Fertility Journeys
Not pregnant yet?
Who? What? Where? When?
Chana’s guide to figuring out your next steps
This leaflet is intended to empower you with the knowledge of what can be involved in a fertility journey and help you understand the terminology you might come across. Chana provides medical, emotional, practical, Halachic, and financial support to Jewish couples struggling with fertility.
You are not alone!
Who should we turn to?
Your GP is always your first port of call. If something doesn't feel right or it’s taking time to fall pregnant, whether you already have children or not, make an appointment to see your GP. Your GP will likely run some blood tests to get a clear picture of hormone levels and sperm quality to rule out any obvious issues.
The consultant may run some further tests depending on your medical history and background, for example: ultrasounds, a laparoscopy or physical examinations. These will help to identify what next steps could be taken to help.
Depending on the outcome of the results they may then refer you to a fertility consultant for further testing or investigations. Different fertility consultants specialise in different areas. Details about consultants are usually available online, and you can make sure you have been referred to a relevant specialist.
What can I do in the meantime?
Prepare for your GP appointment by gathering some basic information on your medical history and background:
Track your menstrual cycle pattern and see if it is regular or irregular
Check if you are ovulating and on which day of your cycle
Check your ovulation date in relation to your mikveh date
Check that you are actively trying to conceive around your ovulation date
Familiarise yourself with information on your general lifestyle, medications and any previous pregnancies
What treatment will we need?
Different types of fertility treatment are available. Your consultant will suggest a treatment relevant to the nature of your fertility problem. They range from more minor procedures, like taking fertility drugs to get ovulation started, to more complex treatments such as IVF or ICSI. Your consultant will identify which treatments can help you. Some examples of treatment options are:
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Fertility drugs can be used in the treatment of some women who have been trying to get pregnant but have been unable to do so naturally. They are the main treatment for women who have fertility issues related to polycystic ovary syndrome and men and women who have fertility issues related to hormone imbalances.
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This is a type of fertility treatment in which the better-quality sperm are separated. These sperm are then injected directly into the womb. This can be with the partner or donor’s* sperm. It is usually used in cases of unexplained infertility.
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For around 50% of couples who are having problems conceiving the cause of infertility is sperm-related. ICSI a technique used for invitro fertilization (IVF) in which an individual sperm cell is introduced into an egg cell to help create an embryo. This is used in cases where sperm parameters are abnormal.
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Suitable for people with a wide range of fertility issues and is one of the most used treatments. This comes in a variety of different forms dependent on medical need.
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Some conditions that affect your fertility may be treatable with surgery. This includes for example, women with blocked fallopian tubes, endometriosis or fibroids and men who have varicoceles, amongst others.
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For some cases there is an option of using donor sperm/egg/embryos or surrogacy when appropriate. It is important to be aware of the complex halachic questions involved in these cases it is essential to consult with a Rabbinic authority with specific expertise in this area when deciding upon a course of action. Chana can help you with this should you choose to go down this route.
Having a good understanding of your treatment plan can help you prepare yourself. Helpful things to ask are:
What side effects are involved?
What risks are involved (e.g. multiple pregnancy)?
What are the costs?
How likely would be for the treatment to work first time?
Where should I have my treatment?
You may be able to access treatment on the NHS dependent on your circumstances, but this varies across the country. If you are not eligible for NHS treatment, Chana can provide financial assistance towards the cost of treatment at a private clinic.
Choosing your clinic and consultant can be overwhelming as there are so many options to choose from. Thinking about where you live, work, and your medical requirements is a good starting point towards making your choice. Chana does not endorse any one clinic or doctor; however, we can provide information on different clinics and consultants. This might make it easier to come to a decision. We can also help you to understand the treatment options that have been suggested.
When do I need to start fertility investigations?
There is a 25% chance of falling pregnant in one cycle, so if you have not conceived straight away this does not mean that you have a problem. If you’re age 20-35, there is a good chance you will conceive within 6 months. When fertility is optimal in both partners, it can still take up to a year to fall pregnant. If you have not conceived within a year of trying, contact your GP to investigate. If you are age 35 or over, you can ask your GP to run baseline tests after 6 months of trying.
If you have obvious signs of concern such as very long or very irregular cycles, or evidence that you are not ovulating, then see your GP without delay when you start to think about conceiving.
If you notice that something has changed or seems unusual for you, or if you experience unusual pain or bleeding, see your GP straight away.
Chana’s Fertility Dictionary:
Familiarise yourself with these fertility related terms to help you on your way
Anti-Müllerian Hormone (AMH)- Produced by small follicles (pouches which contain the eggs) growing in the ovary. It can be measured in a blood test. The level of AMH reflects how many follicles are growing, which gives an indication of how many eggs are present in the ovary.
Azoospermia: Complete absence of sperm in the ejaculate.
Endometriosis: A condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. It can be a cause of infertility in women.
Embryo transfer: A procedure following IVF/ICSI in which the embryos are placed into the uterus.
FSH- follicle stimulating hormone- A hormone produced by the pituitary gland that stimulates the growth of the egg-containing follicles in the ovary. In males it contributes to the production of sperm.
Infertility: The inability to conceive after a year of unprotected intercourse (six months if the woman is over age 35) or the inability to carry a pregnancy to term.
Laparoscopy: A camera procedure in which the surgeon passes a small, lighted instrument through a small incision under the belly button to explore the internal structure of the pelvis, particularly the ovaries, fallopian tubes and uterus.
Oestrogen: A female hormone secreted chiefly by the ovaries that stimulates the development of female secondary sex characteristics and promotes the growth and maintenance of the female reproductive system.
Ovulation- The release of an egg (ovum) from the ovarian follicle.
Ovulation Induction: Medical treatment performed to initiate ovulation.
Progesterone- A female hormone secreted by the corpus luteum in the ovaries during the second half of a woman’s cycle. It thickens the lining of the uterus to prepare for the implantation of a fertilised egg.
Premature Ovarian Failure: Indicated by an elevated FSH. The ovaries are no longer producing follicles, this can be due to congenital, genetic, chromosomal factors, or damage caused by toxic drugs, such as chemotherapy.
PCOS- A common endocrine disorder affecting the function of the ovaries. This can cause cysts on the ovaries that disrupts the hormone balance.
Semen: The whitish fluid containing sperm (plus other substances) that is released during male ejaculation.
Semen Analysis: Analyses the health and viability of a man’s sperm
Sperm: The gamete (reproductive cell) that contains the genetic material of the male.
Sperm Morphology: Size and shape of sperm.
Sperm Motility: Another parameter that it checked in the semen sample. It is the ability of the sperm to swim to the egg that enables fertilisation to occur.
Thyroid- a small, butterfly-shaped gland located at the front of your neck under your skin. It's a part of your endocrine system and controls many of your body's important functions by producing and releasing (secreting) certain hormones.