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Dear doctor, I am having difficulty conceiving...

06 February 2017

Q: I’m in my late 30s and considering children. We’ve been trying to conceive for a year, and nothing is happening. What do we do next? 

A: The age of the female partner is the single most important factor affecting the chance of any couple achieving pregnancy naturally or through fertility treatment. This means that time is of the essence. If you are in your late 30s and you have been trying to conceive for a year, you and your partner should be investigated to try to find out any underlying reason as soon as possible.

It would be crucial to run these tests in order to shed light on any underlying problems such as; low ovarian reserve (number and quality of eggs), problems with ovulation, blocked Fallopian tubes or low sperm quality.

The test for ovarian reserve is a blood test that is normally done on day 2-5 of your period to check the level of hormones. You also need a blood test to be done seven days before starting a period to determine whether you are ovulating or not. Ideally, you should have an x-ray and dye test to check whether your Fallopian tubes are opened or blocked. Finally, your partner should have a semen analysis to check sperm parameters as to whether sperm count, motility and normal looking sperm are all functioning as normal.

One quarter of couples trying unsuccessfully have unexplained infertility, meaning there is nothing wrong affecting the male or female partner. IVF (In-Vitro Fertilisation) is recommended for couples who have unexplained infertility especially if the female partner is in her late 30s.

IVF would be the best way forward if you are in your late 30s and are found to have a low ovarian reserve, blocked Fallopian tubes or if your partner has a low sperm quality. However, if the Fallopian tubes are found to be blocked and full of fluid, it is advisable to have surgery in order to clip or remove the tube and maximise your chance of achieving pregnancy after IVF. There is strong evidence that the fluid inside the tube would significantly reduce the chance of IVF success.

Mr Ehab Kelada is a Fertility Consultant practising at Spire Portsmouth Hospital.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.

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