Five fertility questions to ask your GP

This is one of the early findings of “Fertility Journey” research commissioned by Bourn Hall Clinic in partnership with the British Infertility Counselling Association.  The Healthwatch organisation have helped to promote the survey through their regional networks across the East of England.

Initial findings from the research indicate that, contrary to popular belief, couples are not leaving it too late to seek advice, but instead are frequently told by GPs they are “too young to have a problem and should try for longer” – and this may be compromising their chances of success.

GPs can’t be expected to be experts in all areas. Dr Arpita Ray, lead clinician at Bourn Hall’s Colchester Clinic says: “It is well known that fertility declines with age but there are many other causes. Common reasons for infertility such as blocked fallopian tubes or low sperm count won’t be improved by waiting, so it is important that these conditions are addressed to maximise the chance of conception.

“We are concerned by these initial findings and want more people to complete the survey so that it is more representative.”

Time is often used as a key indicator of a fertility issue. According to data from the HFEA (Human Fertilisation and Embryology Authority), on average 80% of couples will get pregnant within a year if they have sexual intercourse every two to three days and do not use contraception, so couples that are unsuccessful after two years should seek help.

However the “Fertility Journey” feedback suggests that for many younger couples the fertility testing – which might reveal the medical cause for their infertility – was often delayed for several years due to confusion over how long to wait before referral. This may be because GPs are using the time couples say they have been ‘trying for a baby’ as an indication of the length of infertility. However most couples have had unprotected sex for several years before they start to get concerned and the vast majority of those that later go on to have IVF say they knew they were infertile before they were 30.

Anything that may delay seeking help is concerning to fertility experts. There are many ways that natural fertility can be boosted if the condition is recognised early, including taking nutritional supplements to increase sperm quality, drugs to stimulate ovulation, and minor operations to restore fertility.

In response to these early findings, Dr Ray suggests those experiencing infertility should explore with their GP a number of questions such as the following:

1. We have been together for three years without using contraception and have been trying for a baby for one year – is there a difficulty? (The answer is most likely yes; most couples wrongly consider the period of ‘trying hard’ as the duration of infertility and may not give their previous history.)

2. If all our tests are normal, is it possible we may still need fertility treatment? (The answer may be yes; the causes for one third of all cases of infertility are unexplained.)

3. If I delay getting treatment now will my egg store decrease? (Perhaps; the basic tests may not include ovarian reserve testing, which is an indication of egg store, and even if tests indicate that the egg store is good it does not predict future fertility.)

4. If my sperm analysis is poor is there anything I could do to improve the situation? (Potentially; lifestyle changes such as stopping smoking, reducing alcohol and enhancing nutrition with selected supplements can improve sperm quality.)

5. I am 42 years old, fit, healthy and ovulating every month, so should I be reassured about my fertility? (The answer is no; although it is possible to get pregnant naturally at 40 the egg store will have been decreasing rapidly since the age of 35. This doesn’t mean that IVF is necessary but fertility options should be discussed with a specialist.)

Reproductive medicine is still a relatively young field of medicine; until the 1970s the focus was on preventing pregnancy. It was really only after the success of Cambridge scientist Professor Robert Edwards and gynaecologist Mr Patrick Steptoe with the world’s first test-tube baby, Louise Brown, in 1978 that infertility was even considered a worthwhile research subject, so there is still much that is unknown.

The idea behind the “Fertility Journey” research is to gain anecdotal evidence from individuals and couples with infertility issues, which can then be used to inform new thinking on how to support them. For example, mental wellbeing is known to be important to fertility success so access to counselling is one of the areas being explored. More responses are required to build up a better understanding of how help can be given.

If you would like to contribute your experiences to the “Fertility Journey” research please do so; the survey is available at bit.ly/FertilitySurveyHW. It is anonymous but there is a chance to win a £50 John Lewis gift card as a thank you.