In this article, Mr Kuhan Rajah, Consultant Obstetrician and Gynaecologist, and Subspecialist in Reproductive Medicine, provides answers to a wide range of questions on the subject of fertility.
Who do you typically see regarding fertility issues?
Women, men or couples who want to have a fertility assessment and discussion, women who want to explore the option of egg freezing, female same-sex couples wanting to explore assisted conception using donor sperm and heterosexual couples who are experiencing difficulty conceiving should arrange an appointment.
How long should heterosexual couples try to get pregnant before seeing you?
Typically recommend heterosexual couples try for at least 12 months if the female partner is under the age of 40 and has regular monthly periods, this is because over 80% of couples will conceive after 12 months of trying. This should however be earlier if there is a known cause with either partner that may reduce the chances of conception. Some couples choose to have a fertility assessment and discussion before starting to try.
How can women tell if they are ovulating regularly?
Women who have menstrual cycles that last between 21 and 35 days are almost certainly ovulating regularly. Women can consider using urine ovulation prediction kits to estimate timing of ovulation. If there is uncertainty regarding ovulation or its timing, I recommend follicle tracking which consists of 2-3 ultrasound scans during a natural menstrual cycle to assess this further.
How often should couples be trying?
Couples should have vaginal sexual intercourse every 2-3 days, particularly from the 10th day of the menstrual cycle.
What lifestyle changes should couples make before starting to try for a pregnancy?
Couples should stop smoking, reduce their alcohol intake and aim to get their body mass index within the normal range.
What are the causes of delayed conception?
In the United Kingdom, one in six couples experience a delay in conception. Broadly speaking, the cause could be an issue with the male partner in approximately 30% of couples, with the female partner in 30% or an issue with both in 20%. In about 20% of couples, a clear cause is not identified.
Does the COVID-19 vaccine affect fertility?
No, it does not. Research has shown that the COVID-19 vaccine does not reduce the chances of conception.
What investigations do you perform initially?
I perform a transvaginal pelvic ultrasound to assess the pelvis for gynaecological conditions that may negatively impact fertility and assess the ovarian antral follicle count. A blood test for Anti-Millerian hormone (AMH) is also performed and this result, in combination with the antral follicle count, is used to estimate ovarian reserve.
A semen analysis to assess the male partner is also carried out. The next investigation I may perform is a Hysterosalpingo Contrast Sonography (HyCoSy), which is an ultrasound procedure to specifically assess if the Fallopian tubes are blocked.
What does ovarian reserve tell us?
Ovarian reserve predicts the ability of the ovaries to respond to drugs used to stimulate them and consequently the number of eggs a woman may produce in a cycle of egg freezing or in vitro fertilization (IVF). It is used mainly to determine the dose of stimulation drugs that should be used. Ovarian reserve does not predict a woman’s ability to conceive naturally.
Are there tests to predict the chances of natural conception?
No, there are not. Even in the context of a normal transvaginal pelvic ultrasound, ovarian reserve assessment and semen analysis, trying for a pregnancy is the only way for a couple to test their natural fertility potential.
What are the possible fertility treatment options?
Treatment options may discuss include assisted conception, medication to induce ovulation if you are not ovulating regularly and surgery if it is required to improve the chances of both natural or assisted conception.
What is assisted conception?
Assisted conception largely refers to intrauterine insemination (IU) or IVF. IU involves inserting better quality sperm that have been separated from sperm that are abnormal in shape or movement directly into the womb with the use of a fine tube through the cervix at the time of ovulation. On the other hand, IVF involves a woman taking hormone injections for about 2 weeks to stimulate the ovaries to produce multiple eggs, the eggs being collected and fertilized with sperm in a laboratory and finally transferring a resultant embryo into the woman’s womb.
What Is the single biggest predictor of successful assisted conception?
A woman’s age is the single biggest predictor of successful assisted conception. This is because egg quality which is the biggest predictor of embryo quality decreases as women get older. Ovarian reserve also declines with age. Therefore, some women who are not planning on a pregnancy in the immediate future undergo egg freezing to mitigate these changes in egg quality and ovarian reserve.
What is involved in an egg freezing cycle?
An egg freezing cycle is similar to the first part of an IVF cycle. However, the eggs collected following stimulation of the ovaries are frozen immediately in the laboratory to be used in the future if needed.
What Is your approach to fertility treatment?
I strongly believe an individualized approach as each patient’s fertility journey is unique, and continuity of care are essential in providing the best chance of successful fertility treatment. My expertise in fertility, ultrasound scanning and minimal access surgery allows me to provide all aspects of treatment and the required continuity of care. My patients consistently feedback that I am honest, kind, empathetic and supportive, which they find very helpful in what can be a stressful time in their lives.
With our Obstetrics and Gynaecology Consultant Mr Kuhan Rajah, you have direct access to one of the leading fertility specialists in London, here at our clinic in Barnes.