So complex are the biological mechanisms through which pregnancy takes place that conception really is a miracle of life.
Although most of us take fertility for granted, for any given couple planning to have a baby there is a certain level of hormonal, anatomical and physiological health required in order for it to happen.
With the stresses and strains imposed on our bodies by today's hectic and often unhealthy lifestyles it is little wonder that one quarter of all couples wanting to start a family have trouble conceiving.
Thankfully there are many positive steps any couple can take themselves, without medical interference, to significantly boost their chances of conceiving.
How does conception occur?
Conception, the beginning of life, takes place when one sperm cell from the male partner joins together with (or fertilizes) one ovum (egg cell) from the female partner to form an embryo.
This usually occurs in one of the woman's Fallopian tubes. The embryo is then transported further down the tube to the uterus (or womb) where it settles into the wall in a process called implantation. This is the start of a pregnancy.
It may sound simple and straightforward but the process demands fine and delicate biological tuning.
An ovum needs to be regularly released each month from the ovary, a process that can only proceed if a complicated cascade of hormonal events takes place without interference.
This egg then needs to be able to move freely along an unblocked Fallopian tube where it can be fertilized by a sperm and then reach the womb.
The sperm have to be healthy, motile and numerous, although only one will ultimately penetrate the egg and form an embryo with it. Then the lining of the womb must also be receptive to this embryo so that it can embed itself within it and begin to produce the hormones necessary to maintain the pregnancy thereafter.
Any one of these sensitive but essential components of fertility can easily be upset by a number of unfavourable factors. Many, however, are within your control.
Before you start
There's little point taking pains to ensure you conceive if the conditions required to produce a healthy baby once you do succeed have not first been met.
So begin with a bit of 'pre-conceptual care' at least three months before trying for a baby.
You need to plan ahead because by far the most vulnerable time for the baby is in the very first days and weeks of its life and only measures taken in advance of the pregnancy will offer the necessary degree of protection.
Take extra folic acid routinely
A daily dose of 400mcg of folic acid significantly reduces the risk of problems known as neural tube defects such as spina bifida.
A higher dose – 5 mg – should be taken in certain circumstances, such as if a previous baby has been born with spina bifida or any related condition, if either parent has a neural tube defect or if the mother has diabetes.
The folic acid supplement needs to be taken as soon as you start to try to conceive, through to at least the first 12 weeks of pregnancy while the baby’s spine is developing.
Check your rubella immunity
Most women of child-bearing age in the UK have been immunised against German measles (rubella) as part of the infant immunisation programme or while at school, but some will have missed out and in a very few the vaccination fails to work.
A rubella infection during the first four months of pregnancy can seriously affect your developing baby's sight and hearing as well as causing brain and heart defects.
So any woman who is unsure of her immunity is best advised to have a blood test to find out and then, if required, a vaccination to protect against the infection at least three months prior to conceiving.
Any concerns you might have as a couple planning a family are often best addressed before pregnancy begins. This means that any environmental or lifestyle hazards, any inherited conditions or any worries about prescription medicines, previous sexually transmitted diseases or AIDS can be put into perspective.
- Talk to your doctor before planning a baby if you suffer from any long-standing problem or have any particular worries.
- There is no need to wait a while after stopping the contraceptive pill before trying for a baby, although giving your body a chance to get back to a natural cycle can help you to be more certain about the date of conception.
- Give up smoking.
- Cut down on alcohol or ideally cut it right out.
- Talk to your doctor about genetic counselling if any inherited disorder exists in either family.
How to boost fertility naturally
It takes the average couple between one year and 18 months of normal 'trying' to conceive.
However, for those who are impatient or anxious when pregnancy does not happen immediately, and for all those who postpone seeking medical help after that duration of time, there are certainly a number of things to consider to help boost fertility naturally.
While late motherhood has much to recommend it, the older you get the less fertile you become – it's as simple as that. This goes for men as well as women.
For women, this is mainly because all the eggs ever released from her ovaries have been there since she was born.
With increasing age there is a progressive reduction in the quantity and quality of those eggs and this affects fertility, which significantly begins to fall after the age of 35.
While men are capable of fathering children into their 70s, most men over 55 experience a gradual reduction in sperm and testosterone production with age and the proportion of men with erectile dysfunction increases too, which only makes love-making more problematical.
Therefore, it's advisable not to leave it too long if you are worried about your fertility.
How often you have sex is another critical factor in fertility. If the frequency is less than about once a week, the chances of pregnancy are very much reduced.
Also, sex needs to involve deep vaginal penetration in order to ensure that the sperm are deposited near to or on the cervix.
The timing is critical too. Fertilization can only happen if lovemaking occurs near the time of ovulation. The egg is released 14 days before the first day of the next expected period (if your periods are regular) and survives for up to 24 hours.
Sperm survive for two to four days inside a woman's body and are most numerous if the man only makes love every second day, so sex every other day from day 11 to 16 of the cycle will maximise the chance of conceiving.
Excess alcohol can cause impotence and reduced sperm counts in men, while increasing the risk of infertility and miscarriage in women. Giving up alcohol at least four months prior to conception is recommended.
Cigarette smoke is toxic to both eggs and sperm as well as to the developing embryo in pregnancy. So much so that smokers take about 30 per cent longer to conceive than non-smokers and have less successful IVF treatments should they become necessary – so quit now rather than later!
Not using other drugs
Recreational drugs, such as marijuana, cocaine and heroin, can all decrease sex hormone levels and make miscarriage, malformation and stillbirth more likely.
A healthy diet begun at least four months before you want to conceive will spring-clean your body and correct any nutritional deficiencies. Eat plenty of unsaturated fats, oily fish, high-fibre foods, complex carbohydrates and non-GM organic soya. Eliminate all drinks containing caffeine, all stimulants and refined sugars. Herbal teas, spring water and diluted pure fruit juices are better.
As well as taking folic acid, add zinc (30mg a day), selenium (100mcg per day), essential fatty acids in the form of linseed oil (1000mg per day) and vitamin B complex to your diet. Vitamin E, C, A and iron are useful too. It sounds a lot, but taking a single multivitamin and mineral supplement designed especially for pregnancy is all that is needed.
Regular moderate exercise confers many health benefits. However, remember that excessive and vigorous exercise and skin-tight nylon shorts can reduce male fertility, while marathon cycling sessions on hard racing saddles can occasionally cause temporary impotence.
The exact link between stress and infertility is not clear but there is no doubt that it exists, and may be contributing factors in as many as 1 in 3 couples who are struggling to conceive.
Too much stress can undoubtedly upset sex hormone levels and the normal menstrual cycle.
Other theories are based on the disruptive effects of high levels of stress hormones such as cortisol, or the effects of stress reduction on improving blood flow to the placenta and improving implantation.
Meanwhile, failure to conceive can in turn lead to tension and further stress.
Stress-reduction techniques do seem to help some women to get pregnant so try to identify and avoid any obvious sources of stress and talk to your doctor if your infertility worries are taking over your life.
Control your weight
Being overweight or underweight can seriously handicap your fertility. Also, changing the quality or quantity of your diet when already pregnant could potentially be harmful to mother and baby, so try to make sure your weight is in the ideal range for your height before you become pregnant.
How can you tell whether you are ovulating?
Ovulation is fairly predictable with a regular menstrual cycle, but knowing that it happens 14 days before the next period is useless if the cycle is not regular.
You can fine-tune the timing of your lovemaking by employing one of the following three methods of discovering when you are ovulating.
A slight temperature rise around mid-cycle can confirm that ovulation has occurred, although it cannot predict it in advance. Electronic digital thermometers allow you to monitor temperatures taken first thing in the morning over a period of time so that lovemaking can be planned at the right time in future cycles.
Cervical mucus method
When a woman is most fertile she will feel wetter vaginally and can test her discharge with her fingers as it changes from dry, lumpy or sticky to watery, clear and very stretchy. This situation lasts for just two or three days each month and this is the time to plan your lovemaking.
DIY ovulation kit method
These kits can be bought over the counter at chemists and measure a hormone surge in an early morning urine sample. A change in colour of the dipstick indicates a hormone surge and predicts ovulation in the next 24 to 36 hours, during which time intercourse should take place.
When to see your doctor
For most couples the chance of conceiving in each monthly cycle is about 1 in 5 or 6 – the same odds as throwing a six with a dice. If you keep throwing a dice, or your keep trying for a baby every month, your chances of conception increase accordingly.
Your GP can also offer advice on any regular medicines you might be taking as some may reduce fertility or have a potentially harmful effect on an embryo, and all are best avoided if at all possible when planning to start a family.
Couples who are in their 30s, when fertility may naturally be starting to decline, should seek advice from their GP sooner rather than later.
Most NHS clinics provide a comprehensive range of basic tests to discover why you cannot conceive.
GPs can themselves initiate the simplest tests and then refer if and when appropriate to the specialist hospital clinics.
It's often suggested that a couple should keep trying for a pregnancy for at least 18 months before its worth thinking about testing fertility. But in older couples, it may be worth getting checked out after a year with no success, or even sooner, as time is not on their side and the likely success of either natural conception or fertility treatments steadily falls.
Many fertility treatments such as tubal surgery or ovulation induction are offered under the NHS and some go further and provide a limited amount of IVF treatment depending on funding. In some cases, however, private clinics may be the only realistic option. To find out more about investigations and treatment please read our factsheet on infertility and assisted conception.
Good luck with your plans to start a family, and whatever you do, enjoy the practice!
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