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Published 31 December 2019
It’s heart-breaking when you try to get pregnant and have no luck, and many couples will be hoping that 2020 will be their lucky year.
We have had a wonderfully fulfilling 12 months at Dr Morton’s with 5 lucky women conceiving under our care. These were women with infrequent periods, who were judged suitable for treatment to drive their ovaries harder; and it was successful. So I thought I would republish this article about fertility, and also introduce our partnership with Apricity. Apricity is a concierge assisted conception service; nurturing couples through the stressful process of IVF and other techniques. Transparency of price and support with the emotional and nutritional aspects of the treatment is their hallmark. Dr Morton’s is thrilled to provide the all-round medical and gynaecological support that Apricity’s patients need.
So let’s just take a broad brush look at the topic of help with fertility.
When you are trying to get pregnant, every period feels like a major disappointment, and when six months has gone by, you feel you are never going to have a baby. The truth of the situation is that 80% of couples who are trying to conceive will have done so within a year of stopping contraception and having sex around the time of ovulation.
So what if it hasn’t happened? Well now is the time to seek advice. There may be something really simple to be done.
If you read my article on how to make a baby it will be clear that now is the time to be thinking about the four things that you need to make a baby.
If your menstrual cycle (that’s the number of days from the first day of one period to the first day of the next period) is regular and between 25 and 32 days long, then it is highly likely that you are ovulating 14 days before the next period. So with a 28 day cycle, ovulation occurs on day 14 and you should have sex on days 12, 14 and 16, to maximise your chance of conceiving. If your menstrual cycle is irregular or longer than 32 days, it may well be useful to take Clomid (clomiphene) to try to drive your ovaries a little harder so that they predictably release an egg on day 14 of the cycle. If you have polycystic ovarian syndrome (PCOS) H3this is usually associated with infrequent ovulation, and infrequent periods. This may be helped by treatment with Clomid, but it may be necessary to bring on a period using progesterone tablets first. Sometimes other medication like metformin will be helpful, as your ability to regulate blood glucose may be affected by the PCOS.
If you are taking Clomid it is a good idea to do a proper ovulation test. A blood test to measure the level of progesterone on day 21 of the cycle is the most reliable method. The ovary only makes progesterone when you make an egg. If the progesterone level is low you will be advised to increase the dose of Clomid. Many women will get ovulation symptoms (lots of egg-white-like mucus and some lower tummy pain usually on one side or the other) but you shouldn’t rely on this to know if the Clomid has worked.
It is really important,from every point of view, not to be overweight, when trying to conceive. Being overweight makes ovaries lazier and more difficult to stimulate with medication. Aim for a BMI of less than 25. Dr Morton’s gynaecologists will not prescribe Clomid for women with a BMI of greater than 35.
Other general health issues are important. Taking folic acid supplements for three months before conception significantly reduces the risk of spina bifida. Take regular exercise to prepare yourself for the physical demands of being pregnant and of looking after a baby and a family. Cut down on alcohol. Stopping smoking goes without saying. In fact it is a good time to look at your life-style in general.
If you have specific medical conditions (for example asthma, diabetes, or ulcerative colitis) you may want advice about how to optimise their treatment and to understand how they might be affected by pregnancy and vice versa.
It is also essential that our doctors speak with you so as to be able to ask all the questions necessary to give the very best advice, and prescribe if appropriate. In this situation an email consultation is not good enough although may be fine for follow-up questions. We will not prescribe without your permission to inform your GP about your treatment, and your GP details.
The gynaecologists at Dr Morton’s look forward to helping you.