After trying to conceive a baby for more than 12 months it is generally suggested that a couple consult their medical professional to perform a few tests to determine the cause of the couple not achieving a successful pregnancy. However, if the woman is over the age of 35, testing can be requested after six months, as fertility has begun it’s natural decline by this age.

The first step for you to take is for both partners to have some testing done to determine where the problem lies.

Generally the male partner is tested first as infertility testing for a man is less invasive than for a woman. Both a blood test and a semen analysis are performed. The semen analysis will tell you about the quantity and health of the male partner’s sperm while the blood test will show if there are any concerns with his hormone levels.

If there are any concerns with the male partner’s tests, it is likely that the female partner is not tested and the couple will work with the information they have already gained. There are times when sperm count and quality can be improved by diet and / or surgery and hormonal issues can be treated as well. However there are times when either the man’s body is not producing the quantity or quality of sperm required for no apparent reason. In these cases it is recommended that the couple look into assisted reproduction therapy (ART).

In the even of the male partner’s tests coming back all clear, the female partner will begin her testing, usually this will involve determining if she is ovulating. The doctor may request that the woman charts her cycle for a few months so she can see if she is ovulating that way. Alternatively, the doctor may request blood tests and ultrasounds at various times of the woman’s cycle to see if her hormones are working correctly and to see if her ovaries are working correctly.

If these tests come back showing that the female partner is ovulating, there are further investigations started. These will check on the health of the woman’s reproductive system and are quite invasive. A hysterosalpingography involves dye being injected into the woman’s uterus through her vagina, she is then given x-rays to determine whether there are any blockages in her fallopian tubes that are stopping the eggs from moving where they need to be. A laparoscopy looks at the health of the ovaries, fallopian tubes, and uterus and can determine if there are any issues such as endometriosis, polycystic ovarian syndrome (PCOS) or if there are any physical abnormalities in the organs investigated.

After testing is completed and an issue is found with either partner, the doctor will help to couple decide which direction to take next, usually this depends on the problem that has presented. Unfortunately though, up to 10% of couples that are tested for infertility in Australia will be diagnosed with “unexplained infertility” which means that they have not conceived a child within 12 months of having unprotected sex, but all of the tests rule out any of the usual problems.

There a variety of options available these days to overcome infertility, such as inter-uterine insemination, IVF, egg or sperm donations or even adoption. Once a diagnosis has been made these options are assessed until the most suitable one is found for your particular case.

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A very helpful way to get to know your body and to learn the best time to conceive a baby is by charting your cycle.

Charting your cycle involves a three steps, the main one is taking your temperature every morning, followed by observing cervical mucus and other cervical changes. To start with, you have to understand why you are taking your temperature.

Over the course of your cycle your basal body temperature changes according to what hormones are in your system. Your temperature starts off low, rises after ovulation and will then either go down to signal your period starting or remain high to signal a possible pregnancy. If you are charting your cycle, you can see graphically where your temperature is and what part of your cycle you are at.

Taking Your Basal Body Temperature

To check your basal body temperature it must be done first thing in the morning before you rise from bed and even before you speak. Set your alarm to wake at the same time each morning & before doing anything else after it goes off, still your thermometer in your mouth (or under your arm or you can even check your temperature vaginally if you choose). Any sort of thermometer will work, but the best type has two decimal places as they are the most accurate in showing any subtle temperature changes.

Record your temperature either on a piece of graph paper or on charting software or websites, such as Fertility Friend.

As the month goes on, you will see that your temperature changes with ovulation and becomes biphasic, which means there are two phases, a lower temperature phase prior to ovulation and a higher temperature phase after ovulation.

It might take a few months to get used to how your temperatures work, but you will start to see patterns emerging about when you will ovulate and how long your luteal phase (the time between ovulation and the end of your cycle) lasts.

The important thing to note is that once the temperature rise has occurred, ovulation has occurred and it is more than likely too late to conceive a baby. You need to be having intercourse prior to the temperature rise, so it is important to chart other ovulation indicators when charting your cycle.

Checking for Cervical Mucus

The next step to helping you understand your cycle is charting your cervical mucus changes.

Like with your temperature, your cervical mucus changes depending on what hormones are dominating at a certain time. Your mucus will change from sticky, to creamy, to water and finally, the mucus at ovulation is named egg white cervical mucus due to it’s consistency being much like that of an egg white.

The best way to check your cervical mucus is to simply look on the toilet tissue when you wipe and then note on your chart, the quality and consistency. At first it may be a bit hard to distinguish between the different types of mucus, but after a little while it becomes second nature.

When recording your cervical mucus on your cycle charting page or software, always record the most fertile mucus that you note for the day. For example you may have creamy mucus in the morning, but then watery mucus in the evening. It’s best to record the watery mucus as your body might be gearing up that night to ovulate.

Observing Cervical Changes

A third way to add to your chart is to observe the changes in your cervix. Some people are uncomfortable about checking this fertility sign, so rest assured that it is a secondary sign, the main two are your temperature and cervical mucus. However if you would like to check your cervix, following are the details on how to do so.

To check your cervix you will need to insert a very clean finger into your vaigna. You will feel a small round object (your cervix) that will have a small hole in it. Notice how it feels.

Prior to ovulation you should be able to feel your cervix quite easily as it starts out quite low in your vagina. Your cervix will feel hard, a little like the tip of your nose and the cervix opening will be closed when you are not in your fertile period. As you come closer to ovulation it will move up higher in your vagina and be quite hard to reach, now it should feel very soft, a lot like your lips. The opening will also be quite noticeable, as your cervix opens up at ovulation to allow the sperm to make their way through. After ovulation the opening will close again and your cervix will go back to being hard like your nose. In pregnancy the cervix stays very high and will become out of reach fairly quickly after ovulation, if conception hasn’t taken place your cervix will move down again ready for your next period to start.

Record your cervical observations on your chart as well.

After charting your cycle for a little while you will start to see some patterns emerging. Perhaps you don’t ovulate on the standard, day 14, maybe it’s earlier or maybe it’s a few days later. No two women are exactly alike and you will see that by browsing through a few different charts.

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There’s a lot to be said for men taking certain vitamin and mineral supplements while they are trying to conceive.

Generally, with most couples, the female partner will start taking some form of prenatal multivitamin formula (like Elevit or Blackmores Pregnancy & Breastfeeding etc) or at the least a folate supplement (like Fabfol), as soon as the couple decides to try for a baby.

More often than not the male partner continues on as before trying to conceive with little regard for changing their lifestyle or increasing their intake of certain vitamins and minerals.

These days however, there are a few options for men in the way of multivitamin supplements that claim to assist with the production of better sperm and overall general health for conception.

The first men’s fertility health supplement to be released was Menevit (in 2008), made by the same people that do the very popular Elevit for women. The key ingredients in Menevit are vitamin C, zinc, vitamin E and folic acid, along with some other vitamins that make it a good well rounded multivitamin as well as a sperm health supplement.

The alternative is SpermMax (released in 2010) which also contains folic acid and zinc, but instead of being a multivitamin it is more aimed at sexual function and decreasing stress.

As you would guess from the ingredients of both of the men’s sperm supplements above, the main ingredient is zinc. Zinc is essential making sperm and the regulation of sperm motility (how the sperm move). The recommended daily intake of zinc is 20-60mg and with so few foods that are high in zinc (oysters, veal liver, sesame seeds & low fat roast beef are the highest) it’s no wonder that men’s fertility rates have been declining in the past few years.

The other common ingredient between the two is folic acid, or folate, which is well known as a supplement for pregnant women to prevent neural tube defects, but it is also beneficial for men’s sperm health as well. Research has shown that men who increase their folic acid intake have fewer abnormal sperm cells. The recommended daily intake for me is 200mg and it can be found naturally in lentils, kidney beans, broccoli and brussel sprouts, but these days there are quite a few different products that are labeled as having added folate.

Of course having a varied diet containing zinc and folate rich foods is the best way to go about things, but we all know with today’s busy lifestyle sometimes we don’t eat as well as we know we should. Sperm supplements such as Menevit and SpermMax are a great way to get the recommended daily intake when your diet is lacking in these essential sperm health vitamins & minerals. They are both simple to take, one tablet once per day, as with female prenatal vitamins they are recommended to be taken for at least a month prior to conception.

While the use of supplements for sperm health can be beneficial, they are not a guarantee to increase your sperm count or improve the health of your sperm. If you have any concerns about the health of your sperm, please see your health professional.

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Recent studies show that both male and female smokers have lower fertility levels than non-smokers and that men and women who are born to mothers who have smoked have a reduced chance of becoming a parent themselves. It is also known that smoking affects the chances of artificial insemination succeeding.

There are more than 4,000 known compounds in tobacco, the most commonly known being nicotine. It has been estimated that every cigarette reduces an individual's life expectancy by 14 minutes.

As well as placing undue pressure on the body's respiratory, circulatory, immune and eliminative systems, smoking interferes with the absorption of vitamins and minerals essential in maintaining reproductive health.

In males, smoking is known to impede fertility by:

• Lowering the sperm count
• Harming the mobility of the sperm
• Affecting the shape of the sperm
• Reducing the amount of semen
• Causing impotence

Sperm Count

Male smokers tend to have a sperm count that is 15 per cent lower than that of non-smokers. It is generally considered that a man has a low sperm count if he has less than 20 million sperm in a millilitre of semen.

There have been a number of reports that male sperm counts have declined over the past few decades and tobacco is known to be one of the key factors.

Other reasons thought to contribute to a low sperm count include nutritional imbalances such as deficiencies in vitamin E, zinc and vitamin B12, and hormonal imbalances. Smoking is also known to interfere with the absorption of vitamins and minerals and disrupt hormone balance.

Sperm Mobility

The health of the sperm will influence performance and therefore fertility. If there is poor mobility of the sperm, also known as "lazy sperm", sperm function and the chance of conception will be affected. Following ejaculation, the sperm may fail to travel the distance through the cervix and uterus to reach the egg where fertilisation can occur.

Quality of Sperm

The quality and shape of the sperm, as well as the quantity, influences the ability to conceive. For example, if there is a deficiency of zinc, the
sperm may fail to penetrate the egg inhibiting fertilisation. Smoking is known to interfere with the absorption of nutrients. Other important trace elements include calcium, magnesium, iron, selenium and copper.

Shape of Sperm

Some sperm are misshapen and therefore cannot function efficiently. The chances of successful conception are unlikely if the sperm are mutated.

Lack of Volume

Smoking has been linked to a reduction in the amount of semen during ejaculation. Low volume is a common complaint in smokers.

Impotence

Also known as erectile dysfunction (ED) impotence refers to the consistent inability for a male to sustain an erection sufficient for sexual intercourse. Males may experience degrees of impotence as a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections.

Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles within the penis to relax, allowing blood to flow in and fill the open spaces.

The blood creates pressure in the muscles, making the penis expand. The membrane surrounding the muscles helps to trap the blood in the muscles thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening out-flow channels.

Any disorder that impairs blood flow in the penis has the potential to cause impotence. It is known that smoking can lead to the degeneration of the blood vessels that carry blood to the penis. An erection cannot occur unless blood can flow freely into the penis. Therefore it is important that these blood vessels are in a healthy condition to facilitate circulation.

Recent studies show that nicotine:

• Closes up the arteries that lead to the penis
• Reduce the pressure of blood in the penis
• Is thought to encourage blood flow out of the penis

Recent figures from the British Medical Association estimate that 12,000 'young' British males are impotent due to smoking. Furthermore the incidence of erectile dysfunction is thought to increase by 50 per cent for men in their thirties and forties.

It is known that smokers who quit immediately improve their chances of producing healthy sperm and conceiving. Health professionals advise couples planning a pregnancy to allow at least three to six months preparation before conceiving so the red blood cells can fully regenerate

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Carbohydrates

Carbohydrates should be unrefined with nothing added and nothing taken away. They include starches, sugars and fibres. They provide energy. Contrary to popular belief they are not fattening if they are eaten in the form of complex carbohydrates.

Good Sources

Whole grains, wholemeal flour, millet, wholemeal bread, oats, oatmeal, buckwheat, brown rice, maize meal, fresh vegetables and fruit. Oats are thought to increase fertility.

Poor Sources

Sugars, white flour, white bread, white pasta, sweets. These are all poor in fibre, vitamins and minerals.

Proteins

Proteins are called building blocks. They are necessary to build or repair tissue, muscles, organs, enzymes and hair.
Proteins are made of amino acids that are broken down in the body to form other amino acids. The potential role of amino acids in preconception health care has only just begun to be understood. Research indicates that the amino acids, spermadine and aspermine, play a major role in the synthesis of semen. Furthermore, the levels of these amino acids have been found to be low in men with low sperm counts. Amino acids are also important in the process of digestion as they form the digestive enzymes necessary to break down food.

Good Sources

Fresh meat, poultry, offal, fish, milk, eggs, cheeses, nuts, pulses and seeds including wholegrains.

Poor Sources

Bought pies, TV dinners, sausages and hamburgers, salamis, pates and other processed meats, and twice-cooked meats.

Fats

Provide energy and build cell walls. Both animal (including fish) and vegetable fats are necessary as part of a healthy diet.
Polyunsaturated fats are found in vegetables, nuts, unheated vegetables and fish oils, all of which should be included in the diet. Monounsaturates such as olive oil are more beneficial in balancing cholesterol levels.

For inspiration on how to incorporate these dietary essentials into the foods you eat check out our Fabulous Recipes and our Healthy Eating section that details information on positive eating and therapeutic foods.

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Cigarettes & Tobacco

Smoking affects the quality of sperm and can inhibit fertility. It interferes with absorption of essential nutrients and has been linked to ectopic pregnancy, critical illnesses at birth and an increased risk of miscarriage. Research indicates that smoking around a pregnant woman affects the developing baby’s growth and causes low birthweight. Smoking in the presence of a newborn can cause chest infections and asthma and an increased risk of Sudden Infant Death Syndrome.

Alcohol

The drinking habits of the male are often overlooked yet it is known that alcohol damages sperm. In heavy drinkers, sperm often lack normal tails adversely affecting the mobility of the sperm. Alcohol is known to affect testosterone levels and has been linked to loss of sperm cells, an increase in abnormal sperm and male impotence.

Recreational Drugs

Marijuana is known to interfere with normal sperm production and harder drugs can damage chromosomes in sperm and cause birth abnormalities. Ideally both parents should avoid taking drugs in the six months before conceiving. Social drugs interfere with absorption of some essential nutrients. Alcohol is known to cause a loss of B vitamins, zinc and magnesium.
The pregnant mother should avoid recreational drugs throughout pregnancy and during breastfeeding as these are known to cross the placenta and can be passed through breast milk.

Coffee

Caffeine is believed to affect sperm mobility and to inhibit the absorption of important nutrients such as iron. Decaffeinated coffee is generally not recommended due to the chemicals used in the decaffeinating process.

Toxic Metals

Toxic trace elements include lead, cadmium and mercury.

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Have More Sex

It’s logical to have more sex. The more sex you have, the more chances you create.

Sexual Positions

Some sexual positions are more favoured for conception than others. Being on all fours with entry from the rear, known as “doggy style” and the conventional “missionary” position of the man on top, are considered best positions as they allow for deeper penetration and work with gravity, depositing the semen at the cervix entrance. This will help in cases of lazy sperm. Sitting positions, the woman on top, or side by side, are less favoured for these reasons.

Stress-Free Sex

A most important factor is to be relaxed. Stress can inhibit reproduction by affecting hormonal balance. Our hormonal system, or endocrine system, is a highly sensitive system. Women whose cycles are not regulated by the pill often experience variations in their cycles.

Many couples become despondent when they do not conceive as quickly as they expected, however, medical experts do not consider it a problem worth investigating until a couple has been trying for a minimum of 18 months. Even then, the chances of a couple conceiving naturally, without medical intervention, remains high and figures indicate that about 90 per cent of couples will succeed within two years.

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Preconception care is equally as important for men as it is for women. Men contribute half the genetic material to the developing baby and the health of both parents at conception contributes to the baby’s wellbeing. For many couples, the birth of a healthy baby is a time of great fulfilment and happiness. Poor health, exhaustion and a low immune system can affect your baby’s development both within the womb and throughout its entire life.

Medical and scientific research is constantly evaluating the factors that contribute to fertility and healthy foetal development and evidence indicates that genetic, microbiological, biochemical, dietary and environmental factors all play a major role. It is now known that smoking, both actively and passively, the prolonged use of the female contraceptive pill, exposure to some pesticides and nitrates, food additives, inadequate dietary status and poor food quality influence chances of conception and the health of the pregnancy, birth and baby.

It takes sperm three months to develop and health professionals advise couples planning a pregnancy to allow at least three to six months preparation before conceiving to enable red blood cells in your body to fully regenerate. During this time, particular attention should be given to maintaining a nutritious and balanced diet, reducing stress levels and conserving your energy.

Establish new habits and make the changes together.

These steps will improve you and your partner’s chances of conception and having a healthy, happy baby:

• plan balanced meals
• always eat breakfast to avoid fluctuations in blood sugar levels
• drink lots of fresh water (2-3 litres daily)
• cut down on ready prepared foods and junk food
• eat fresh, preferably organic, vegetables
• introduce fresh fruits instead of sweets
• reduce coffee and tea to a maximum of one a day
• substitute soft drinks with freshly-squeezed juices and herbal teas
• cut down on alcohol and cigarettes
• do three sessions of exercise a week, brisk walking is beneficial
• allocate time for relaxation

Make the transition gradually so it becomes a way of life rather than just a fad. You will notice an increase in energy and clarity and improved sleeping patterns.

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Conception is the fertilisation of the egg by the sperm and its implantation in the uterine wall.

Not all couples conceive as soon as they stop oral contraception and decide to become parents as some couples are more fertile than others. It may take many cycles for conception to occur, even if both partners are normally fertile, healthy, fit and sexually active.

Many couples today are confronted with “unexplained” fertility problems or have experienced a previous pregnancy that resulted in miscarriage, stillbirth, malformation or impaired development.

It's been estimated that 60 per cent of couples will conceive after three menstrual cycles and that 85 per cent will conceive within a year.

Timing, health, hormonal state and age of both the male and female can all affect conception. A woman under 25 may conceive within two or three months, whereas a woman over 35 may take six months or longer. The reason for this is that as a woman gets older, the vitality and number of her eggs being released which are capable of being fertilised, is in gradual decline.

The quality of sperm is also an important factor, but deterioration only becomes significant beyond the age of 60.

Fertility Times

Women remain fertile for only 24 hours a month. During ovulation the ovum or egg is released by the ovary into the fallopian tube. Whereas ovum remain ripe for 24 hours, male sperm have a longer life span, surviving for four to five days in a woman’s body. This means that there are about five or six days during which time conception could possibly occur each month. To maximise the chances of conception, sexual intercourse ideally should occur in the six days leading up to and on the day of ovulation as the quality of sperm deteriorates the longer it is inside the woman’s body.

Most women ovulate in the middle of their menstrual cycle. In a 28-day cycle, ovulation will occur around day 14.

Your partner may recognise the most reliable signs of ovulation as follows:

• a distinct rise in temperature
• the cervix becomes softer and slightly more open
• the mucus plug, or discharge, comes away from the cervix to allow the entry of sperm
• the discharge has a similar consistency to egg white and is elastic in texture
• an increased libido
• a tugging sensation in her lower abdomen
• The nature of this fertile mucus helps your sperm to swim up through the vagina and cervix, through the uterus and into the fallopian tubes.

Genetic and Medical History

It is important for both of you to assess your family medical and genetic history. Is there a history of diabetes, high blood pressure, heart disease (especially valve replacement), epilepsy, kidney disease, tuberculosis, syphilis, active herpes, cerebral palsy or AIDS/HIV? It may be wise to seek genetic counselling and discuss prescribed medication with your doctor to see if there are implications for a healthy pregnancy. You may need to adjust your medication.

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Absence of live sperm

This can arise due to structural problems such as blocked or twisted seminal tubes or no tubes at all. The endocrine system may not be working properly to stimulate the production of sperm. An injury or birth defect may also be the cause.

Low sperm count

It is generally considered that a man has a low sperm count if he has less than 20 million sperm in a millilitre of semen. There have been a number of reports that male sperm counts have declined over the past few decades.It is generally considered that a man has a low sperm count if he has less than 20 million sperm in a millilitre of semen. There have been a number of reports that male sperm counts have declined over the past few decades.

• Reasons for low sperm count include:
• nutritional imbalances including deficiencies in Vitamin E, zinc, Vitamin B12
• chemicals in the home and workplace
• high stress occupations
• exposure to chemicals and vibrations in the workplace
• high levels of toxic metals such as cadmium or lead
• overheating of testicles caused by wearing tight and frictional clothing
• overheating caused by frequent hot baths. Males are advised to avoid hot baths, as sperm require cool temperatures to survive. This is why sperm are stored in testes that hang outside the body.
• medical conditions including circulatory problems around the testicles
• Drugs, both medical and recreational. Long-term use of tobacco and alcohol can also affect fertility.
• infections
• excessive exercise
• hormonal imbalances

Unhealthy sperm

The health of sperm will influence performance.

• The sperm may have poor mobility and fail to reach the egg
• If there is a zinc deficiency, the sperm may fail to penetrate the egg
• Smoking, alcohol, chlamydia infection, social drugs and some medicinal drugs may also affect sperm function.

Healthy Sperm

Antibodies

Sometimes the man has antibodies in his own sperm that may prevent the sperm from being released at all.

Physical problems

These could include injury to the male sex organs, damage to the testes, or in more rare cases an absence of vas deferens or testes.

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