After years of using contraception, it can be distressing when, after going off it to start a family, falling pregnant takes longer than you anticipated. When you’re eager to have a baby, it’s easy to grow impatient after a month or two, and then anxious. However, medically, infertility is diagnosed only after 12 months of having regular unprotected sex.
What the numbers say
Statistics suggest that after one month of unprotected sex, only about 25% of couples conceive; after three months, 30% of couples; after six months, 60%; after nine months, 75%; and after a year, 80%. After 18 months, a full 90% couples conceive, so your best approach is to relax. “If you are in your twenties, be patient for at least 12 months,” says Dr Danie Botha, gynaecologist and fertility specialist at Life St George’s Hospital and Fembryo Clinic in Port Elizabeth.
However, if your menstruation cycles are totally irregular, or you have excessive pain with menstruation and intercourse, ask your gynae to do baseline testing to exclude common conditions like endometriosis and polycystic ovarian syndrome and to help with ovulation.
When to consult a specialist
The exception is if you are older than 35, when you should see a fertility specialist after six months, as fertility begins to decline rapidly from that age, with loss of up to 50% of your fertility potential at 35 compared to women of 25. “Full investigation of both male and female partners and discovering problems early can save valuable time,” says Dr Botha. “Female age is still the most important factor in the developed world leading to infertility.”
Age aside, fertility can also be affected by being seriously underweight or overweight, by certain medications (such as steroids for asthma or arthritis, and some antidepressants), stress and depression, regular intake of alcohol or smoking (including dagga), and certain contraceptive drugs.
“It can take a year to conceive after you stop using certain contraceptive injections, for example,” Dr Botha says. “The oral contraceptive pill, however, is not responsible for infertility, independent of duration of use.” If any of these factors apply to you, chat them through with your doctor.
It’s possible your partner may be the reason for your seeming inability to conceive. “In couples failing to establish pregnancy, men are found to be the factor in 30% of cases, with another 20% of men contributing when a female fertility factor is also present,” says Dr Botha. “It is therefore very important to have him tested early on at an andrology laboratory at a fertility clinic, with a semen test.”
Conditions that affect fertility
Your ability to conceive can also be affected by medical conditions which disrupt hormones or have an impact on your fallopian tubes. Speak to your gynae if you’ve had any of the following, or get tested in case you’re an unwitting sufferer – symptoms may not always be obvious.
Uterine fibroids: Also known as myomas, uterine fibroids affect up to one in three women during their reproductive years and may require surgical removal.
Pelvic inflammatory disease (PID): This affects about one in five women in developing countries but can often be treated. “After one episode of pelvic infection, 12% of women will be infertile due to tubal damage, and after three episodes, 50% of women,” says Dr Botha. “Having multiple sex partners significantly increases your chance of getting pelvic inflammatory disease.”
Adhesions, scar tissue: These result from conditions such as endometriosis or sexually transmitted infections (STIs), as well as previous abdominal surgery, especially open surgery (laparotomy), Dr Botha says, and may need to be surgically removed.
Ovarian cysts: These may resolve themselves or can be surgically removed. “Ovarian cysts, however, are seldom the reason for infertility and having multiple operations to remove them may damage your ovaries permanently,” he cautions.
Polycystic ovarian syndrome (PCOS): This is the most common hormonal abnormality found in young women, Dr Botha says, and may affect one in 10. Symptoms of polycystic ovarian syndrome (including irregular periods, acne, excess facial hair and weight gain along with difficulty getting pregnant) can be eased with exercise, weight loss and medication.
Irregular periods: These may indicate that you do not ovulate, Dr Botha says. “The underlying reasons should be looked for before any form of treatment is given, as abnormal thyroid function is often the reason, or a prolactinoma (a non-cancerous tumor of the pituitary gland that produces the milk-forming hormone prolactin).” These can be treated by diet, exercise or hormonal medications.
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