Infertility is defined as the inability to conceive after one year of regular unprotected sex. Over 80% of couples who are having regular unprotected sex will conceive in the first year if the woman is under 40, and of those that don't conceive in the first year about half will conceive in the second year of trying. From age 40-44, infertility affects around 30% of women. On the NHS you will be advised to try for one year before possible causes of infertility are investigated: however, if you are over 36 or have some medical problems that might be linked to fertility problems, don't wait a year - you should be investigated sooner. If your GP refers you for fertility investigations, it is likely these will include: a sperm test for the male partner and for the female partner blood tests for FSH and LH around day 3 of the cycle, blood tests for a day 21 progesterone level, a screen for some sexually transmitted diseases, and a dye test that checks the patency of a woman's fallopian tubes. Depending on these results, a management plan will be suggested - for example blocked fallopian tubes may require tubal surgery.
However if these tests come back negative and a woman is left with a diagnosis of unexplained fertility this can be a difficult time - the advice might be to keep trying naturally (for a total of 2 years) before more invasive options such as intrauterine insemination or IVF are offered. Its a stressful time, and understandably many women in this position want to know what else they could be doing.
Here are the basics:
Maintain a normal weight - your body mass index should be between 19 and 24.9; don't smoke; don't drink alcohol at all! (yes this might be a surprise); eat complex carbs (wholegrain bread, brown rice, vegetables, beans, pulses), eat nuts, seeds, olive oil, 2 portions of oily fish per week (don't go overboard on fish since fish may contain low levels of mercury that can build up in the body) and some protein every day (for example organic meat, eggs or beans). In animal studies, monosodium glutamate, aspartame and acrylamide have been linked with decreased fertility so try to avoid these in processed foods where possible. Take a pre-conception multivitamin and mineral such as Pregaday. Manage stress as excess cortisol disrupts other hormones.
What else can you do? Some women may have had a one-off blood test that suggests they are ovulating, but want to stay reassured that they are continuing to ovulate every cycle: in this case using an ovulation prediction test kit is helpful. These kits work by measuring the levels of LH in the urine, and ovulation typically occurs 10-12 hours after the peak of the LH surge. Studies have shown that urine LH testing is a reliable way to predict ovulation.
Should you have further tests privately? In unexplained fertility there may be other areas that are worth looking at in more depth and working with a doctor whilst you continue to try naturally can make a lot of sense. Testing other hormones such as thyroid function and androgens is useful and DHEA supplementation may have a role. Testing for mycoplasma and ureaplasma (small organisms commonly found in the genitourinary tracts of men and women that often don't cause symptoms but are possibly linked with miscarriage and abnormal sperm) may have a role. The other thing that you can have to get a better idea of what is happening in your cycle is a monitored cycle which uses serial ultrasound scans to track follicle growth, the thickness of the womb lining, and the development of the corpus luteum after ovulation. I have to say that I have found this to be a very interesting test for a number of my patients, because it does help narrow down the problem by accurately showing the time of ovulation, whether a follicle has truly ruptured and whether the lining of the womb is adequate, and it can be very useful used alongside complementary therapies.
Its good to have a plan, and to know at what point you would or would not be willing to consider assisted conception. For example, if you are not ovulating, at what point might you consider taking clomid ( a drug that stimulates the ovaries - be sure that if you are prescribed this you are also being given regular ultrasound scans); intrauterine insemination or IVF? If you have premature menopause, would you consider treatment with a donor egg?
Dealing with fertility problems can be an emotionally and physically challenging experience, but being armed with information so you know that you are doing everything you can, and making a plan (even if it changes!) are two things that I really find help reduce the stress.