Trying to conceive for a year now, should I be worried?

Dear Dr Murage,

I had my implant contraceptive device removed over a year ago in order to conceive. Unfortunately I haven’t become pregnant yet. Should I be worried?

Constance

Dear Constance,

Many couples get concerned if conception doesn’t happen within a few months of trying. If you are young, below the age of 35 and in good health, you can always wait till a full year elapses prior to seeking help. If older, or have other issues like irregular periods, you should usually seek help within six months of delay in conception.

You are right to be getting concerned as a year has already elapsed and you haven’t conceived. Reversible contraceptives, which include implants, do not usually interfere with future fertility potential.

You can rest assured that your reproductive system has not been messed up by the implant. Permanent methods of contraception are the only ones that will negate future conception, unless they fail or there has been a successful reversal.

You may wish to have a review with your doctor together with your partner. A basic assessment for both of you will direct efforts towards the most likely reason there has been a delay in conception.

Depending on what comes up, you may just need reassurance and possibly a further wait say for six months or so. It’s also likely that some tests may need to be done to exclude some possible causes for the delay.

Initial evaluation will include sperm analysis, a confirmatory test for ovulation, and a check for the function of your fallopian tubes.

If any tests come out positive, then what gets done will depend on the specific results. Potential fertility interventions will range from simple things like just taking ovulation tablets, to more complex treatment options.

The guiding principle is to settle for the most appropriate treatment option that will be successful within the shortest time. Majority of young and healthy couples who experience a delay in conception after stopping contraception have nothing to worry about.

You can be confident that your fertility potential remains good. Live a lifestyle that optimises reproductive capacity. You and your partner should not smoke or drink excessively. Ensure you both have healthy weights by watching what you eat, and doing some physical activities.

Both of you must be cognisant of your sexual health; sexually transmitted infections are responsible for many cases of infertility. You should also already be taking pre-conception supplements containing folic acid. It should just be a matter of time before you miss a period, and confirm a positive pregnancy test.

— Dr Alfred Murage is a consultant obstetrician and gynaecologist