If you are having problems conceiving, you are not alone. The World Health Organisation (WHO) estimates that there are 48.5 million infertile couples worldwide after 5 years of trying to conceive.1
Globally it is estimated that 15% of couples are affected by infertility issues.3 According to the UK – NHS, 1 in 7 couples in the UK have issues naturally conceiving during their lifetime, that’s almost 3.5 million people affected by infertility.4 An important factor in women’s fertility is age. Studies show that women’s fertility begins to decline in her late 20s. The probability of pregnancy is twice as high for women aged 19-26 years compared with women aged 35-39 years.5 Your fertility potential depends on the availability of healthy eggs and as you get older your ovarian reserve declines with access to fewer eggs of reduced quality.
What causes infertility?
According to the WHO infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. Infertility can be caused by many different things, including male or female factors or a combination of the two. Male factors include sperm issues, such as low sperm count, poor motility, poor sperm quality, or problems with the tubes carrying the sperm.
What causes infertility in women?
The most common identifiable causes of female fertility problems are ovulatory disorders, tubal disease or endometriosis. According to UK – NICE guidelines 1 in 4 women with infertility issues have ovulation issues, which means there is no egg released or the ovaries only release a mature egg in some cycles but not all.6 Ovulation issues can result from;
• premature ovarian failure, which is a loss of function of the ovaries before the age of 40
• thyroid problems, if your thyroid gland is either over or underactive, both can impact ovulation
• polycystic ovary syndrome (PCOS)
Getting pregnant with Polycystic Ovary Syndrome (PCOS)
In the UK it is estimated that 1 in 5 women are affected by PCOS, over half of them don´t have symptoms.4 PCOS is a hormonal imbalance, including high levels of insulin. The exact cause of PCOS is not known, but in many cases it is congenital. Women with PCOS often fail to ovulate or ovulate infrequently and may have elevated Luteinising Hormone (LH) concentration levels.7 The ovaries develop many small cysts instead of maturing one egg each cycle. Women with PCOS could have symptoms like irregular periods, excessive hair growth, acne and weight gain. Changes to diet and lifestyle, ovulation-stimulating drugs, or IVF might be offered as possible treatment solutions. Most women with PCOS are able to get pregnant with treatment. Many women don´t even know they have PCOS as more than half of the women who suffer with PCOS show no symptoms.4 Testing your LH levels with myLotus provides a first indication of your LH base level and whether it is high from the start of your cycle testing. If you get consistently positive results at the beginning of your LH tests you need to consult your doctor for further advice.
Lifestyle and fertility
Factors such as heavy workload, chronic stress, environmental pollution and unhealthy lifestyles are also known to be related to a rising infertility level. Obesity and smoking have also been shown to reduce fertility in both men and women. There are a large number of parameters that need to combine to form the optimal conditions for a successful conception. Many of these parameters are easily influenced and can fluctuate from cycle-to-cycle depending on the woman. For many women who have problems conceiving it will be a case of aligning as many of these parameters as possible to positively affect conception in a given cycle. To diagnose the cause of infertility is difficult so the general advice is to keep trying, which can be unsatisfactory.
A surprisingly high number of couples (about 25%) receive a diagnosis of unexplained infertility.6 It is unexplained because doctors cannot find any obvious reason why you or your partner might not be able to conceive. Doctors often give advice to keep trying to conceive by having regular, unprotected sex. Typically, after 2 years of naturally trying to conceive, IVF can be offered as an alternative. There is nothing more frustrating than being told to just wait and see. Unexplained infertility is not a disease so there is no treatment, but there are many things you can do to get more information on your fertility.
With unexplained infertility, you and your partner can look after several factors that, cumulatively, could improve your chances of a successful conception. There are a number of hormonal issues and at the early stages of wondering why conception doesn’t happen it is worthwhile checking and monitoring those linked to ovulation. Women may think they know their cycle length and when their fertile phase is but there is sufficient error in their assumptions to potentially affect their chances of conceiving. With an increasing decline of fertility with age it is important to cover as many parameters as possible.
Fertility hormones – Testing at home
The Luteinising Hormone (LH) is the most accurate marker for impending ovulation. Traditional ovulation tests measure LH over a number of days and provide qualitative results when the concentration of LH reaches a certain level. They show symbols for high or peak fertility, when the LH concentration in the urine rises. Many women report that these tests don’t work for them. Women do have a certain amount of LH in their urine at the beginning of the cycle, which is called the base level, but unfortunately there are variations in this base level from woman to woman but also from cycle to cycle.
Some women have a very high LH base level, for example women suffering from PCOS. Others have very low base levels. As a result some women could be shown by these ovulation tests to always be positive, others to always be negative.
There are not only variations in LH concentration levels but also in the type of LH curve, some women have one peak, others 2 or even multiple peaks. 19% of women have a small peak, but only 44% of cycles in women fall within the classic curve pattern, which is a low base line, a single LH surge and back to normal base line level.
myLotus is a new personalised fertility testing and tracking device. It shows what is happening in your body with your fertility hormones. It allows you to measure your fertility hormone concentration levels at home giving you more information, more frequently than other conventional ovulation tests. myLotus provides a “+” and “-“ fertility result as well as showing how much of the LH concentration is in your urine. As myLotus allows you to continue testing for the whole menstrual cycle you can build up a complete picture of your LH profile and check this profile against previous cycles. This could highlight what type of LH surge you have and could provide useful information for the doctor.
Several published research articles show the value of knowing what type of LH surge you have and whether this pattern is similar for each cycle. Information about base levels, the increase from base level during your LH surge, the length of the LH surge and whether or not you have multiple surges can provide useful information for fertility experts as some patterns are linked to the probability of conception in that cycle. Being able to look at your LH concentration level and seeing your personal LH profile will help you to improve your chances of conception.
1 Mascarahas et al., World Health Organisation report looking at regional, national, and global trends using data from 227 health studies from 190 countries; PLOS 2012.
2 Moghadam et al., The global trend of infertility: an original review and meta-analysis; International Journal of Epidemiologic; Reaserch 2014.
3 Agarwal et al., A unique view on male infertility around the globe; Reprod Biol Endocrinol 2015.
5 Dunson et al., Changes with age in the level and duration of fertility in the menstrual cycle; Human Reproduction 2002.
6 NICE Fertility Guidelines 2013
7 Stanger et al., Reduced in-vitro fertilisation of human oocytes from patients with raised basal luteinising hormone levels during the follicular phase; British Journal of Obstetrics and Gynaecology 1985