Dr Chris Steele gets back to basics talking about conception, fertility and pregnancy.

All about fertility and conception

Planning for a baby is one of the most important times in a couples lives, but many men and women still do not know the best time to conceive and the problems that could affect fertility. Dr Chris is here to take us back to basics and giving a master class in planning for a baby.

Fertility
The fertility of both men and women reaches its peak at about the age of 24 and then begins to wane. A woman's entire stock of eggs, or ova, are formed in her two ovaries while she is still in the womb. Many of these will die before she is born, leaving her with approximately two million eggs at birth.

This process continues until puberty when between 200,000 and 500,000 eggs survive. Of these only 400-500 are released by the ovaries during a woman's fertile years - roughly one per lunar month.

After an egg is released it can be fertilized for around 12-24 hours afterwards.

Fertility facts
- Women can normally conceive from the time of their first period to about 47 years of age
- Women aged 20 years have around 50,000 eggs
- By the time a woman turns 35, she has 15,000 eggs left
- Women in their mid-40s have a 5% chance every month of conceiving

Source: The Family Planning Association

As more and more couples are postponing having children until later in life, reported cases of fertility issues are increasing. Age is the single biggest reason for fertility issues.

The cycle:
It is important for a person to understand their monthly cycle to be able to time ovulation accurately. Ovulation is the release of an egg from the ovary into the fallopian tube where it waits to be fertilized. The egg will remain here and is capable of being fertilized for around 36 hours after release. Sperm live for up to 72 hours, so the optimum chance for conception is the 3-4 days around ovulation - the day before, and 36 hours after release.

Approximately 20% of women in the UK wrongly believe that they are likely to conceive just before or just after their period. Many also believe that it's possible to conceive during any one of the 28 days of their cycle.

If a women has a consistent 28-day cycle, ovulation is likely to begin about 14 days after the day of her last period began. Fresh sperm It is also important that sperm has maximum energy and life. Sperm dies after about 7 days in the testes and therefore ejaculation every 3-4 days is essential to ensure maximised chances of conception.

Infertility - The facts:
- Infertility is defined as 12 months of unsuccessful conception for women under 35. For women over 35, this decreases to six months of unsuccessful conception.
- Women with irregular cycles, suggesting a problem with ovulation, can consider evaluation and treatment as soon as this problem is identified.
- Infertility affects both men and women. Infertility results from a male factor in about 35% of cases, and a female factor in 50%.
- About 10% of infertility problems remain unexplained even after complete medical evaluations.

Medical conditions that can affect fertility
- Polycystic ovary syndrome (PCOS)
This condition - where a woman's ovaries contain a large number of little cysts - cause hormonal imbalances and makes it difficult for eggs to be released. This causes irregular periods, weight gain, hair growth on the body and acne. If you suffer from PCOS talk to your GP for treatment - up 50% of women may conceive within 6-9 months of taking the prescribed drug treatment.

- Blocked Tubes
Damaged, blocked or twisted tubes can cause fertility problems for both men (blocked tubes that carry the sperm) and women (fallopian tubes that carry the egg to the womb). Endometriosis can cause tubal blockages as the womb lining comes away and adheres to the lining inside the fallopian tubes. This is usually accompanied by painful, irregular and heavy periods.

- Hormonal imbalance
As we age hormone levels change. A key hormone Follicle Stimulating Hormone (FSH) increases as we get older. This hormone helps the follicles containing the egg within the ovary to ripen and push mature eggs to the surface of the ovary to be released. As the quality of eggs declines, increasing amounts of FSH are released in order to produce eggs capable of fertilisation. More and more FSH is produced to try and produce eggs capable of fertilisation, and indicates that egg quality (ovarian reserve) has decreased and the chances of the egg being fertilised are reduced. FSH is one of the key hormones that at a significant raised level, indicates the onset of menopause.

- Poor sperm quality
The most important factor is a low concentration of motile sperm. Motile sperm are sperm that swim well. These sperm need sufficient energy and motility to reach, penetrate and fertilise an egg. If concentration of motile sperm is low, there is a reduced chance of conception. Sperm motility is affected by a number of things, including Misshapen sperm (poor morphology). If sperm are poorly formed this will affect their ability to swim well and in the right direction. Obstructions in the vas deferens (the tubes that carry the sperm) will affect the concentration of healthy, motile sperm ejaculated. Various lifestyle factors can also affect the concentration of motile sperm, including smoking, drinking alcohol, diet.

Fertility myths:
1) Myth: It's easy to get pregnant Dr Chris says: "For many people, it's not easy. Yet, friends and family often still put undue pressure on couples with the "what's wrong with you?" syndrome."

2) Myth: Having sex every day will increase our chances of conceiving
Dr Chris says: "The truth is that timing sex during the most fertile days of a woman's monthly cycle will increase your chances - not how many times you have sex."

3) Myth: A woman's menstrual cycle begins when she starts spotting
Dr Chris says, "Close, but wrong. If you're trying to time intercourse, it's critical to identify the first day of your reproductive cycle. Start counting on the first day of normal bleeding or full flow, not when spotting begins. Being off by just a day or two can make a big difference."

4) Myth: I can wait until I'm 40 to conceive. Everyone's doing it.
Dr Chris says: "When you choose to start a family is up to you. But as you make your decision, you should be aware of some basic fertility facts. Getting pregnant - at any age - is not an automatic. And as you get older, it may become increasingly difficult to conceive - despite all the stories you've heard in the media."

Plan Ahead Fertility Test Plan Ahead is a test to help women plan for the future by giving a predictive assessment of the number of eggs in their ovaries, compared to levels expected for women of the same age. It is anticipated that Plan Ahead will be rolled out to chemists, pharmacies and private clinics later in the year.

Plan Ahead measures three hormone levels in the blood. The first two are the ovarian hormones, Inhibin B and AMH; and the third is FSH, a pituitary hormone. The test requires 3mls of blood, to be taken from the arm, on the second or third day of the woman's period. From analysis of the blood sample, the number of eggs present in the ovaries is calculated using the Ovarian Reserve Index and this is plotted onto a graph to show the woman's 'actual' position compared to the average population at that age.

Launched by Lifestyle Choices Ltd, the kit is initially available by mail order (0114 275 5723) or from Boots.com and costs £179.
This content was created on Wed 20 June 2007

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