What are the odds?

When my husband and I started trying to make a baby, we were halfway through a round-the-world trip and having plenty of sex. Yet, when we returned home I was not pregnant. I began using ovulation-predictor kits and our lovemaking became less spontaneous, more "we-need-to-do-it-today", especially since my 35th birthday was looming.

Like many women who are hoping to conceive, I had heard the standard advice: if you have regular periods (every 26 to 32 days) and are younger than 35, you should wait a year before consulting a doctor; if you’re older than 35, wait just six months.

Sound rationale backs up this advice, as half of couples trying to conceive will be pregnant by the end of six months, and 80 per cent will be pregnant by the end of a year, according to Dr Mary Jane Minkin, co-author of A Woman’s Guide to Sexual Health (Yale University Press). "The odds are in your favour," says Dr Minkin. "Knowing exactly when you ovulate can boost those odds".

If you’re still not conceiving after six months to a year of properly timed intercourse, see your gynaecologist, who can perform or recommend several simple tests, including hormone-level blood tests for you and a semen analysis for your husband. "A sperm count is a non-invasive, easy and relatively inexpensive test. It tells when the problem lies with the guy, not the gal; 40 per cent of infertility is what’s known as ‘male factor’, " says Dr Minkin.

Another common, relatively non-invasive test, a hysterosalpingogram (HSG), occasionally has an unexpected upside. The X-ray of the uterus and Fallopian tubes is used to determine if there’s a blockage in one or both of the tubes (thus preventing egg and sperm from meeting), and there’s a slightly increased conception rate afterwards, as the procedure itself sometimes clears small blockages. Your gynaecologist also may prescribe the oral ovulation-stimulating drug Clomid.

If these steps and other advice on how to fall pregnant don’t help you in conceiving, your next one should be a consultation with a fertility specialist, who can perform more specialised tests and procedures.

When to get assistance

While six months to a year is the standard time to wait before seeing a doctor about fertility issues, here are some circumstances in which you shouldn’t wait:

• Negative ovulation-predictor kit test results for two consecutive months.


• Signs of hormonal fluctuations, such as experiencing night-time hot flushes or irregular intervals between periods.


• Symptoms of polycystic ovarian syndrome (PCOS), such as excess facial hair, light periods, thinning hair, acne, irregular cycles or steady weight gain.


• A family or personal history of endometriosis, which is linked to infertility.


• A short luteal phase, indicated by getting your period 13 days or less after a positive result on a urine ovulation kit.

As for my husband and me; after six months of unsuccessful attempts to conceive, I saw my doctor for blood tests, and my husband had a semen analysis. No problems were detected. I also underwent an HSG – and a few days later, we conceived our first child.

All in the timing
Many women don't know the most fertile time in their menstrual cycle. Most think it’s day 14, but ovulation doesn’t always occur on the same day. It moves around, even in the same woman.

A normal woman's potential fertile days are days eight through to 19 of her cycle. During this time, you need to have intercourse at least every other day. Having intercourse regularly – about three times a week – is enough (remember that sperm can stay alive inside a woman for up to five days).

If you do want to keep closer track of when, or if, you're ovulating, simple methods that can help include: ovulation-predictor kits, charting your basal body temperature and checking your cervical mucus.

Fertility and the pill

Dr Antonio Rodrigues of Gauteng’s Medfem Fertility Clinic stresses that combination oral contraceptives like the pill are not in any way linked to long-term infertility, and that most women take about two to three months to fall pregnant after discontinuing use. He points out that large studies have shown that the majority of women conceive in the first year and nearly all women conceive within two years.

"The return of fertility in women taking a progestogen-only oral contraceptive [the mini pill or POP] is more rapid than after the combination oral contraceptive [COC]," he notes. He advises women who have a normal cycle length and no past history of problems to be patient and to be prepared to wait for a year before seeking fertility intervention.
"But if the couple thinks they may have have problems then they should be assessed sooner than later." "The real danger", explains Dr Rodrigues, "is to be aware of age-related fertility problems. After the age of 30, there is a significant reduction in fertility. This means that if a woman stops the COC at age 36, her chances of becoming pregnant are lower than if she had decided to try to fall pregnant 10 years earlier." He says, "This is often forgotten and the COC is then blamed for any difficulties in becoming pregnant."

If you are one of the women who might wait for up to two years to fall pregnant regardless of your age, this might effectively close your fertility window. Dr Rodrigues also warns that the older the woman, the more likely she is to develop fertility-related conditions, including endometriosis, autoimmune diseases, insulin resistance, PCOS and fibroids. Also, egg quality diminishes with age and, therefore, monthly pregnancy rates decrease and miscarriage rates increase. By Laura Twiggs.