Trying to Conceive – Fertility Tips and Treatment

What Is the Trying-to-Conceive Phase?

The trying-to-conceive (TTC) phase refers to the period during which an individual or couple actively attempts to achieve a pregnancy. It begins with the conscious decision to start a family and ends either with a confirmed pregnancy or the conclusion of fertility treatments. This life phase carries significant biological, emotional, and psychological dimensions.

Biological Foundations

Achieving a pregnancy requires several biological conditions to be met. In women, a regular menstrual cycle, healthy ovulation, and open fallopian tubes are essential. In men, sperm quality — including count, motility, and morphology — is the key factor. Conception is most likely when intercourse occurs during the fertile window surrounding ovulation.

Fertile Window and Timing

In a typical 28-day cycle, ovulation occurs around day 14. The fertile window generally spans the five days before ovulation and the day of ovulation itself. Methods for identifying the fertile window include:

• Basal body temperature (BBT) charting (a slight rise in temperature occurs after ovulation)
• Cervical mucus monitoring (mucus becomes clearer and more elastic around ovulation)
• Ovulation predictor kits (OPKs) that detect the LH surge
• Ultrasound monitoring by a healthcare provider

How Long Does It Take to Conceive?

For healthy couples under 35, approximately 80–85% will conceive within one year of regular unprotected intercourse. After two years, the figure rises to around 90%. Medical guidelines recommend consulting a specialist if pregnancy has not occurred after 12 months (or 6 months for women over 35).

Possible Causes of Difficulty Conceiving

When pregnancy does not occur despite regular attempts, a range of underlying causes may be present. Both partners can be affected equally:

Causes in Women

• Ovulation disorders (e.g., polycystic ovary syndrome, PCOS)
• Endometriosis (uterine tissue growing outside the uterus)
• Blocked or damaged fallopian tubes
• Thyroid disorders
• Diminished ovarian reserve (often age-related)

Causes in Men

• Reduced sperm quality (oligozoospermia, asthenozoospermia)
• Hormonal imbalances
• Varicocele (enlarged veins in the scrotum)
• Previous infections (e.g., mumps orchitis)

Unexplained Infertility

In approximately 10–15% of couples, no specific cause is identified despite thorough testing. This is referred to as idiopathic infertility.

Diagnostic Evaluation

Evaluation of couples struggling to conceive typically involves testing of both partners:

• Hormonal blood tests (FSH, LH, AMH, testosterone, and others)
• Ultrasound of the uterus and ovaries
• Semen analysis (spermiogram) for the male partner
• Hysterosalpingography (X-ray imaging of the fallopian tubes)
• Laparoscopy when endometriosis or adhesions are suspected

Treatment Options

Depending on the underlying cause, several treatment approaches are available:

Medical Treatment

Ovulation disorders are commonly treated with clomiphene citrate or gonadotropins to stimulate egg development. Thyroid conditions and elevated prolactin levels are managed with targeted medication.

Intrauterine Insemination (IUI)

Prepared sperm are placed directly into the uterus to shorten the distance to the egg. This method is often used for mild male factor infertility or unexplained infertility.

In Vitro Fertilization (IVF) and ICSI

In IVF, eggs are retrieved from the ovaries and fertilized in a laboratory setting, after which resulting embryos are transferred to the uterus. ICSI (intracytoplasmic sperm injection) is a variant of IVF in which a single sperm is injected directly into an egg — particularly useful in cases of severe male infertility.

Surgical Interventions

Blocked fallopian tubes, uterine fibroids, or endometriosis can be treated surgically to improve the chances of natural or assisted conception.

Lifestyle and Recommendations

A healthy lifestyle can have a positive impact on fertility. Key recommendations include:

• Maintaining a healthy body weight (BMI 19–25)
• Quitting smoking for both partners
• Reducing or eliminating alcohol consumption
• Taking folic acid (400 µg daily) at least 4 weeks before trying to conceive
• Engaging in regular, moderate physical activity
• Managing stress through relaxation techniques or counseling

Psychological Aspects

The trying-to-conceive phase can be emotionally demanding. Anxiety, repeated disappointment after negative pregnancy tests, and social pressure can significantly affect the well-being of both partners. Psychological counseling and peer support groups can provide valuable assistance. Open communication between partners and professional support from fertility specialists are both important components of navigating this phase.

References

1. World Health Organization (WHO): Infertility – Fact Sheet, 2023. Available at: www.who.int
2. National Institute for Health and Care Excellence (NICE): Fertility problems – assessment and treatment. Clinical guideline CG156, 2013 (updated 2017). Available at: www.nice.org.uk
3. Gnoth C. et al. – Time to pregnancy: results of the German prospective study and impact on the management of infertility. Human Reproduction, 2003; 18(9): 1959–1966.