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Scenario

Customer Alison Kilian is chatting to pharmacy technician Vicky.

“Simon took me to Paris for our wedding anniversary last week,” she says. “I thought we were going somewhere for dinner, but he drove us to the Eurostar!”

“How romantic!” exclaims Vicky. “I can’t believe it’s been a year already.”

“Well yes, it seems only last week we got married, but then on the other hand, I thought our lives would be very different by now,” replies Alison.

“In what way?” asks Vicky.

“To be honest, I thought we’d have had a baby or I’d at least be pregnant,” says Alison. “I came off the pill as soon as we went on honeymoon – I’m starting to think there might be an issue. I’m 30 next year and I’m sure I read that fertility starts to decline then. Any ideas before I go to the doctor?”

Answer

Infertility is usually defined as the failure of a heterosexual couple to fall pregnant within a year, assuming they are having sex two or three times a week. However the National Institute for Health and Care Excellence (NICE) states that while more than 80 per cent of couples will conceive during this time, half of the remaining couples will fall pregnant given the same conditions over the following year. Alison perhaps need not worry too much yet and instead take the following steps to maximise her chances:

• Have sex every two to three days
• Eat a healthy diet
• Stop smoking, including in passive form
• Cut back on alcohol; one to two units no more than once or twice a week
• Ensure a healthy body mass index – being underweight can be as damaging as being overweight or obese
• Manage stress levels – techniques such as yoga and meditation may help
• Check that none of the medicines she is taking (OTC, prescribed, complementary and supplements) can interfere with fertility, and avoid recreational drugs
• Consider whether any environmental factors may be a problem, such as working in a factory or around chemicals.

Alison should also make sure her smear test and rubella vaccination are up to date, and start taking folic acid supplements.

The bigger picture

It is thought that around one in seven couples in the UK has trouble conceiving, and increasing numbers are seeking medical help for the issue. In a quarter of cases, no cause is identified, but in over half of couples the woman is discovered to have a problem (most commonly related to ovulation), and in four in 10 cases, issues are uncovered in both the man and the woman.

NICE states that couples should try to conceive for at least a year – and in line with the frequency of intercourse already stated – before seeking medical help, though there are exceptions. Investigations range from basic blood screens to more invasive keyhole procedures. If a reason is unearthed, attempts will be made to restore fertility if practicable, rather than starting with assisted reproductive techniques.

The emotional turmoil of trying to conceive and it not happening as planned should not be underestimated. Pharmacy staff have a role in supporting customers who are on this difficult journey, wherever it takes them, and can help by lending a sympathetic ear as well as advising on coping strategies, from keeping a journal in order to express emotions and taking regular exercise, to seeking professional counselling.

Extend your learning

• Is Alison’s age a concern? Find out what the British Fertility Society has to say
• Find out about the impact on fertility of being underweight or overweight with information from Tommy’s
• Read the factsheet published by Fertility Network UK on conception and dietary advice
• Access what Fertility Network UK refers to as “a toolbox” of coping strategies
• Read TM's pharmacy scenario on male fertility.