Pregnancy

3 Reasons Why You're Not Pregnant (Yet)

When you’re trying for a baby, every month can feel like a lifetime – worse if you have been trying for years to conceive. Struggling with infertility can be a very frustrating and disheartening for affected ladies. Well, here’s help: We ask Dr Michele Lee, Obstetrician & Gynaecologist from Mount Alvernia, what might be the problem – and how to fix it.

  1. You’re over 30

    A woman is most fertile before she reaches 30 years of age. Beyond 30 years old, fertility begins to decline and becomes insignificant around ages of 37 to 38 onwards. A woman is born with a fixed number of eggs (about a million).The decline in age is due to the decline in the number of healthy eggs which starts in childhood and continues into adulthood.

    In addition, as we get older, our bodies are likely to undergo hormonal changes as our ovaries ages or develop medical conditions that can affect our health. This results in irregular ovulation and luteal phase deficiencies where not enough progesterone is produced to maintain the womb lining that is vital for embryo implantation and development.

  2. Your menstrual cycle is too long

    The onset of menses marks the start of a new menstrual cycle, which is about 12 to 14 days after ovulation has taken place. So for a lady with a 28-day menstrual cycle, her ovulation should take place around day 14 to 16 (taking the first day of menses as day 1). Sperm survival is about 48 hours after ejaculation into the female partner. Hence the time a woman can conceive is about four or five days in a month. So for the lady with a 28-day cycle , her fertile period would be day 12 to 16. 

    As menstrual cycles can vary, it helps to track one’s menstrual cycle length for a few months. If the cycle length is 35 days of more, you may need to consult your gynae as you may be a problem ovulating.

  3. You (or your partner) have underlying medical conditions

    Problems with ovulation are the most common female cause of infertility. Other causes of female infertility would include endometriosis, large uterine fibroids or past pelvic infection resulting in blocked tubes.

    As for male infertility, varicocele is a common condition where the veins surrounding his testicles are swollen with blood and sperm production is compromised. Low sperm density and motility also contributes to male infertility.

    Baby Shoes

How To Treat Infertility

Your gynae may prescribe you with oral medication like clomiphene, or hormonal injections to induce ovulation if you have irregular menses.

If you need extra help, your gynae may recommend artificial insemination (AI). AI is the process of inserting processed, washed sperm into the women’s womb cavity at the time of ovulation. This can be combined with ovulation induction as mentioned in the above, or in a natural cycle when the woman is tested positive for ovulation with a urine test kit. This technique requires the woman’s fallopian tubes to be unblocked, and is especially useful for those with a low semen volume or reduced sperm motility.

In-vitro fertilization (IVF) is usually taken as the last step. However, it is the treatment of choice for severe male factor infertility, or women with blocked fallopian tubes not amenable to tubal surgery. Couples with unexplained infertility and have been trying to conceive for a reasonable length of time (depending on age of women) may avail themselves of this treatment.

Surgery can help to correct or remove structural abnormalities within one’s reproductive tract to improve her chances of spontaneous conception. Conditions in which surgery is useful are:

  • Hysteroscopic removal of polyps and septum within the womb to significantly improve spontaneous conception and pregnancy outcomes.
  • Laparoscopic removal of hydrosalpinx (fallopian tubes distended with water) prior to assisted reproductive technique.
  • Laparoscopic restoration of pelvic anatomy affected by endometriosis by adhesiolysis and ovarian cystectomy.
  • Tubal reconstructive surgery. Successful tubal surgery may help the lady avoid fertility treatments like in-vitro fertilisation( IVF) , in a reasonably young lady and in the absence of other causes of infertility.

    Baby Chick and egg

When To Seek Help

You should seek the help of your gynae or a fertility specialist if you have had regular, unprotected sex for one year. However, if the lady is over 35 years old, and has pre-existing gynaecological conditions like irregular menses, painful periods, fibroids or ovarian cysts, she should seek help much earlier. 

It is recommended that women with pre-existing medical conditions see their relevant specialist to optimise their health and review their medication, before embarking on fertility treatment and pregnancy.

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