After some months of trying for a baby, it is very common to begin to wonder if it is going to happen at all. Difficulties are even more unexpected when you've already had a baby before without much delay - why should there be a problem this time? It is generally considered reasonable to see a specialist after 12 months of trying, for 'further investigations'. This article will cover what to expect if you are referred to a gynaecologist or specialist infertility clinic.
Normal conception rates
Even for a normal, fertile couple, the 'per month' success rate is around 20%, so it is not at all uncommon for it to take some months to conceive. Overall, around 70% of couples will have conceived by 6 months, 85% by 12 months and 95% will be pregnant after 2 years of trying. Although for a normally fertile couple, the 'per month' rate is around 20%, as you might expect for couples where there actually is a problem, this rate is lower. It is useful to know the overall background rate of pregnancy after any given duration of trying, particularly to make sense of success claims of any treatment. Studies have looked at the ongoing success rates after many years and the results are sumarised below:
| Number of months trying | Overall % of couples having not conceived | Monthly success rate (%) | Proportion (%) who will conceive in the next 12 months |
0
6
12
24
36
48
60 | 100
30
14
4.3
1.9
1
0.6 | 20
14
11
8
6
5
4 | 86
77
69
57
48
41
36 |
As you can see, 'infertility' is really a poor term to use, because this implies that there is no chance of getting pregnant. For most couples who are referred for further investigations, it would be best described as 'subfertility', meaning reduced fertility, as there is usually a background fertility rate - it's just taking longer than they would wish. Of course they will want to exclude an insurmountable cause of subfertility, or one which will definitely require some form of treatment to succeed.
Many people will have tried methods of timed intercourse, detecting ovulation either by temperature changes & cervical mucus production or with urinary ovulation prediction kits. The Royal College of Obstetricians & Gynaecologists advise against this approach as research has not demonstrated that it results in improved pregnancy rates and it is frequently psychologically draining.
Causes of infertility
For conception to occur following normal intercourse, adequate numbers of actively swimming (motile) sperms need to enter the cervix, work their way up the uterus and into the fallopian tubes. At the same time, an egg must be released from the ovary and be able to make its way down the tube to meet the sperm. The egg and sperm combine at fertilisation and the dividing egg makes it way back down to the uterus to implant into the thickened lining of the womb. Any proble...
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