Home > IVF & Fertility > Pregnancy > My Struggle with IVF. Am I Infertile?

Part 2 of our 6 part series with Keeley Dwight on fertility..

It’s such a provocative word isn’t it? INFERTILE. I know that when I was starting to have to investigate my own fertility, it felt like I began to be defined by it! Who’s the infertile over there? I mean no one actually said that out loud, but I saw it in their eyes. But unless we use these words, how will people understand.I will admit I never really used it, because you always want to think it doesn’t actually apply to you, but the more we talk about it and the more people understand it, the more help and support you will get as a result.

Infertility is classified as the inability to become pregnant after 12months or more of regular unprotected sex. But what does infertility look like? Is it just a woman’s problem (as usual!)? How do I know what to look out for? Now I know the answers to these things on the whole, but I thought it best that an expert impart their wisdom, so I enlisted the help of the lovely Dr Belinda Coker to help me out.

Belinda is not only an experienced GP, medical director and digital health Consultant, but also lives with endometriosis, adenomyosis and infertility. As a result of her personal experiences, and her desire to help others she is the founder of Your Trusted Squad, a new fertility concierge service. She seemed pretty qualified to me, so I put some questions to her…

When should we be worried about our fertility and what are the options out there?

A: I wouldn’t want to use the word worry, perhaps a better word is ‘aware’. Ideally, we should be fertility aware from our teen years particularly when we become sexually active.

1. To prevent sexually transmitted infection (STI), particularly chlamydia, which can lead to infertility. This is why it’s important to use condoms and having regular STI testing after a new partner or if in a long-term relationship at least once a year.

2. To become cycle aware. Learning about your cycle; bleeding patterns, fertility awareness signs e.g., basal body temp, cervical mucus, mood changes and sleep patterns provides such valuable information (see next point). Having confidence in understanding when one ovulates well before they start trying to conceive (TTC) can be a form of contraception but also a source of knowledge to be able to know if there are any problems that require medical review. Additionally, by the time one starts TTC, the stress and pressure of learning your own cycle are greatly minimised. I write about being cycle aware, about fertility awareness and recommend some books in this blog about period tracking.

3. To be able to identify any problems early on. Currently, conditions like endometriosis take 6-7 years to diagnose so the earlier one is aware and takes action to obtain a diagnosis; the better. This also allows one to consider options to protect fertility e.g., start TTC at an earlier age (if desirable and relevant) or consider egg freezing (see below). However, it is important to understand that our fertility declines with age. The decline may be slower for some women than others but overall, the number of eggs available for fertilisation and the quality of the genetic material in the eggs declines with age.

Once we are ready to start trying, we look forward to getting pregnant quickly and some couples are fortunate to conceive within a few months. For most couples it takes longer than this and may take up to 1-2 years to get pregnant even if the couple are healthy, do not have any fertility issues and are under 40. It can potentially take longer in a couple over 40. So, there is something around helping people manage expectations and understand that getting pregnant can take some time and this is normal so they don’t worry that there is something wrong with them. However, it is important to get checked out to ensure that there aren’t any irreversible conditions or problems that could affect fertility and be easily treated.

Therefore, couples should have a preconception review with a nurse or GP to:
  1. Ensure smear is up to date (women)
  2. Ensure no sexually transmitted disease
  3. Discuss any medical conditions which could potentially affect their fertility including review of medications
  4. Start taking supplements, stop smoking, illicit drugs and drinking alcohol and making other lifestyle changes to improve overall health and the health of the sperms and eggs.
  5. Have the chance to ask questions. Unless someone is super knowledgeable about their cycle, using apps and ovulation prediction sticks can be counterintuitive and misleading and therefore couples may time sex incorrectly leading to more frustration and stress.

If it’s realistic and possible for the couple the advice is to have unprotected sex twice a week every week as ovulation can vary with each cycle and having sex twice a week means that sperm will always be ready in the fallopian tube to meet with an ovulated egg.

I’ve written this blog called why am I not getting pregnant? Which explains a lot of the above.

If a couple hasn’t conceived after 1 year (if age 35 or under) or 6 months (if age 36 or more) they should visit their GP together as a couple for a fertility review. Fertility preservation is an option that someone could consider if they wish to delay TTC to a later age. It is also used for medical reasons. You can read more in these blogs should I freeze my eggs? and the costs of egg freezing.

Q: Do you feel like there is enough awareness around male factor infertility and the role it plays?

A: If a couple is finding it is taking longer to conceive than they originally hoped they should see medical advice. In the UK, this can be from an NHS GP or a self-paying individual/couple can approach a specialist directly.

The couple should attend the initial appointment with the GP together. The GP should assess both the male and female and arrange tests for both individuals.

However, yes, there is a perception that the cause of infertility lies mainly with the female. The reality is that 1/3 of cases of infertility in heterosexual couples are related to the female, 1/3 to the male and 1/3 are either unexplained or related to both the male and female.

Here are some articles I’ve written on male infertility.
The most common causes of male infertility and why male fertility testing is important.

Often there is also an unawareness around secondary infertility. An assumption just because you got pregnant once, it will be as easy again. Can you talk about this, and again what signs should you look out for?

A: The majority of heterosexual couples who are under 40 will conceive within 1 year of having regular unprotected sex (80% in 1 year and 90% in 2 years). Many couples will not experience difficulty in TTC during their first attempt at trying to conceive but by the second time they start TTC they are older. Some may be in the late 30s or early 40s when fertility has naturally declined (discussed above). This means that because fertility has declined (discussed above), many couples will take longer to conceive. So just by being older, most couples will take longer and are at greater risk of living with infertility. This could also be called subfertility.

Again, this relates to fertility awareness; understanding one’s own menstrual cycle, understanding that fertility declines with age, which can lead to pregnancy loss, and it’s difficult to predict whether one will be able to conceive naturally.

Regardless, the same advice still applies; to seek medical advice if there is a delay in becoming pregnant.

There is also a lack of awareness, understanding and empathy towards those who experience secondary infertility, and this is something that needs greater attention.

Do you feel like the media has an important job in helping to dispel the myth that fertility treatment is a lifestyle choice or an opportunity for a designer baby? Do celebrities contribute to this misconception?

Tricky but good question…

I certainly believe that more information should be included on the reality of living with infertility, the reality of the success rates of these treatments and that they aren’t an easy option to have a baby. A journalist could write about the celebrity and then provide some useful facts to provide a more balanced and realistic view. This information is readily available, and I don’t believe it would detract from the story. I believe they have the power to make the change.

It’s really an individual’s choice to decide whether to share the details of their fertility journey especially as it’s such a difficult journey to experience. Therefore, I would not expect a celebrity to tell us whether they used a donor egg, surrogate or adopt etc but sometimes this means that Journalist doesn’t have the full picture and presents the story as they see it or as it is presented to them. I certainly appreciate those celebrities who are forthcoming and who are sharing their experiences as it does help those of us who are living with infertility and can help inform people who have not started their fertility journey.

You can read more about Belinda and her fertility journey, alongside some brilliantly informative articles at
Living with endometriosis and infertility: the lessons I’ve learned https://www.thebearingallproject.com/stories/ihadnoideaiwouldstillbechildless

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