Content:
- Let’s first understand when we can talk about infertility?
- What is a regular sex life?
- What are the most common causes of infertility?
- How can you understand whether ovulation occurs?
- What tests should a couple take when they fail to get pregnant?
- What day of the menstrual cycle should I take tests?
I can’t get pregnant – it’s a problem that, unfortunately, often arises in couples. Approximately 15% of all couples suffer from infertility.
How often have you heard the questions: ‘When are you going to have kids?’, “You’re over 30, maybe it’s time to think about children?” or “The clock is ticking, maybe it’s time to have children?”. We often answer with a smile that it is not yet time or we are not ready, but we hide the tears and pain inside us. Your husband often accuses you of being the cause. However, it is not always a woman who is the problem.
According to the Ministry of Health statistics, in about 25% of cases, the cause of infertility is a female factor and in 25% – a male factor. In another 25%, the cause is in both partners and in the remaining 25%, the cause remains unknown.
Let’s first understand when we can talk about infertility?
Infertility is the inability of a couple to conceive a child within 12 months of regular sexual activity without contraception for women under the age of 35 and within 6 months for women over 35.
What is regular sexual activity?
For successful conception, regular sexual activity is required from the 7-9th day of the menstrual cycle, that is, unprotected sexual intercourse with ejaculation into the vagina every 1-3 days (during the week, a couple should have at least 2-3 sexual intercourse, but not several times a day, as sperm motility is significantly reduced with very frequent ejaculations).
What are the most common causes of infertility?
According to the classification of the Ministry of Health of Ukraine, these are:
- Ovulation disorders (20-30%);
- Poor sperm quality (20-40%);
- Pathology of the fallopian tubes (10-15%);
- Endometriosis (10-20%).
How can you tell if you are ovulating?
- If your menstrual cycle lasts 25-37 days and you have certain symptoms before your period (breast tenderness, bloating, dysmenorrhoea), you can usually talk about regular ovulation.
- If menstruation is irregular (the cycle lasts more than 37 days or less than 21 days) and there are no symptoms before your period, there are problems with ovulation.
However, in order to understand exactly whether ovulation is occurring, it is necessary to take a blood test for progesterone levels on the 21st day of the menstrual cycle (provided that the menstrual cycle lasts 28 days), however, if the menstrual cycle lasts more or less than 28 days, then progesterone should be taken 7 days before the expected menstruation. If the result is above 3 ng/ml, you have ovulated, if it is below, you should repeat the test in 1-2 days or in the next menstrual cycle.
Which tests should a couple take when they fail to get pregnant?
For women:
- Follicle-stimulating hormone (FSH);
- Estradiol (E2)
- Luteinising hormone (LH)
- Progesterone
- Prolactin (PRL)
- Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4)
- Antimullerian hormone (AMH)
- Free testosterone index (total testosterone; sex hormone binding globulin; free androgen index)
The results of these tests will help determine the cause of ovulation disorders and select the appropriate treatment (polycystic ovary syndrome, thyroid diseases; hyperprolactinemia; congenital adrenal cortex dysfunction, hypothalamic-pituitary amenorrhoea, menopause (including premature menopause)).
For men – a spermogram.
On what day of the menstrual cycle to take the tests?
Prolactin, FSH, LH, estradiol, free testosterone index, and AMH should be tested on the 2-3rd day of the menstrual cycle or, if there is no cycle, on any day.
Progesterone is recommended to be tested on day 21 of a 28-day menstrual cycle or on day 25 of a 32-day menstrual cycle. If the menstrual cycle lasts more or less than 28 days, then 7 days before the expected menstruation.
TSH, T3 free, T4 free on any day of the menstrual cycle.
Only a specialist should interpret the tests.
Remember, infertility is not anyone’s fault, so there is no need to feel guilty. Early diagnosis and treatment will help you become parents as soon as possible.