If you are reading this it’s highly likely that you have been trying to get pregnant and are disappointed that it hasn’t happened yet.
You want a baby so much so when you see the single line on the pregnancy test and your period starts, your heart sinks. You just want to become pregnant and have a healthy baby. You want to return to having sex for pleasure and fun again rather than for functional purposes.
You’ve been following the advice you’ve read online so why aren’t you pregnant yet? This article will help you evaluate your situation so you know when to see a healthcare professional.
Time for a review
Just to be on the safe side, it’s worth checking what you have been doing so far to get pregnant and whether you should do anything different.
So many readers and clients tell me their friend told them to download an ovulation and menstrual cycle tracker app, buy some ovulation sticks or an ovulation monitor, follow the instructions and have sex when the app or monitor advises them to.
Yet doing this can be risky if it isn’t done properly and if it isn’t done properly it could delay your chances of becoming pregnant.
If you have regular sex rather than timing sex to when you suspect you ovulate you do not need to do any of this. I’ll explain why this is in the next few sections of this blog.
Fertility Awareness and estimating the day you ovulate
As mentioned in the previous section using certain apps or ovulation predictor kits to guestimate when you ovulate can be risky and may prolong your attempts to conceive if you aren’t doing it correctly. This is why the national institute for clinical excellence (NICE) guidelines for fertility problems don’t recommend timing sex to ovulation or the ‘fertile window’.
Many apps apply a standard textbook menstrual cycle to their algorithm to estimate your day of ovulation. The typical menstrual cycle, as written in the textbooks is classically 28 days length, with day 1 being the first day of the period, and the day of ovulation being day 14 of the cycle.
Many apps use this textbook standard and then adjust your estimated day of ovulation proportionally to the length of your cycle so if you inform them your cycle is shorter e.g. 24 days, your estimated day of ovulation will be day 10. However, this is an estimation and this estimated day of ovulation may not be accurate for your particular cycle as your body may not fit this textbook cycle.
In 2019, a study of 600,000 menstrual cycles showed that the average menstrual cycle was 29 days and the average day of ovulation was day 17; not day 14. Evidence also shows the menstrual cycle can shorten with increasing age. Therefore the typical textbook cycle does not reflect the most recent modern day findings.
Furthermore, at-home ovulation tests most commonly measure and compare the changes of the amount of a hormone in your blood called Luteinising hormone (LH). If you don’t start using the sticks early enough or for long enough you could miss the day of ovulation.
Period tracker apps and ovulation predictor kits are easy to use but aren’t reliable if you have irregular periods or have polycystic ovarian syndrome (PCOS) so if this is you, do not use these methods.
The most reliable ways to estimate when you ovulate is by doing fertility awareness properly. Fertility awareness involves using a calendar to mark the days of your cycle whilst checking and understanding how your own natural body indicators of ovulation change during your cycle.
This information can be used to help you avoid pregnancy i.e. as a natural family planning method or to help you become pregnant by estimating when you ovulate. Natural indicators of ovulation include measurement of basal body temperature (BBT), checking the consistency of your cervical mucus or measuring LH levels (which can be done using at home ovulation predictor kits)
Learning fertility awareness can be done:
Manually: You can use books or these fertility guides or learn from a fertility awareness practitioner. They will practically and physically show you how to view these. You can also work with a fertility nurse or a fertility coach that specialises in fertility awareness.
Use Tech: You can use an app that measures at least one natural marker of ovulation together with tracking your cycle on a calendar. Natural Cycles is a highly rated app and is discussed in my blog about the best period tracker app. Natural Cycles uses the calendar together with BBT. The data from users of the Natural Cycles app was used in the menstrual cycle study described earlier in this article. The users had consented to their data being used for research purposes.
It may take a few cycles to get used to doing this. Ideally, all womxn should learn fertility awareness well before they start trying to conceive so that it becomes second nature to understand your body.
If you are doing this already, that’s great!
You can find more trusted resources on how to get pregnant and a video about the process of conception on Your Trusted Squad’s blog. Information for readers with PCOS will be available on this blog soon.
Estimating your ‘fertile window’
Knowing your estimated day of ovulation isn’t quite enough. The next thing to check is that you calculate your ‘fertile window’. The ‘fertile window’ is the time during your menstrual cycle where the sperm can fertilise your ovulated egg.
After you have sex, sperm can live in your womb and fallopian tubes for up to 5 days. Some sperm live longer than others and some sperm do not travel make it all the way to the fallopian tube which is where it needs to meet the egg.
Around 40 million sperm can be found within one ejaculation of semen. Only one sperm is required to meet the egg but it can take several hours for the sperm to get to the fallopian tube after ejaculation and a large number do not make it to the fallopian tube.
When you ovulate, the egg travels from your ovary to the fallopian tube. This egg must be fertilised within 12-24 hours after ovulation because this is how long it survives.
Your ‘fertile window’ is therefore approximately 5 days before you ovulate and up to 1 day after you ovulate. Again this is an estimation as the length of time the sperm survive will vary so you can add a few days on each side to be safe.
Read the next section ‘what can I do to maximise my chances of getting pregnant?’ which discusses how you use all of this information to help you conceive.
What can I do to maximise my chances of getting pregnant?
Estimating your ovulation or fertile window isn’t essential
As mentioned earlier, if you are trying to conceive and become pregnant, it is recommended you have sex at least twice a week every week of the month (NICE).
This improves your chances because sperm will always be located in the fallopian tube, ready to meet an egg if you have sex twice a week. Remember that sperm lasts in your body for up to 5 days. If you randomly ovulated later or earlier than usual a sperm will still be ready.
Therefore by having sex twice a week, you can avoid the need to estimate your fertile window.
Regular sex and sex during your ‘fertile window’
If you also have sex more often during your fertile window e.g. every 2-3 days and you have estimated your fertile window correctly, then you can have an even higher chance of conception.
So if you have sex twice a week during the month and twice during your fertile window including the 1-2 days before your estimated ovulation day, you should have the best chances of conceiving.
How often should you have sex when trying to get pregnant?
You do not need to have sex every day or several times a day. Having sex twice a week or every 2-3 days should be sufficient.
The information gives you the best chance of conceiving but may not be practical for you so if having the amount of sex described in the previous section isn’t practical (and there are so many reasons why this might be the case) then focus on the having sex 2-3 times evenly spaced during your estimated fertile window. This does mean you have to be really aware of your menstrual cycle.
Having a healthy diet and looking after your mind and body
Ensure you are eating a healthy diet, staying active, taking prenatal vitamins and looking after your mental health with self-care. Avoid alcohol and stop smoking. More tips can be found on Tommy’s website. Make sure your cervical smear test is up to date and you’ve had an STI screen. You can speak to your practice nurse for preconception advice.
How long does it take to get pregnant?
It can take months or it may take 1-2 years. For some people it takes longer than 2 years. The majority of couples will conceive within 1 year.
Figures show that over 80% of couples aged below 40 in the general population will conceive within 1 year if they are having regular sexual intercourse (twice a week) and are not using contraception.
Of the 20% that do not conceive in the first year, about half will do so in the second year.
This means that over 90% of couples will conceive within 2 years.
See table 1 from the NICE guidelines which shows the percentage of couples that have conceived after having sex twice a week in 1 or 2 years against their age (all under 40).
Over 50% of women aged under 40 years will conceive within 6 cycles of artificial insemination or intra-uterine insemination (IUI). Of the 50% that do not conceive, around 25% will conceive with a further 6 cycles of IUI. Therefore 75% of women will conceive within 12 cycles of IUI.
See table 2 from NICE guidelines which shows the percentage of couples that have conceived in 6-12 cycles of IUI against their age (all under 40).
It can take 1-2 years and even longer if you are over 40. This is because the number and quality of eggs reduce as we get older. Taking longer to conceive does not necessarily mean there is something wrong with you.
You may be living with infertility
Infertility is defined as the inability of a sexually active couple, who are not using contraception, to achieve pregnancy in one year (World Health Organisation). However, some couples may not be able to become pregnant from the outset and this is usually related to a medical condition and is still definied as infertility.
The causes of infertility will be discussed in the next blog. Infertility affects 1 in 7 couples in the UK and 1 in 8 couples in the US.
Living with infertility can be challenging emotionally, physically and financially. The experience of infertility can affect you for years to come so please get help and support early on in your journey.
I haven't become pregnant yet. When should I get advice from a healthcare professional?
Arrange to see a healthcare professional if you have been trying to conceive and have not become pregnant:
After 6 months if you are 36 years old and over
After 12 months if you are 35 years old or younger
Have not conceived after 6 cycles of artificial insemination
Attend the appointment with your partner so you can both be assessed and be referred for appropriate tests. In the UK, it is the GP who performs the initial assessment and then refers to a fertility clinic.
However, there are a number of women’s wellness clinics, private GP services and fertility clinics that offer assessment and fertility testing. Depending on the results of your tests you or your partner may need a referral to another specialist such as a gynaecologist, endocrinologist, urologist first so you can receive further tests and treatment.
Specialist fertility treatment using assisted reproductive techniques such as IVF may or may not be required at a later stage.
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