What else should I do now in order to conceive?

Woman praying

I am a 28y woman and have been married for 3 years. I have never conceived all this time despite not using any contraception. All my check-ups have turned out normal. 

You have a genuine reason to get concerned after having failed to conceive for 3 years. One year is considered as the maximum period that should have elapsed prior to couples getting concerned about a potential delay in conceiving. However, very young couples like yourself could always give themselves extra time, as most would still conceive within 2 to 3 years without resorting to fertility treatment.

The initial steps should be a gynecological assessment, both for you and your partner. It is important that both of you get to be seen together, as the problem could be from either of you or shared between the two of you. Women have always taken the initial initiative for a fertility assessment, but this unfairly implies a one-sided responsibility for infertility. Men’s contribution to infertility is in the region of 30 to 40 percent, hence their involvement in a fertility assessment is crucial to identifying a cause in a timely manner.

Your basic assessment should include a review of your reproductive system, in addition to your general health and lifestyle. Regular periods imply a normally functioning female reproductive system. If you are in good general health, a non-smoker and of normal weight, your potential for spontaneous conception remains good. Initial tests include confirmation of ovulation, assessment of the Fallopian tubes, and pelvic imaging to assess the reproductive organs. Further tests may be advised depending on individual parameters.

Male assessment is fairly simple. If your partner is in good general health and lives a relatively healthy lifestyle, a sperm test is all that is required to start with. Men who have a normal sperm test don’t usually require additional testing unless they have other issues like problems with maintaining an erection. Any abnormal sperm results require additional testing to explain the abnormality and identify a remedy.

Your partner’s assessment is the only missing link as you say your tests are all normal. If his testing turns out abnormal, then further efforts must be directed to him. Remedial measures will depend on the specific problem identified and may range from simple lifestyle modifications to complex fertility treatments.

If his testing turns out normal, you would then be categorized as having an unexplained delay in conceiving. This warrants a referral to a specialized fertility clinic as 3 years have already elapsed without conception. You may be subjected to additional fertility testing prior to some form of assisted conception. Due to your young age, the chances of success with assisted conception are pretty good. Your chances of spontaneous conception still remain relatively high as well.

Dr. Alfred Murage is a Consultant Gynecologist and Fertility Specialist. 
Contact: amurage@mygyno.co.ke
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