because there is really no reason you cannot get pregnant right? You also don’t want to be on any hormonal medicines and certainly not IVF! Maybe it’s the stress, maybe both of you are traveling too much. Which really leads us to the first question: When does it become a problem?
By definition, if you have been having regular unprotected sex for 1 year and have yet to get pregnant, it’s a problem. This duration is shaved down to 6 months for women above the age of 35 simply because for these ladies, we don’t have a lot of time to waste. Conversely, for women younger than 30 years, we sometimes wait 2 years.
OK scary thought that you may actually need to see a doctor. But take heart that you are not alone. In the latest MOH published guideline on infertility, 1 in 7 couples are affected by Infertility. Shocking but true.
In fact, the average monthly probability of getting pregnant is only about 15%. The cumulative probability is 60% in 6 months, 85% in 1 year and 95% in 2 years. Fertility peaks at age 20 to 24 and more or less maintains that way till 30 to 32 then declines till 40 years than really drops after that.
So what is usually the problem?
Well guys, time to man up and take some responsibility. Male factors make up 30% to 40% as the cause of not being able to conceive. 20% are due to a problem with ovulation. 35% are due to a problem with the tubes. And to back up my earlier statement of this shrouded in mystery, 5% to 10% of cases in infertility are unexplained.
What can you do about it?
Before we get into the really complicated stuff of tests and medicines and assisted reproduction, let’s first look at some of the simple things we can do to maximize our chances.
Have sex every 2 to 3 days.
This was published in the latest guidelines with Level 4 evidence (very poor quality evidence). This is frustrating because they are always changing this recommendation. The advice used to be ‘Have sex daily because this increases sperm quality’. Now it’s ‘Have sex every 2 to 3 days because timing sex to coincide with ovulation is too stressful’. My view: time the ovulation and the days leading up to and after ovulation, have sex every day.
This applies to men and women. Limit yourself to less than 2 drinks per day. In fact, less than 1 if you can help it. This is Level 2++ evidence folks. Take it seriously.
Anybody who still believes smoking has no effect on fertility is either living in la-la land or is legal counsel for a tobacco company. Women who smoke are significantly more likely to be infertile. Level 1+ evidence. Yup, just about as definitive as you can get.
Don’t be too fat, Don’t be too thin.
BMI of between 19 and 29 is optimal. Level 1+ evidence.
Don’t take recreational drug.
Really??!! We need a guideline to tell us this?
Check with your doctor about your long term medicines and possible occupational exposure to chemicals.
Certain long terms medicines can affect fertility. In men, Cimetidine, Sulphasalazine, certain antibiotics and testosterone can affect sperm quality. Medicines used for high blood pressure and depression can cause erectile dysfunction.
Immunosuppressive drugs and anti-inflammatories can affect conception. Of course, chemotherapy can cause the ovaries to stop producing eggs.
Occupational exposures to solvents used in dry cleaning and printing, heavy metals, pesticides, lead and industrial microwaves have all been documented to be hazardous to conception.
That about covers the basics.
Watch out for our next article!
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.
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