Good things come to those who wait, or so the saying goes. The virtue of patience is a concept that’s drilled into us from the day we’re born. From the playground to the office, we’re consistently striving to master the art of moderate anticipation, though the practice takes on a more philosophical form as we mature. Eager to just ‘let it be’, we’re inclined to wait for the right moment, trust in the appropriate timing, learn to persevere and avoid forcing anything, whether that be a relationship, a baby or an ill-fitting shoe.
But when it comes to fertility, a passive approach to starting a family is a trend that worries some experts. According to Dr Bohaira El Geyoushi, a Dubai-based gynaecologist, fertility and IVF specialist with Fakih IVF, from the age of 30, a woman’s chances of conceiving naturally gradually decrease from 20 per cent per cycle to just 5 per cent per cycle at the age of 40. Despite this, societal shifts including more equal opportunity in the workplace, prioritising a career and education and a lack of financial stability in the early years of marriage mean the number of women delaying raising a family has increased.
But whether you’re still trying, want to get started right away or are waiting for the right partner, making an informed decision can help ensure you get the outcome you want. We spoke to the experts to create a step-by-step guide to navigating your fertility…
Read more: 'Why I wish I'd had children earlier'
If you’re struggling to conceive…
Review how long you’ve been trying
“Fertility declines with age, affecting both egg number and quality,” says Dr Bohaira, who is also the brand spokesperson for ovulation kit company Clearblue. “Most couples (84 out of every 100), will get pregnant within a year if they don’t use contraception. However, those chances decrease as a woman gets older. One study found that among couples aged between 35 and 39, about 82 per cent will conceive after one year and 90 per cent after two years. Whereas, among couples aged between 19 and 26, 92 per cent will conceive after one year and 98 per cent after two years.”
Try ovulation kits
“Ovulation kits are a good method for women to keep track of their ovulation and narrow down their fertile window to 48 hours,” says Dr Bohaira. “They provide you with information about your cycle, like whether you’re ovulating or not and when. They also increase your chances of natural conception by indicating your most fertile days.
The way they work is by detecting the surge in LH [luteinising hormone] in your urine to determine the peak fertility. Women can track their most fertile time by being aware of their fertile window or with Clearblue digital ovulation kits, which narrow it down to between 36 and 48 hours.” Be warned though; if you have or suspect you may have PCOS, ovulation kits will not work for you, as women with PCOS tend to have elevated levels of LH anyway.
Read more: 'The diet to cure PCOS?'
Download a fertility-tracking app
While ovulation kits can be very accurate when used correctly, they will also pick up on any luteinising hormone changes that are not linked to ovulation, which can give you a false reading. Natural Cycles is a natural family-planning app that applies an algorithm to period-tracking technology - combined with analysis of LH levels and basal-body-temperature readings - to provide the most accurate prediction of your fertile days.
The science behind it is simple: post-ovulation, progesterone warms our bodies by up to 0.45°C, which a sensitive basal thermometer can detect. While you need to log your basal body temperature every day, the Natural Cycles app indicates when you should take an LH test (which you can buy from their online shop or at a pharmacy) and compiles all the information to highlight when your best chance of conception is.
While Natural Cycles costs around Dh230 per year, there are free apps such as Clue that will track your periods over time and highlight when ovulation is likely to occur, which you can combine with your own basal body temperature charts for improved accuracy.
Change your lifestyle
“Many lifestyle factors such as the age at which to start a family, nutrition, weight, exercise, psychological stress, environmental and occupational factors can have substantial effects on fertility,” says Dr Bohaira. “The smoking of cigarettes and shisha, use of illicit substances and caffeine consumption can negatively influence fertility both in women and men. Simple lifestyle changes may be all that is needed to assist in conceiving naturally. Weight loss and exercise are key factors to consider, especially in women. Cutting down and quitting smoking can have a very positive impact on men’s health. Looking after your body and treating medical conditions that can affect fertility such as thyroid disorders is also advised. There are many proven therapies that assist in increasing your chances of a natural conception. I would recommend acupuncture, reducing stress and, for women, taking supplements including prenatal vitamins and folic acid, as it protects against deformities of the brain and spinal cord. Supplements that men can take include vitamins E, C, zinc, delenium and anitoxidants such as co-enzyme Q10. We now know that lifestyle factors impact both men and women. When both partners work together they also encourage each other. They share out the responsibility without putting too much burden on one partner more than the other. Leading a healthy lifestyle will also pave the way for a healthy family to grow and thrive.”
Know when to see a fertility specialist
“We usually advise women who have not conceived previously to wait one year before seeking advice and two years if they have had children before,” says Dr Bohaira. “If you know that you have a certain condition such as polycystic ovarian syndrome, cancer treatment, or declining ovarian reserve if you’re 35 or older, then we advise you to seek help after six months. In that case, seek assistance from a fertility doctor who is an expert in the field of infertility to avoid unnecessary delays.”
“A fertility specialist is someone trained to diagnose what’s going wrong when a couple is unable to conceive and then suggest various forms of treatment to achieve a pregnancy,” says Dr Pankaj Shrivastav, a gynaecologist and fertility specialist at Conceive Hospital, which has locations in both JLT and Sharjah. The specialist will then organise some initial tests, which vary for women and men. “Females will have a complete examination, ultrasound scan of the pelvis, a check to see if the fallopian tubes are open and hormonal tests if necessary. Males will undergo a semen test and a hormonal test.”
“The success rate of in-vitro fertilisation (IVF) depends to a large extent on the women’s age,” says Dr Pankaj. “Between the ages of 25 and 30, the success rate is 55 per cent. Once the woman is over 40, that rate drops to between 20 and 25 per cent.” He points out, too, that the risk of miscarriages is also higher with increased age, as is the risk of having a chromosomally abnormal child.
The procedure can be explained in four basic steps, says Dr Pankaj. “We begin with controlled ovarian stimulation. Then egg retrieval to get the eggs. We then fertilise the eggs in the embryology laboratory before finally transferring the embryo to the uterus.”
In the first step, the woman is stimulated with injectable hormones, called gonadotrophins, from the second day of her period to develop multiple follicles in the ovaries. The dosage of the injection is determined by the age of the patient and the ovarian reserves of the patient. The injections are given daily for 10 to 12 days to achieve maximum follicle stimulation. An ultrasound scan is done every two to three days to monitor the development of follicles and when a sufficient number of follicles has grown to the desired size, the trigger injection is given to stop the eggs being released.
In the second step, explains Dr Pankaj, egg retrieval or pickup is done under sedation and usually 36 hours after the trigger injection. Under ultrasound guidance, a needle is introduced into the ovaries and the eggs are sucked out from the follicles. The woman rests for about two hours after procedure before being discharged and the eggs are then fertilised in the laboratory with her partner’s semen.
In the final two steps, the embryos are cultured for two to five days and the embryo transfer procedure is done within two to five days after the egg retrieval. “It’s a simple procedure to place the embryos in the woman’s uterus. Patients can resume normal activities after the embryo transfer and the woman will have a pregnancy test about seven to 10 days after the embryo transfer to see if she is pregnant. The total IVF procedure takes around three weeks,” says Dr Pankaj.
The price of one IVF cycle varies from clinic to clinic, but comes to around Dh30,000.
“Couples should consider making some lifestyle changes to increase their chances of success. I recommend losing weight if necessary, a body mass index between 23 and 25 is ideal, stop smoking, decrease coffee and tea intake, eat healthily and minimise alcohol consumption”
If you’re not ready to have a baby right now, but think you might want to in the future…
Freeze your eggs.
“The best age for women to freeze their eggs is before 32,” says Dr Pankaj. “As age increases, the quality of eggs starts to decline, so it’s best to bank them before the deterioration sets in.” The process is exactly that of IVF, with daily hormone injections to stimulate the ovaries, but no final embryo transfer. Though the procedure is elective, there are some cases where egg freezing is medically required, such as in cases of severe endometriosis and cancer diagnosis.
Dr Pankaj says: “Medical freezing is usually for cancer patients before they start chemotherapy treatment or radiation and elective freezing is done if the woman hasn’t found Mr Right or if her education or career does not permit her to start a family, even though she’s married.”
As with all fertility procedures, lifestyle factors can affect the amount of eggs you’re able to produce, as well as the quality of the eggs. “Smoking is toxic to eggs and a woman who smokes will run out of eggs five years earlier than would have occurred if she did not smoke. You should stop smoking to preserve eggs,” says Dr Pankaj.
The quality of the eggs refers to their chromosomal content. A chromosomally normal egg will make a chromosomal normal embryo which has a better chance of implantation. There is no guarantee that eggs will survive the freezing process, but with new vitrification techniques, the statistics are about 85 to 90 per cent.
In the UAE, you must be married to use the eggs and once you do decide to use them, you will be prescribed medication to develop the lining of the uterus. When it’s ready, the eggs are thawed and injected with the husband’s sperm. The embryos are then generated and grown for two to three days and placed into the uterine cavity. “At Conceive Hospital, we charge Dh17,000 for freezing and an additional Dh1,000 a year for egg storage,” says Dr Pankaj.
Reviewing the other options
Although adoption is not officially recognised in the UAE, couples can adopt while living here if their country and that of the adopted child’s allows it. For more information on adoption while living in the UAE, Synergy Integrated Medical Centre (www.synergyctrdubai.com, 04 348 5452) can offer guidance and advice, with home study programmes available to those considering the international adoption process. The Dubai-based Adoption Support Group, https://groups.yahoo.com/neo/groups/asgdubai/info, can also be a source of valuable advice, especially from those who have successfully completed the process.
Surrogacy is not permitted in Islam and is illegal in the UAE.