“I don’t really know what the problem is… but I’m sure it’s me”
Over the years, I’ve heard lots of versions of this statement, normally based on something that has happened in the past or an offhand comment from a friend or relative. As certain as you are that you’re the problem, it’s not until your particular history has been heard and investigations undertaken that you really know where there may be an issue and how it can be addressed. It’s only then that a treatment plan can be made to fit your unique situation.
There are lots of reasons why it’s usually the female partner who books the initial appointment. Generally women are in touch with their bodies in a different way to men and as a woman’s reproductive setup is more complex, it’s easy to jump to the conclusion that fertility issues always lie with the female partner, even though that’s often far from the truth.
I’m sure its me because…
“I’ve been on the pill for 10 years without conceiving and now I’ve stopped, I’m going to have problems”
The contraceptive pill is designed to prevent pregnancy… and it does so very effectively! It’s important to remember that while the pill may have prevented pregnancy for the last ten years it does not have any negative impact on your long term fertility. After stopping the pill, you may find that your periods are irregular, but it may just be that your cycle is returning to how it was before taking the pill and you’ve forgotten what that looked like.
“I had unprotected sex for years in a previous relationship and never fell pregnant”
This may be the case, but it’s only part of the picture. We can never be sure that your previous partner did not have an issue and we need to look at both partners in the current relationship to try and find out where there maybe an issue and make a treatment plan that is right for both of you.
“my partner has children from a previous relationship”
This seems like a logical conclusion but sperm count and motility can vary a great deal from month to month, so your partner may have been more fertile in the past. There’s also a chance that your partner may not be the biological father of any children from his previous relationships!
“I tried unsuccessfully with my previous partner too”
In this scenario, there are many possible explanations. Surprisingly often, it later transpires that a previous partner had fertility issues. There’s no way we can be sure why you didn’t conceive in previous relationships, but perhaps there was a male factor, perhaps timing, it’s difficult to know. What’s important to remember is that it’s the fertility of you and your partner right at this moment that’s important. It’s helpful to know what has happened in the past but your previous fertility history is just one of many factors that we need to take into consideration.
“I’ve had abortion(s) in the past”
This can be a difficult topic to discuss, as abortions are often a source of mixed emotions and need to be treated sensitively. The crucial element here is that as long as the abortion was medically uncomplicated, with no infection or problems following the termination, it’s unlikely to affect your fertility. Be reassured that subfertility would be a lot more common if it were directly linked to abortions and it’s unlikely to be the cause in your case.
“I drank, partied and had too much unprotected sex in my twenties”
Running the risk of sounding like a magazine advice column, each stage of life is different. You spent your twenties living your life; there’s is no use regretting those decisions today. The good news is that only very significant drinking over a prolonged period would have a negative impact on fertility, and if this is not the case, a wild youth is probably not a factor. In regards to unprotected sex, STIs do not usually impact fertility as long as they are treated quickly and correctly. Particularly bad pelvic infections, such as syphilis and gonorrhoea have been linked to sub-fertility, so if this features in your medical history it would be worth investigating.
“his penis is the wrong size/ doesn’t produce enough ejaculate/ all the ejaculate leaks out after sex”
While all of these are entirely understandable concerns, you’ll be relieved to hear that none of them translate into fertility issues. For the last on that list, it’s entirely normal for a mixture of semen and vaginal fluid to leak out of the vagina after sex, which doesn’t affect the chance of conception. On that topic, while a woman lying with her legs in the air after sex may seem sensible, it doesn’t actually improve the chances of pregnancy… but I think everyone has tried it!
What these questions show us is that people are quick to point the finger of blame when it comes to fertility issues, but generally problems conceiving are much more complex than that. To get a clear picture of a couple’s fertility we need to look at both partners’ fertility independently and combine it to give us all of the information. Every couple’s level of fertility is different. For example a woman in her 20s may have no problem conceiving with a man with a lower sperm count, but the same couple may struggle for another child when she is in her late 30s as her fertility will have decreased.
To offer the best level of care, it’s important for us to get the full story, to really listen to both partners and understand both your medical histories and your current problems in context. People are more than just numbers and to put together a personalised treatment plan, a wider view is needed than just the results of the tests we conduct. When we use all of the information available to us, we’re then in the best position to look at the problems you’re facing as a couple and start working towards a solution together.
Treatment plans differ according to your specific circumstances, and must be tailored to your individual needs.
To discuss what might be right for you please contact Yvonne on firstname.lastname@example.org