Dr Sarah Brewer talks to iVillagers about their concerns about getting pregnant live on the Fertility Issues message board

How can I improve my conception chances?

A kick-start without clomid

Problems with conception after depo provera

Trying for a baby when sperm count is low

Treatments to improve sperm count

Coming off of the Pill and conceiving

A complementary approach while waiting for IVF

Conception after a miscarriage

Live discussions on the Fertility Issues message board

How can I improve my conception chances?
Q: I have had ME for 14 years and I came off the pill last August. I have only just started ovulating. I am full of spots and ovulate really late. My periods are painful and I feel ill and tired throughout. I am currently seeing a homeopath but can you suggest anything else I could be doing to improve my chances of conception? birdie280

b>A: The best advice is to eat a healthy (preferably organic) diet, avoid stress, alcohol and cigarettes, take a preconceptual care supplement that includes folic acid, and take evening primrose oil for essential fatty acids. Now you are ovulating it will hopefully be just a matter of time until you get pregnant. The average chance of conception per month is 20 per cent. Make sure your partner is following a healthy regime too. A multivitamin supplement with extra antioxidants, and avoiding alcohol and cigarettes are important for him, too.

A kick-start without clomid?
Q: I tried to get pregnant for three years without success. Then I got pregnant with my first cycle of Clomid but sadly miscarried. I then got pregnant again on Clomid after three more cycles and I now have an eight-month-old daughter. So it seems Clomid works for me. We're now trying for another baby but I can't take Clomid as I am still breastfeeding. I seem to be ovulating, but wondered if there's an alternative you could suggest to give me a kick-start. A friend has suggested homeopathy but I don't know anything about it. I had reflexology the month I conceived my daughter. kirsty_c

A: It is surprising how many women find they conceive naturally without needing Clomid again after having a successful pregnancy using it. Breastfeeding itself does reduce the chances of conception for up to six months after delivery, but now you are not breastfeeding exclusively and are further than six months since delivery, this should not be a barrier to conception. If you are ovulating naturally, there is every chance you will conceive naturally. It is important to take a multinutrient supplement that includes folic acid. I also feel an essential fatty acid supplement (for example, evening primrose oil) is important as your levels may be depleted following a recent pregnancy.

Back to main question page

Problems with conception after depo provera
Q: I am posting this question on behalf of lots of girls on the board who have had difficulties with their periods after coming off depo provera, or the Pill, following several years of treatment. The main problems seem to be:
1) Irregular cycles on a monthly basis 2) No sign of periods at all for several months after treatment has finished 3) Heavy bleeding immediately after finishing the depo treatment. petals2004

A: Research suggests that women trying to conceive after stopping depo progestogen take at least four months longer to become pregnant compared with women stopping other methods of contraception. In some cases, fertility may take up to a year or longer to return. Therefore, if there is no sign of a period returning after treatment, it is really just a question of waiting for menstruation to start again. If it is delayed for more than six to 12 months, your GP may be willing to start tests looking for another cause such as polycystic ovary syndrome (PCOS). If your periods have returned but are irregular, it is helpful to use an ovulation predictor kit to see whether or not you are ovulating. This can work out expensive each month, however, so I like the new re-usable kit called Calista, available from most pharmacies. Calista consists of a powerful, pocket-sized, back-lit microscope through which you examine a sample of saliva (really!). You just place a little saliva on the optical block and wait for it to dry. Your dried saliva will show a dotted pattern on non-ovulating days, or a clear fern-like pattern that indicates ovulation is imminent and you have reached your fertile peak. Clinical trials show that Calista is 98 per cent accurate and - unlike urine-based ovulation predictor kits - can be used month after month for over two years, making it a less expensive method to use.

When periods are really heavy, this will usually settle down within a few months but keep seeing your doctor to ensure you don't become anaemic and that you don't have another gynae problem such as dysfunctional uterine bleeding (again, usually associated with not ovulating).

Back to main question page

Trying for a baby when sperm count is low
Q: My husband and I have been trying for a baby for four years now. We had tests and found out that my husband has a very low sperm count - he has a 20 per cent chance of having a child. We have sex regularly and I use no form of contraception but so far nothing has happened. We were told that a course of sperm donor treatments were our only option. I had 10 treatments, but still nothing has happened. My doctor said this could be because I have a very small cervix opening and maybe the sperm is not getting through. We have not got a lot of money so IVF is not an option for us, but is there another way to have a baby. honey1971

A: Do see your doctor to find out what options are available in your area. Don't give up hope however. It only takes one sperm, and a 20 per cent chance of success is worth going for. Another possibility is intra-cytoplasmic sperm injection (ICSI) which can be used when a male has only a few live sperm or where sperm quality is poor or lacking motility. During ICSI, a single sperm is injected directly into one of your eggs using an ultra-fine glass needle (pipette). The fertilised egg is then observed until it has undergone a certain number of divisions before being transferred back into your womb. The average live birth rate is 22 per cent per embryo transfer, but the success of ICSI depends on the skill and experience of its practitioners.

More information is available from the Infertility Network UK (formed from the merger of CHILD and ISSUE). You might also think about discussing adoption with your partner to see how you feel about that if you still have not conceived at some time in the future.

Back to main question page

Treatments to improve sperm count
Q: I was wondering if you could recommend any particular alternative treatments to improve sperm counts? cl-kathy_02

A: Avoiding alcohol is important - even a moderate intake has been linked with 40 per cent of male subfertility. Antioxidants are important - vitamins C, E, selenium, zinc plus folic acid have beneficial effects on sperm quality and quantity. Wearing loose cotton boxer shorts, and even cold water douching of testicles to cool them down is also beneficial (really). I've written a lot about sperm health in my book Planning a Baby (published by Vermilion), which you can request through your library (new edition out soon).

Coming off of the Pill and conceiving
Q: I have been trying to conceive for five months since coming off the Pill in November 2003. I realise that it can take some time to regulate cycles after coming off the Pill. However, my cycles to date have been 34 days, 40 days and I am now currently at 55 days with no sign of my period. This latest cycle is worrying me and I wonder whether you can suggest anything to reduce my cycle times. I started taking agnus castus at the start of this cycle, other than that, I am only taking folic acid. zagster

A: Agnus castus can help to regulate a cycle. As you have only been off the Pill for five months, it is still early days. In general, taking the Pill does not seem to reduce fertility and 90 per cent of previously fertile women who stop using the Pill have a baby within 30 months. This is only two months longer than the average figures for women who had previously used the diaphragm or coil, and is thought to reflect that fact that many women stop the Pill two to three months before trying to conceive a child so the hormones are out of their system.

After stopping the Pill, half of older women (30-35 years old) take up to a year longer to conceive compared to those of the same age who had previously used a diaphragm. The number of women in both groups who successfully became mothers within 72 months was similar however, suggesting there is no long-term effect on fertility. It does mean that a few older women who have used the Pill may face a delay of up to six years before conceiving once they decide to start a family, however. There is no firm evidence that this is due to the Pill. Chances are good that you will have a successful outcome.

Back to main question page

A complementary approach while waiting for IVF
Q: I am currently on a seven-year waiting list for IVF as I suffer from hostile cervical mucus, PCOS and blocked tubes. We are trying to save up to have private IVF treatment but are desperate to try anything we can in the meantime. I read an article recently which stated that traditional Chinese medicines such as herbs and acupuncture can have amazing results for women with fertility problems and at one clinic in London over 70 per cent of the women on the treatment became pregnant after being told that IVF was their only option or previous attempts at IVF had failed.

I have regular reflexology sessions and the occasional kinesiology session in the hope that they might help me become pregnant. What is your opinion on alternative therapies? geelh

A: I am very much in favour of complementary alternatives - all approaches, both natural and conventional, have a role to play. It's not a question of choosing one or the other, but of selecting the best of both worlds. If you can afford a complementary approach while awaiting IVF, then go for it. Make sure your practitioner is fully trained, accredited and insured, however.

Conception after a miscarriage
Q: I had a miscarriage almost eight weeks ago (my second one) and started having acupuncture and taking herbal medicine having been diagnosed at a traditional Chinese medicine clinic with low energy and poor blood circulation. I was given a concoction of herbs, which I had to brew into tea and drink in the morning and at night for two weeks. Then the doctor told me I could take herbal pills (30 twice a day!) instead of the tea until my period came and then on the fifth day of my period swap back to tea for ten days (I guess this is to prepare for ovulation). I still have not had a period since the miscarriage and I usually have a 28-day cycle. Do you think that the acupuncture and/or the herbs are causing this problem? laurashew

A: After a miscarriage it can take six to eight weeks, or occasionally longer, for periods to restart. It is possible that the herbs are having an effect, however. Ask your practitioner about this, and double-check that the herbs are safe to take during very early pregnancy in case you conceive again quickly.

Back to main question page