Once you have decided that you want to become pregnant, this decision is usually accompanied by a lot of enthusiasm and impatience. Ideally, you want it to work out the next cycle, but that luck is only available to a few couples. It usually takes a number of months before pregnancy occurs. In some cases, about ten to twenty percent, it even takes longer than a year.
What to do if a pregnancy does not occur
It is usually advised to keep trying until a year has passed. An exception is if there are indications of medical problems. For example, if there is a very irregular cycle or if there is pain during sex or irritation of the genitals. In the first instance, you should consult your GP if you have any questions about the lack of pregnancy. The GP will then refer you to a specialist if necessary.
Referral to a specialist
Once a year has passed, a referral is usually made to the hospital’s Gynecology department. We start with a number of standard tests to determine fertility. The process starts with completing a questionnaire in which both the man and the woman provide information about their current health and lifestyle and about their history. During the first visit, this questionnaire will be discussed and, if necessary, tips and advice will be given, such as quitting smoking or losing weight. An (internal) ultrasound is usually also done during the first visit. This shows whether there are any abnormalities in the ovaries or uterus. A culture and a smear are also usually taken. Follow-up research can take place in both men and women. The man is usually asked to submit his sperm for testing. He makes a separate appointment for this. It is important that the seed is delivered shortly before the delivery appointment and that the seed remains at the right temperature.
The woman is usually given forms for taking temperatures. By taking the temperature every morning before getting up, the doctor can gain insight into the progress of the cycle. Furthermore, a hormone test can be linked to these temperatures. Blood is taken on the third day of menstruation to determine the presence of the hormones FSH, AMH and estradiol. The values of the test say something about the sensitivity of the egg sacs and the relative fertility. If the temperature rises and remains high compared to the beginning of the cycle, blood is taken again on the fifth and eighth day after this rise. This blood is tested for the presence of progesterone. A good result means that ovulation is taking place.
In most cases the result is good and no abnormalities are found. In that case, tips and advice are mainly given about lifestyle and about the time and method of sex. It is then advised to try it for a while (usually six months). In some cases, abnormalities emerge from the investigation, which may or may not be corrected. Appointments are then made with the specialist for further examination or treatment. An example of such further examination is an x-HSG, which uses an X-ray examination to examine the fallopian tubes and the uterus. In appropriate cases, this is also done through keyhole surgery.
Medical science has now progressed to the point where a lot of treatment options are still available for reduced fertility. Examples of such treatments are IUI and IVF. Even if one of the partners is infertile, there are still options, such as sperm donation or egg donation. In both of the latter treatments, it does mean that one of the partners is not the genetic parent of the child. A decision for such treatment is therefore usually not easy to make.
There is an association in the Netherlands for people with fertility problems, called Freya. More information about fertility problems and everything that comes with them can be found on the website. The website also offers experience stories and contact with fellow sufferers.