After pregnancy, anxiety about infertility is the main reason women of childbearing age consult their GP. One in three women experience problems in getting pregnant, with seven out of 10 childless women over 30 worrying that they are infertile. Such fears may well be justified, as the trend towards older motherhood is creating an infertility epidemic that is turning conception into an event that increasingly commonly requires medical intervention – with a record 36,861 women having IVF in 2007. The treatment is so common that it is all too easy to forget how invasive it is, involving large doses of fertility drugs.
Assisted conception is increasingly effective with the development of new technology – and the number of women giving birth over the age of 40 has doubled in 10 years. Yet in their anxiety to beat the biological clock, many couples may be opting unnecessarily for assisted conception before they have exhausted natural alternatives that cost less in time, money and emotions. So if your resolution was to get pregnant in 2010, here are six ways to improve your chances of making a baby with none of the expense, the side effects or the hassle of IVF – along with two good reasons to avoid assisted conception.
As the joke goes, keep on trying normal conception methods – in the kitchen, the bathroom, the garden shed, anywhere and everywhere you fancy. If you've been on the Pill or are trying for a baby in your late 20s or your 30s, it's normal for conception to take some time – and you might as well enjoy the wait. After six months of trying, 60 per cent of couples have conceived. After a year, this rises to 80 per cent. Instead of panicking that you're infertile or turning your encounters with your partner into a baby-making chore, follow the advice of the numerous online conception-wise women and keep the romance alive and the sex hot while making babies.
Have sex often rather than when you think you're fertile
Getting to know your menstrual cycle and particularly the signs that you are ovulating is becoming a popular method of speeding up conception through monitoring vaginal discharge or vaginal temperature, or by using a commercial kit such as the Clear Blue Ovulation Kit. There is some evidence that these are successful – with one study showing a 65 per cent pregnancy rate among 500 couples who used a self-monitoring technique for 18 months.
However, Zita West, a fertility guru, warns such methods can make conception more problematic, simply by creating an obsessive atmosphere. "Men need testosterone for drive and passion. Getting texts at work telling them that tonight's the night can interfere with their sex drive so that they can't get an erection," says West, whose latest book Guide To Fertility and Assisted Conception will be published by Ebury in March. "I sometimes feel that women today share too much information with their partners and that they might do better to be more like their grandmothers and keep a bit more mystery about the whole business of conception."
In any case, she says, ovulation shouldn't be the focus of attention. "Women should keep their eye on the sperm which is able to fertilise an egg over a period of several days," she says. "As long as a couple is having sex three times a week every week, they are ensuring that active sperm will be available whenever ovulation occurs."
Get a test
Over the last three years, home kits have become available over-the-counter that test female fertility potential by accurately predicting a woman's ovarian reserve – many of them developed by infertility experts. Plan Ahead, a test kit which works by measuring the number of eggs in a woman's ovaries and indicating what that level might be like in two years time, with the opportunity for a follow-up consultation, was developed by Professor Bill Ledger, of Sheffield University.
"Women do not realise the importance of age when it comes to fertility," he says. "They think, 'It won't happen to me, I'm 37, I go to the gym twice a week, I don't drink, I don't smoke, I'm fit – everything about me is young.' Well it is, except your ovaries."
Another method, Body Clock Test, which checks women's future fertility by using ultrasound and measuring hormone levels, is being launched by fertility expert Professor Robert Flemming and fetal medicine expert Dr Bryan Beattie, with plans for a national network of private fertility centres aimed at offering fertility assessment to all women over 30 years of age. It's already available to women in Cardiff at the Spire Hospital.
Having a test as part of a wider consultation makes sense, says Zita West, whose clinic in London offers a Fertility Health Check that includes the AMH test (£185 with consultation). "Assessing fertility will not give a simple yes/no answer. A fertility test doesn't show whether a woman is ovulating or whether her tubes are blocked. And there are all sorts of other factors including the woman's physical health, that of her partner, potential risk factors, lifestyle issues and your psychological health – all of which need to be taken into consideration."
Increase sperm motility with a gel
Conceive Plus is a new non-spermicidal lubricant gel that mimics the natural fertile cervical fluids to help increase the motility of the sperm, thereby increasing the chance of getting pregnant. At least one study claiming efficacy has just been published – and at £14.99 a tube from Boots, it's one of the cheaper ways to assist conception.
Don't leave it too late
Is the trend to late motherhood truly irreversible? Yes, say many experts. "You can lecture or moralise to modern women that they should get married young and have children early like their grandparents did, but they will not accept that condescending, patronising view – in fact they very much resent it," says Dr Sherman Silber of the Infertility Centre of St Louis in Missouri.
Dr Geeta Nargund, head of reproductive medicine at St George's Hospital in South London, disagrees. "Society can make it easier for women to decide not to postpone motherhood," she says. "There are always going to be women in their 20s and early 30s who put off having children because they haven't found a partner. But many others delay because of money worries or because they haven't got anywhere to live or they're not settled in a career. Affordable housing, good, free childcare and flexible career posts will all help make early parenthood attractive."
Dr Nargund will be helping to launch a political campaign on fertility next month on International Womens Day (8 March) on behalf of the charity, the HER Trust (www.hertrust.org). It will call for "fertility protection" featuring in secondary education, with pre-conception care clinics set up to provide individualised advice on fertility to couples. "I'd like to see a truly family-friendly policy be debated in the forthcoming election, with a strategy for reproduction and family life replacing the current focus on fertility treatment," she says.
Obesity is a leading cause of irregular ovulation, making it more difficult to conceive naturally – as well as interfering with assisted conception. Getting to a healthy weight raises the chances of getting pregnant – though women should never be made to feel that this is yet another pressure at a time when their peers are all reproducing. Stopping smoking and cutting out recreational drugs is definitely necessary, however. "Stopping drinking will speed up conception, but bearing in mind it can take a year or more to conceive naturally, that's a long time to live without alcohol. So we advise couples to keep their intake below six drinks a week."
Assisted fertility: The success rates
Having three courses of IVF at the end of the first year of trying for a baby gives a woman an extra 4 per cent chance of getting pregnant. After three years, that figure doubles to an extra 8 per cent chance of a woman becoming pregnant with IVF. The statistics were reported last year by Dr Geeta Nargund, who created a computer programme that simulated the success rates of 100,000 women trying for a baby to compare the success rate of IVF with normal conception methods. The message, says Dr Nargund, is that except where there is an obvious cause of infertility, younger women should avoid stressful and unpleasant IVF and instead follow lifestyle and nutritional advice and other simple approaches to conception for at least a year.
Freezing your eggs is complex
It's being touted as the simple solution to late motherhood. Removing and freezing eggs or even ovarian tissue is becoming a realistic option for women in their 20s who want to put their biological clock on pause either because of money or career concerns or because they have not found Mr Right. Yet far from being an alternative to IVF, using frozen ovaries or ovarian tissue inevitably involves ever-more complex in-vitro technologies to make a baby. "It's a lot more complicated to fertilise a frozen egg than one that has just been removed," points out Dr Nargund. There is also concern that as an insurance measure, the risks are high and the guarantee of success at the end of it all is low – with the chances that the procedure may create false optimism for women. In November 2009, the British Fertility Society warned that while egg freezing was acceptable as a method of preserving the fertility of women hit by cancer, "it is not a solution to counteract age-related fertility decline".
However, taking a fertility test can provide reassurance and take the heat out of trying for a baby – or highlight any problems. Create Health Clinic in London offers a one-stop fertility check for £200, including a 3D detailed ultrasound scan for egg reserve, uterus and blood flow to uterus and ovaries, as well as a consultation with a gynaecologist.Reuse content