We all know about the birds and the bees but what about basal body temperature and luteinising hormone (LH)? Having perhaps focused on contraception and avoiding pregnancy for many years, beginning a fertility journey can be daunting, sometimes disheartening and even devastating. It’s no wonder so many women hoping to conceive have questions that they can’t always find the answers to.
This was highlighted by research recently carried out by Boots Ireland. They found that 57 per cent of people aged 25-45 are concerned about their fertility. The survey, which aimed to highlight common fertility concerns and issues, also showed that not being able to have children was the biggest worry for 13 per cent of respondents; for those aged between 25 and 35, this proportion was 19 per cent.
Susan O’Dwyer is the pharmacy strategy and development manager at Boots Ireland. As a qualified pharmacist, she admits that the survey results mirror what she has seen in her years as a pharmacist.
“I have spoken to many people about these issues over the years,” O’Dwyer says. She explains that the survey highlighted the range of concerns people have when it comes to fertility.
“We saw from the survey that the biggest concerns were not being able to have children at all, or not being able to afford any fertility treatments if required,” she says, noting that the survey was carried out in a general population. “Other concerns were perhaps not finding out about potential fertility issues until it is too late, while some people were worried about not being able to have more children.”
For people with specific fertility issues, the survey uncovered a clear knowledge gap, adds O’Dwyer. “They had concerns about where to get more information, the first step to take, or how to understand what their issues might be,” she says. “These were the concerns for people at the beginning of that journey and wondering what they might be able to do to help themselves. We also saw that for people already going through fertility treatment such as IVF, they had concerns around understanding the medication, when to take it and time it properly within their cycle.” This also caused significant stress, adds O’Dwyer; “not only is it expensive but there is also the worry that it’s not going to work.”
Yet despite fertility issues clearly being at the forefront of so many minds, it can still be something of a taboo topic, and problems can often be dealt with alone. It isn’t something that’s necessarily discussed openly, O’Dwyer admits. “It can be very personal. In a pharmacy setting you would have people coming into you for advice, it’s different because they are happy to talk to us and their GPs as health professionals.”
The research findings gave a strong hint that this may be changing, however; 72 per cent of respondents agreed that people are beginning to open up about their fertility and infertility issues. “Obviously some people would prefer to be private but others are still afraid to talk about it. Things are starting to change but we probably still have a way to go in that area,” O’Dwyer says.
The survey also illustrated how women are often disproportionately impacted by fertility struggles, shouldering much of the responsibility in the quest to start a family. “We know that some fertility issues will be down to the women, some to the man and in some cases they can’t determine the reason,” O’Dwyer explains. “Unfortunately, much of the investigation does focus on the women and when it comes to fertility treatments, the vast majority is focused on the female - trying to ensure that the cycle is optimal, that the female is ovulating, that you are timing intercourse to coincide with the best time in her cycle.”
The reality is that the biological clock ticks for everyone. O’Dwyer points out that same sex couples, whether male or female, can experience the same struggles and worries. “You can also have individuals on their own struggling with these issues,” she adds.
Understanding the basic biology behind conceiving is key. There are only certain days of the month when conception is likely
Women aged under 35 are advised that it can take anything up to a year to conceive - by the end of that year, most couples will have conceived naturally and it’s suggested that those aged over 35 wait six months before seeking assistance. Playing the waiting game can be challenging, O’Dwyer says. “People get downhearted if they start trying and nothing has happened within a couple of months but it can take up to a year. That said, a year is quite a bit of time and that can cause stress so it can affect people emotionally and mentally.”
O’Dwyer suggests that couples who want to take some control of the situation in the meantime can ensure they are in the best health as they try to conceive - that means eating well, taking lots of exercise, avoiding stress, and maybe limiting or cutting out alcohol, tobacco, and caffeine. “You want to be in a good place physically,” she explains.
Dietary supplements may play a role, she adds. “Every female that is trying to conceive should be taking a 400 microgram daily supplement of folic acid. Vitamin D contributes to the normal function of the immune system and has a role in the process of cell division. Some studies suggest it may be beneficial and supplementation may help if someone is deficient for example. There are also fertility-specific supplements that are available that would have a range of vitamins and minerals tailored to support conception. Speak to your pharmacist to see what specific supplements they would recommend for you as some may not be suitable for everyone so it’s important to have that conversation.”
Understanding the basic biology behind conceiving is also key. There are only certain days of the month when conception is likely, so O’Dwyer advises women to become familiar with their menstrual cycle.
“You need to understand how the woman's cycle is working, as you can only get pregnant in the five days leading up to and around ovulation. That’s because sperm can survive in the body for up to five days but once the woman releases an egg, that’s only available to be fertilised for 24 hours.” Having regular intercourse every two to three days during the month will ensure this window is captured but simple ovulation kits available over the counter in the pharmacy can help couples be more precise. “These detect a hormone called LH that tends to peak in the middle of your cycle when you are ovulating. Using things like ovulation kits to understand that can really help with timing.”
O’Dwyer adds that some women prefer to chart their daily basal body temperature, by taking their temperature using a very accurate thermometer, typically first thing in the morning. “Your core body temperature rises by about 0.2 of a degree immediately after you ovulate and stays elevated until the end of your cycle. You need a very accurate thermometer to see that minor shift in temperature but by tracking your temperature over a few cycles you can often find a pattern,” she explains.
Ultimately, O’Dwyer recommends a combination approach: “Tracking your cycle, looking at your basal body temperature, maybe looking out for signs of your fertility like cervical mucus and trying the ovulation kits that you can purchase over the counter in your pharmacy. Talk to your pharmacist - if what you are doing doesn’t seem to be working or you are getting invalid results, they can help.”