Most couples will seek their GP's advice after a year or so of trying for a baby, but it's possible for couples to seek advice at an earlier stage - before embarking on 'starting a family'. GPs will provide pre-pregnancy counselling, giving advice on strategies to maximise your chances of becoming pregnant, and ways to ensure the best possible health of both parents prior to conception.
The medical definition of infertility is not conceiving after a year of trying at least three times a week. One in seven couples suffer infertility and nearly a fifth of this is caused by male infertility.
Sperm production occurs in cycles of 74 days and sperm develops best at 34 degrees. Interestingly, it has been observed that, generally, the average sperm count has been dropping over the years - although we don't know definitively know why!
There's a number of variables which can affect your chances of conceiving. Some of these are:
• Ejaculate volume (the average is 3-5ml per ejaculation);
• Sperm count ('normal' is greater than 20 million per millilitre);
• Sperm motility at 1 and 3 hours after ejaculation ('normal' is greater than 50%);
• Sperm morphology ('normal' is greater than 60%)
In the surgery, I would offer the following advice to men to maximise the chance of conception:
Improve Your Sperm Quality
1. Manage stress
Stress can have an effect on fertility and many of the patients I see in the surgery are running at a baseline stress level, which they consider acceptable. Some patients say "Yes, but who isn't stressed?", but I always advise relaxation techniques. You would be surprised how something as simple as yoga or meditation can influence your health for the better.
2. Quit smoking
Smoking may reduce fertility, and there are many other health benefits from quitting.
Interestingly, I find that women are highly motivated to stop when they are planning a pregnancy but the men don't seem to. This may be because they aren't aware that smoking can have a direct effect on the man's fertility.
Do seek advice about how to stop smoking correctly. Far too many patients buy some Nicotine gum, try it for a week or two and stop; to be successful most people need a course of nicotine replacement appropriate for their level of smoking for at least three months.
Good news – it's currently available on prescription!
3. Reduce your alcohol intake
Too much alcohol may decrease fertility, so ease off on the booze if you want to maximise your chances.
If you think you drink too much (more than 28 units per week) and can't stop, then seek help from your GP now. You may be referred to a team of counsellors, therapists, doctors who all specialise in managing the alcohol problem in partnership.
There are some studies that suggest that zinc supplements could improve sperm quality, as zinc is essential in the formation and maturation of sperm cells.
5. Tight Pants
Sperm quality is best at 34°C, a little cooler than core body temperature. Sperm cannot survive at body temperature, which is why testicles hang on the outside! So wear loose fitting underwear to avoid your testicles getting too warm.
Apart from sperm quality, some men suffer with erectile dysfunction, defined as an ongoing inability to achieve or to maintain an erection sufficient for sexual intercourse. This happens if the flow of blood to the penis is reduced, and can be caused by certain medications, diseases such as diabetes, or injury. In any case, the chance of erectile dysfunction increases with age.
The bad news - many men don't come to the surgery to discuss this problem.
The good news - for most of these men treatments work. They range from medications (like Viagra) to psychotherapy and even devices like implants. Your GP should be well placed to discuss what would be best suited to you.
Your sperm numbers will be greater in an ejaculate if you abstain for 2-3 days. This can be synchronised with your partner's most fertile time to maximise your chance of a pregnancy.
There are several areas where women can improve their fertility too. Some of these are similar to the advice for men.
Alcohol should be taken in moderation, and certainly avoided during pregnancy. In the first three months abstinence is especially important as it can affect the growth of the baby as well as its intellectual development.
2. Quit smoking
Smoking can reduce your fertility, and there is also increasing evidence that there is a higher chance of your baby suffering cot death if you or your partner smokes. Smoking during pregnancy is also linked to reduced growth of your baby and an increased chance of the baby being born prematurely.
I would strongly suggest seeking support from your GP to give up smoking, ideally in advance of trying to become pregnant. Nicotine replacement therapy over a course of three months can be really effective.
A healthy balanced diet will help your fertility as well as your general health. In addition I suggest you speak to your nurse or GP about a list of foods you should avoid during pregnancy like liver, soft cheeses, any uncooked meats and vitamin A. Surgeries usually provide a leaflet listing the foods to steer clear of.
4. Review existing medical conditions
The pre-pregnancy counselling is an excellent time to review any pre-existing conditions to maximise your fertility and chance of a successful pregnancy. If you are diabetic, ensuring good blood glucose control before getting pregnant is important. If you have asthma then you should ensure you have this controlled as your asthma can be affected by your pregnancy.
There are medications you can buy over the counter, which may affect your fertility and pregnancy. You should always consult the pharmacist if you are, or are trying to become, pregnant.
You can maximise your chance of conceiving by targeting your ovulation time. Typically this occurs between day 11 and day 15 of your cycle, where day one is the first day of your period. This does assume that your cycles are regular. Some women's cycles vary but your GP should be able to help you calculate your most fertile period. Alternatively you can buy packs at the chemist which help you predict your ovulation by measuring your body temperature, which rises as you ovulate.
If you are planning a pregnancy I suggest checking your Rubella status with your GP and to start taking a vitamin called Folic Acid, which you can buy over the counter. This has been shown to reduce the risk of your baby developing spina bifida defects.
Seeking GP's advice
If you haven't been successful after trying for a year you may want to discuss possible causes with your doctor. Typically this involves a series of blood tests for women and a sperm count for men.
The good news - six out of seven couples are perfectly fertile so, along with the advice above, the best thing you can do to maximise your chance of a pregnancy is to enjoy sex at least three times per week!