Trouble conceiving? Health expert Dr Rachel Mackey on the next steps

It can be frustrating.

If you are trying to get pregnant and nothing is happening, consider this checklist before you start to worry. First of all, consider this check list:

1 Are you having enough sex? Sounds simple, but the recommendations are that you have sex every day or every second day for about seven days around the time of ovulation, and at least twice a week on the other weeks. 2 Do you know when you are ovulating? Some women know because of their cervical mucus, or they might get a little abdominal pain around that time. But a lot of women don’t know exactly when it happens and this is pivotal to your attempts to conceive. You can work it out using a calendar once you know how long your cycle is – it occurs 12-14 days before your next period. Beware of ovulation sticks from the pharmacy – they can be inaccurate. 3 Keep a menstrual diary of your cycles. As well as helping you target your most fertile time in the month, this is also invaluable information for your doctor when they are trying to evaluate your fertility. 4 Are you both optimising your health? You should both be nonsmokers and minimising your alcohol intake. Binge drinking, which is only five units of alcohol at any one sitting, can damage sperm production for up to ninety days so alcohol intake should be very moderate for both parties. 5 Are you overweight or underweight? This may be contributing to a delay in conceiving. 6 Are you eating a well-balanced diet, managing your stress levels and exercising regularly? All these factors boost your fertility.

Have you been trying for twelve months or more? 84% of couples without fertility problems will have conceived in twelve months of regular intercourse without using contraception. Couples who having been trying for 12 months or more should be investigated for possible infertility. For women aged 35 or older, investigations should be done after six months of trying to conceive. Infertility can be divided into four categories: 1 Ovulation problems – examples include Polycystic Ovarian Syndrome; ovarian insufficiency 2 Male factor problems – low sperm count, poor motility 3 Womb/fallopian tube problems – fibroids, blocked tubes 4 Unexplained infertility – no abnormality found but no pregnancy. This accounts for approximately 20% of all cases of infertility. You will need the following basic investigations done: 1 Pelvic ultrasound to assess your womb and possibly a HyCoSy which determines if your fallopian tubes are open and working properly. 2 Bloods tests on day three (to check ovarian reserve) and approximately seven days before a period (to check that ovulation is occurring). A full general health screen should also be done at the same time to make sure your thyroid function etc is normal. 3 Semen analysis for your partner These tests should give some indication as to whether there is a detectable problem so that appropriate treatment options can be discussed with you and your partner. At this point it would be reasonable to refer you to a specialist fertility clinic for further evaluation. For further information, contact the Women's Health Clinic.