Thinking of using IVF? Try this first
After pregnancy, anxiety about infertility is the main reason women of childbearing age consult their GP. One in three women experience problems in getting pregnant, with seven out of 10 childless women over 30 worrying that they are infertile.
In their anxiety to beat the biological clock, many couples may be opting unnecessarily for assisted conception before they have exhausted natural alternatives that cost less in time, money and emotion.
So, if your new year's resolution was to get pregnant in 2010, here are some ways to improve your chances with none of the expense, side-effects or hassle of IVF.
As the joke goes, keep on trying normal conception methods -- in the kitchen, the bathroom, the garden shed, anywhere you fancy. If you've been on the Pill or are trying for a baby in your late twenties or your thirties, it's normal for conception to take some time -- and you might as well enjoy the wait. After six months of trying, 60pc of couples have conceived. After a year this rises to 80pc.
Instead of panicking that you're infertile or turning your encounters with your partner into a baby-making chore, follow the advice of conception-wise women and keep the romance alive and the sex hot while making babies.
Have sex often
Getting to know your menstrual cycle, and particularly the signs that you are ovulating, is becoming a popular method of speeding up conception through monitoring vaginal discharge or vaginal temperature, or by using a commercial kit such as the Clear Blue Ovulation Kit.
There is some evidence that these are successful -- with one study showing a 65pc pregnancy rate among 500 couples who used a self-monitoring technique for 18 months. However, Zita West, a fertility guru, warns such methods can make conception more problematic by creating an obsessive atmosphere.
"Men need testosterone for drive and passion. Getting texts at work telling them that tonight's the night can interfere with their sex drive so that they can't get an erection," says West, whose latest book Guide To Fertility and Assisted Conception will be published in March.
In any case, she says, ovulation shouldn't be the focus of attention. "Women should keep their eye on the sperm, which is able to fertilise an egg over a period of several days," she says. "As long as a couple is having sex three times a week every week, they are ensuring that active sperm will be available whenever ovulation occurs."
Get a test
Over the past three years, home kits have become available over the counter that test female fertility potential by accurately predicting a woman's ovarian reserve -- many of them developed by infertility experts.
Plan Ahead, a test kit which works by measuring the number of eggs in a woman's ovaries and indicating what that level might be like in two years' time, with the opportunity for a follow-up consultation, was developed by Professor Bill Ledger of Sheffield University.
Having a test as part of a wider consultation makes sense, says fertility expert Zita West. "Assessing fertility will not give a simple yes/no answer. A fertility test doesn't show whether a woman is ovulating or whether her tubes are blocked.
"And there are all sorts of other factors, including the woman's physical health, that of her partner, potential risk factors, lifestyle issues and your psychological health -- all of which need to be taken into consideration."
Increase sperm mobility with a gel
Conceive Plus is a non-spermicidal lubricant gel that mimics the natural fertile cervical fluids to help increase the mobility of the sperm, thereby increasing the chance of getting pregnant.
One study claiming efficacy has just been published and, compared to other options, it's one of the cheaper ways to assist conception.
Don't leave it too late
Is the trend of late motherhood truly irreversible? Yes, say many experts. "You can lecture or moralise to modern women that they should get married young and have children early like their grandparents did, but they will not accept that condescending, patronising view -- in fact, they very much resent it," says Dr Sherman Silber of the Infertility Centre of St Louis in Missouri.
Dr Geeta Nargund, head of reproductive medicine at St George's Hospital in south London, disagrees. "Society can make it easier for women to decide not to postpone motherhood," she says.
"There are always going to be women in their twenties and early thirties who put off having children because they haven't found a partner. But many others delay because of money worries or because they haven't got anywhere to live or they're not settled in a career.
"Affordable housing, good, free childcare and flexible career posts will all help make early parenthood attractive."
Dr Nargund will be helping to launch a political campaign on fertility next month on International Women's Day (March 8) on behalf of the charity, the HER Trust (www.hertrust.org).
It will call for "fertility protection" featuring in secondary education, with pre-conception care clinics set up to provide individualised advice on fertility to couples. "I'd like to see a truly family-friendly policy be debated . . . with a strategy for reproduction and family life replacing the current focus on fertility treatment," she says.
Obesity is a leading cause of irregular ovulation, making it more difficult to conceive naturally -- as well as interfering with assisted conception. Getting to a healthy weight raises the chances of getting pregnant -- though women should never be made to feel that this is yet another pressure at a time when their peers are all reproducing. Stop smoking and cut out recreational drugs. It is advisable for women trying to become pregnant to keep their alcohol intake to fewer than six drinks a week.
Assisted fertility: the success rate
Having three courses of IVF at the end of the first year of trying for a baby gives a woman an extra 4pc chance of getting pregnant. After three years that figure doubles to 8pc.
The statistics were reported last year by Dr Geeta Nargund, who created a computer programme that simulated the success rates of 100,000 women trying for a baby to compare the success rate of IVF with normal conception methods.
The message, says Dr Nargund, is that, except where there is an obvious cause of infertility, younger women should avoid stressful and unpleasant IVF and instead follow lifestyle and nutritional advice and other simple approaches to conception for at least a year.
Freezing your eggs is complex
It's being touted as the simple solution to late motherhood. Removing and freezing eggs or even ovarian tissue is becoming a realistic option for women in their 20s who want to put their biological clock on pause either because of money or career concerns or because they have not found Mr Right.
Yet far from being an alternative to IVF, using frozen ovaries or ovarian tissue inevitably involves ever-more complex in-vitro technologies.
"It's a lot more complicated to fertilise a frozen egg than one that has just been removed," points out Dr Nargund.
There is also concern that as an insurance measure, the risks are high and the
guarantee of success at the end of it all is low -- with the chances that the procedure may create false optimism for women.
In November 2009, the British Fertility Society warned that while egg freezing was acceptable as a method of preserving the fertility of women hit by cancer, "it is not a solution to counteract age-related fertility decline".