It is a common fallacy that all a woman has to do to become pregnant is to stop using contraception.
For a lucky minority who are ready to start their families this may indeed be the case but for many other women and their partners timing is all important, especially when both have careers, and postponing a family until the woman is in her late 30s is an option that is occurring more and more frequently.
Unfortunately some women find at this stage that conception is not automatic or easy and indeed it can be a very difficult and stressful time.
What can go wrong?
When investigating a woman who has not become pregnant after trying for some time, it is standard procedure to measure her progesterone levels on day 20 (if she has a 28 day cycle) to establish whether or not she has ovulated.
A rise of progesterone to a specific level indicates that this has happened. It is then often assumed that because she is producing progesterone at this point in her cycle she will go on producing sufficient to maintain the lining of the uterus and for the pregnancy to implant.
It is important to realise that this is not always the case. Sadly it is not uncommon to find that women who have reached the mid 30s are producing insufficient progesterone in the second half of the cycle and this failure in its levels can be enough to prevent the survival of the egg or embryo. This condition is known as luteal phase progesterone deficiency.
The cause of this failure to continue to produce quantities of progesterone is not certain. It may be a failure after ovulation and prior to fertilisation, the result of which would be that the egg would not survive.
Alternatively the failure may occur after fertilisation because the embryo did not produce sufficient Human Chorionic Gonadotrophin to stimulate the corpus luteum to continue to produce progesterone. It could also be a failure of the corpus luteum to respond to the Human Chorionic Gonadotrophin.
Whatever the cause of the lack of progesterone the effect will be the same. The endometrium will be shed and the woman will have a bleed. It can mean that either the pregnancy will never have even started or that, if it did, then an early miscarriage will have occurred.
Often these miscarriages are so early that they are not recognised as such and are considered to be a late period. It is helpful to know if conception has actually occurred, to help pinpoint which problems need to be addressed.
Some miscarriages that occur a little later (say at 10 or even 12 weeks) and are due to the early death of the embryo, may also be due to a lack of progesterone. However, it must be remembered that lack of progesterone is one of only several possible reasons for an early miscarriage.
Pregnancy will obviously not occur if ovulation does not take place. Anovulatory cycles, that is cycles where the woman has a normal bleed and is not ovulating, are quite common in women particularly from then mid thirties onwards.
Unless a woman needs to have blood tests done, or some other reason to investigate her periods, this lack of ovulation can go completely unrecognised – indeed may do so for several years unless there are other symptoms.
If anovulatory cycles are discovered by routine blood tests on day 20 of a 28 day cycle, then the orthodox approach is to stimulate ovulation by use of hormone treatment. This may not always be necessary, and sometimes the use of bioidentical progesterone may stimulate the feedback mechanism between the ovary and the pituitary and re-establish the normal hormone cycle and ovulation.
Also do bear in mind that men have been experiencing declining sperm rates for more than 50 years according to US figures so their fertility too is being affected. French researchers conducted a recent study on men from 17-70 and found an annual drop in both numbers and motility of sperm.
“It’s most likely a reflection of the fact that many environmental and lifestyle changes over the past 50 years are inherently detrimental to sperm production,” says Professor Richard Sharpe, a fertility research expert at the U.K. Medical Research Council (MRC),
What can help?
When stopping the contraceptive pill, or having a coil or implant removed, means it can take up to two years to conceive as the body readjusts and tries to restore normal hormone balance.
Supplemental bioidentical progesterone is key in this process as it is essential in ensuring optimal conditions for the egg to be fertilized and viable and to prevent miscarriage.
Also, ensuring that your diet – and that of your partner – aids fertility is essential. Infertility due to poor nutrition is not uncommon as are the effects of continuous and stringent dietary regimes.
What is needed are good supplies of vitamins A and C and the amino acid cysteine found in dairy foods, onions, garlic and eggs as all these are necessary for the production of the sex hormones. Vitamins B6 and B12 have also shown that they have significantly improved fertility when supplemented in the diet.
‘Fertility foods’ include citrus fruit, wholewheat, fennel, celery as part of a balanced wholefood diet that is low in sugar and any artifical sweeteners or additives.