Sunday, 12 April 2020

Vol.1 April 2020 - Towards a Successful TTC (Trying To Conceive)


Human desire to reproduce is innate and God-given. This is encapsulated in the biblical mandate to ‘be fruitful and multiply’ (Genesis 1:28). Not surprising therefore that fertility frustration can be all-consuming and paralysing. I know because my patients from across several continents tell me so. It never ceases to amaze me the length to which affected couples would go and efforts they make to find solutions. In Nigeria, affected couples especially women are ridiculed and sometimes rejected. Across Asia the attitude is similar. A study of patients attending my clinic in the UK shows that in 30% of couples either the woman or man is on antidepressants based on fertility difficulties. Some couples split up due to distress arising from difficulty to conceive.  

To complicate matters, many nations offer little or no financial help to affected couples. In the UK, NHS funding is available in some regions but overall funding falls short of the three IVF treatment cycles recommended by NICE guidelines. In Nigeria, fertility care is uncoordinated, unregulated and unaffordable by many. Ultimately, the subfertile couple goes on the trying-to-conceive (TTC) journey without a compass or compassion, and without financial aid.

Quality information is key in the pursuit of any goal, not least for a successful TTC journey. The following are useful points based on good clinical evidence, not anecdotes or myths.

1)      Seek medical advice early. Don’t delay. Time is of the essence.

If you are under 35yrs and have been trying unsuccessfully for 12 months; or over 35years and trying for 6 months, you should go and see a gynaecologist for advice. Advice should be based on results of tests including a hormone tests and check on fallopian tubes for the woman, and semen analysis for the man.

Never mind stories of your aunty or your neighbour who conceived at 40+ age, the reality is that female fertility peaks at around 23years and starts to decline from 37years age. Yes, Sarah in the bible conceived in old age, but you are not Sarah and your husband is not Abraham. Be realistic.

Even if you conceive in your later years, your baby carries a high risk of chromosomal abnormalities.

In choosing which doctor to go to, be aware that not all doctors have training or experience in diagnosing and treating fertility problems. Find out if the doctor is a qualified gynaecologist and if facilities are in place for tests and treatment. Be bold. You must ask questions about test results to be explained in plain English, refuse to be blinded by medical jargon. In deciding which treatment to go for, ask about the success rate and possible complications and how many cases the doctor has handled in the past.

2)      Review your lifestyle

Maintain a healthy lifestyle. This means lose weight if you are overweight, keep fit by exercising moderately, and eat well. The ideal fertility-enhancing diet should be low in carbohydrates, with little or no red meat and regular fish consumption, vegetables and fruits. The woman should take folic acid tablets supplement.

3)      Prayer works but it MUST be backed up by action


Nothing just happens.

You may be waiting on God, when GOD is waiting for you to take action.

4) Have sexual intercourse 2-3 times a week, from day 7-21 of your cycle. This is adequate for women who have ovulatory cycles (typically, menstrual cycles of 25 to 35 days). It is not necessary to do ovulation prediction tests or to use an app. Ovulation prediction tests don’t really pin-point ovulation and can put the man under pressure to ‘perform’ to order. For many men, such pressure is a passion killer and a libido depressant. Menstrual cycles longer than 35 days are associated with anovulation (failure of ovulation) and require fertility tablets to boost ovulation. Fertility tablets should only be prescribed if sperm quality is good and fallopian tubes are open.

5) Reduce Stress: This is important for both partners. High stress level is bad for fertility. Stress stimulates secretion of hormones including cortisol and adrenaline both of which exert negative effects on the fertility. The stress of day to day living coupled with stress arising from delay in conception can become too much for some couples. It is important to find ways to relax individually or as a couple. Maintaining marital harmony and reducing work related stress are very important.

6) Take Steps to boost sperm quality: A healthy lifestyle is key. Avoid the following: smoking, alcohol consumption, recreational drugs, tight underpants. Healthy diet and regular exercises are essential.

 7) Consider Assisted Conception Treatment sooner rather than later: The type of assisted conception treatment required depends on the results of your tests. For blockage of fallopian tubes or poor sperm quality,  IVF (in vitro fertilization) is the best treatment option. If fallopian tubes are open and sperm quality is good or only mild abnormalities, low tech treatment options may be appropriate. These include simple ovarian stimulation with ultrasound follicle tracking, and Intrauterine insemination (IUI) with superovulation.

8) Never give up hope. Keep trying.

Pray to God to guide you and direct you to the doctor who has the right skills to solve the problem for you. Don’t do all night prayer in church when you should be sleeping with your husband to boost your chances of conception.

J. Adeghe

Consultant – Gynaecology & Reproductive Medicine

St Jude Hospitals & Clinics

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