Why are we not Conceiving?
In order to get pregnant a couple need some sperm, some eggs, functioning uterus and fallopian tubes and sexual intercourse.
Whilst that sounds simple many couples and even doctors get distracted by obscure potential problems in one of these areas, whilst ignoring glaring problems in another.
Steps of Conceiving
In the woman’s head there is a small gland called the pituitary gland. At the beginning of the cycle this gland will start to secrete a hormone called Follicle Stimulating Hormone (FSH), and this will stimulate the ovaries to produce some follicles which contain eggs (oocytes).
By the end of the first week one of these follicles will become dominant and the others will fall away. Usually by day 10 or eleven this follicle will have grown to about 20mm and the egg inside it will be mature.
At the same time as this the follicle is producing the hormone oestrogen, (commonly referred to as E2 by medical staff). This has several functions, but importantly will make the lining of the womb grow ready to receive a fertilised egg.
Around day 13 there is a surge of hormone called Luteinising Hormone (LH) from the pituitary, which causes the follicle to release the egg. This hormone is detectable in the urine and is the basis of home ovulation tests.
The egg will then fall along with 5 to 10 mls. of fluid into a pouch behind the uterus, called the Pouch of Douglas, into which the fallopian tubes are dangling. The tubes contain millions of hairs which beat in time and suck the fluid along with the egg into the tube.
Hopefully the couple will have had intercourse at the right time and sperm will have been deposited onto the cervix. They will have swum up through the cervix and uterus and into the fallopian tubes, where they will meet and fertilise the egg.
The egg will spend two or three days growing in the fallopian tube before being deposited into the uterus and beginning to implant.
As all of these steps need to occur it is therefore not surprising that pregnancy does not happen every time.
Difficulty in Conceiving
So as stated earlier there are four main areas where you might be having difficulty:
- Ovulation Problems
- Male Fertility/Sperm Problems
- Anatomical Problems
- Sexual Problems and Fertility
Your doctor will take a history and arrange investigations to try and identify the cause.
Fertility Ovulation Problems
If you have regular periods you are usually ovulating. This can be tested at home with a urine test bought from a chemist. Your doctor may also confirm this with a blood test for a hormone called progesterone taken a week after ovulation should have taken place.
Another blood test for hormones may be taken at the beginning of the cycle to try to identify why you might have poor ovulation. These are called Follicle Stimulating Hormone (FSH) and Leutinising Hormone (LH).
When there is an irregular menstrual cycle the hormone Prolactin amy be measured along with the Thyroid hormones.
Male Fertility Sperm Problems
The male may have fathered children previously. In this case it is likely that the sperm count will be normal, but not necessarily so. The doctor will ask you to arrange for a sample to be analysed in the laboratory. Counts vary from day to day in an individual, and a repeat sample will commonly be asked for.
The clinic will usually ask for a repeat test if the initial investigations were performed in a non-specialist centre.
An ultrasound examination will usually confirm the shape of your uterus and the quality of the lining of the womb (the endometrium). However further tests are required to check the Fallopian Tubes. This would normally be a simple operation called a laparoscopy or an X-Ray called an HSG.
Sexual Problems and Fertility
The doctor will discuss this with you.The treatment your doctor recommends will of course depend on the nature of the problem.
Ovarian Reserve Testing
The chance of success with any treatment is closely related to the quality of the woman’s eggs. The quality is in turn related to the number of eggs the woman has remaining in her ovaries, known as the ovarian reserve. This will be related to the woman’s age and other factors such as smoking. There are several ways to estimate the ovarian reserve (HYPERLINK TO OVARIAN RESERVE), including Anti-Mullerian Hormone measurement, and ultrasound scanning of the ovaries.