Fertility. Of all the 'F words' out there, it's by far the most frustrating – not to mention baffling. You spend more than a decade of your fertile life trying desperately not to get pregnant and then, as your 35th birthday edges ever closer, it all gets very complicated. When should I start trying? How long should it take? How can I improve my chances?
The simple answer is that there are no simple answers. Everyone's different, and there's no exact science when it comes to fertility.
But there are some pretty unhelpful myths out there that don't make matters any clearer. And some of them are so widespread you might even have heard them from your GP – never mind what you've been told by your impatient mother-in-law, your best friend, and all those frantic Google searches.
We spoke to the experts to get the lowdown on some of the most common fertility misconceptions.
1. Normal, healthy couples conceive quickly
Wrong. While it is possible to get pregnant on the first attempt, many women have 'an unrealistic belief about how quick it is to get pregnant,' says Mr Mostafa Metwally, a Consultant Gynaecologist and member of the British Fertility Society (BFS) Committee.
'Even if everything is perfect, intercourse happened at the right time, the sperm is there, the egg is there, there's no problem, the chance of that resulting in a pregnancy is only about 20 per cent in any one monthly cycle,' he explains. 'If you had 100 normal couples trying to conceive, only about 75 of them would be pregnant by the end of the first year.'
By the end of the second year, he adds, 95 of them would be pregnant – and only around five per cent of normal couples have problems where it takes beyond two years to conceive. That said, around one in seven couples may have difficulty conceiving – so if it's not happening right away, you're far from alone.
2. If a couple can't conceive, it's usually a problem with the woman's fertility
When it comes to problems conceiving, there's an automatic assumption that it's all down to the woman's fertility – ageing eggs, ticking biological clocks, career women leaving it too late, and all that. According to Mr Metwally, this is where GPs most often get it wrong.
'Often the focus is all on the woman. We'll get a referral just for the woman, and when you ask GPs to do a sperm test, it's like you're asking them to do something extra,' he says. 'It's still very much viewed by many in the medical profession, and by most patients as well, that infertility is a female problem.'
In reality, he adds: 'In at least 50 per cent of couples with infertility, there is a male factor. In 20 per cent or so, it's the sole factor, and for the other 30 per cent there's an additional male factor on top of the female problem. As a fertility specialist, you're treating them as a whole couple – the man isn't just there to drive her to the appointment!'
When it comes to IVF treatment, in fact, patient charity Fertility Network UK) reports that: 'male fertility problems are the most common reason for couples to seek IVF (37 per cent), with female fertility problems and unexplained problems representing 31 per cent and 32 per cent, respectively.'
3. Fertility drops off a cliff at 35
Ok, this is where it gets tricky. We've all heard that 35 is the magic number, but how much truth is there in that? 'Every woman should know her fertility vital statistics,' says Aileen Feeney, chief executive of Fertility Network UK. 'By 28, female fertility has already begun to fall; from 35 female fertility plummets; by 42 your chance of becoming a biological mother is vanishingly small. Beyond 45, IVF has a 96 per cent failure rate.'
But more and more women are leaving it later. The average age of mothers is now 30.5 years, and steadily rising each year, so how important is age really? 'We very often see women who've been told by their GP that it's simply never going to happen, and there's no such thing. Even to women in their mid-forties, we never say never,' says Mr Metwally.
'But it is true that fertility decreases with age,' he adds. 'More importantly, there's also an increase in bad reproductive outcomes. A woman in her early thirties might have a one in four chance of miscarrying; in the late thirties, that might go up to one in two or one in three.'
While women do conceive and give birth naturally well beyond 35, be aware that it's a gamble. Fertility problems increase exponentially, both the older you get and the longer you've been trying,
'If you're 33 years old and you've already been trying for one year, you've never been pregnant before, and your partner's got a progressive sperm count, which is normal, your chance of conceiving if you try for another year is only 29 per cent – which I think is a lot lower than most people would expect,' explains Professor Scott Nelson, a leading fertility expert and researcher funded by charity Wellbeing of Women.
'Even if you're 25, if you've already been trying for a year then your chance of conceiving in the next year is only 38 per cent,' he adds – although at 25 you obviously have more time left to seek treatment if problems do arise.
4. Lighter periods make it difficult to conceive
You might have heard that having light periods means the lining of your womb's too thin for implantation, or that long-term use of hormonal contraceptives can harm your fertility. 'Heavy or light periods are a symptom, not a diagnosis, so can't really be linked to fertility problems,' says Dr Jackie Maybin, who's been funded by Wellbeing of Women to research heavy periods. However, she adds, abnormal menstrual bleeding may be linked to conditions like endometriosis, fibroids, premature ovarian failure, or polycystic ovary syndrome (PCOS), which can all affect fertility, so it's worth checking whether your monthly bleed falls within the 'normal' range.
Likewise, the British Pregnancy Advisory Service(bpas) highlights that there's no evidence that past abortions, or use of hormonal and/or emergency contraception have any long-lasting effects on your fertility – although untreated chlamydia might.
5. You have to time your ovulation to get pregnant
Recent years have seen an explosion in fertility tracking apps, wearables and over-the-counter ovulation tests, but Mr Metwally says obsessively timing intercourse can cause more problems than it solves. 'It often leads to a huge amount of stress, and [sex] becomes a very mechanical kind of act, which can actually be detrimental,' he says.
'What we advise couples is to have regular unprotected intercourse two to three times in a normal week, without any restrictions or timing,' he explains. 'It's really important to know that there is a window of at least 24 to 48 hours for intercourse to happen either before or after ovulation. You don't have to have sex at the exact moment of ovulation to get pregnant!'
6. Celebrities can get pregnant into their 50s, so you can too
We're forever seeing headlines about female celebrities falling pregnant in their 40s and even early 50s, but Professor Nelson says this gives many women false hopes about their chances of conceiving naturally later in life. 'For many of these women, they will have had their baby through egg donation, and they won't necessarily talk about it,' he explains. 'Celebrity culture really contributes to the lack of awareness about the impact of age on fertility.'
7. You have to try for 12 months before your GP can refer you
As a general rule, NICE guidelines state that: 'a woman of reproductive age who has not conceived after one year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner.' However, women should be offered earlier referrals if they're aged 36 or over, or there are possible contributing factors that are already known about.
8. Natural solutions and complementary therapies are an alternative to fertility treatment
There are lots of old wives tales around things you can do to improve your conception changes – ranging from the fairly mainstream to the downright woo-woo, but experts advise caution. 'Alternative treatments are a very hot topic, but they aren't really evidence-based,' says Mr Metwally.
'I would have no problem if a woman came to me for fertility treatment and said, 'do you mind if I do acupuncture at the same time?' but what we don't want to see is patients postponing proper medical treatments to try acupuncture for a year or two first.'
9. If all else fails, there's always IVF
While IVF is a good backup option for couples struggling to conceive naturally, Professor Nelson says, it's important to have realistic expectations about how it works. 'A lot of people will think of it only in the context of one cycle of treatment, because that's all they can afford, or that's all they're funded for, but actually the vast majority of people will not have a baby from one cycle of IVF,' he explains.
'With multiple cycles of treatment there's a really high probability that you'll be successful, so it's important to view IVF as a package of care across multiple cycles, with a cumulative outcome,' he adds.
While this can be an emotionally and physically demanding process, he also advises couples not to lose too much time between cycles if the first (or second) attempt doesn't work. "IVF success rates go down from 34 onwards, by about 0.3 per cent per month, so don't mess around once you're in the programme," he says.
"It sends people on a psychological rollercoaster for sure, but we need to work on setting people's expectations much better at the start.