While many of us spend the best part of our early adulthood desperately trying not to fall pregnant, when we hit our 30s or 40s and decide the time is now right, it may not be as easy as expected.
Facing up to possible infertility is a minefield and something most couples try not to think about. Just to be clear, infertility is usually defined as the failure to conceive after a year of unprotected sex.
There is a long list of possible causes of infertility in women and men. Some are easy to detect, others less so. After discounting "mechanical failures", as one doctor refers to them, you move into fuzzier territory lumped under the heading "environmental factors". These could include anything from inadequate nutrition to stress to raised levels of pollution and increased alcohol intake.
So, what's to be done? Surely there are steps you can take to ensure you're in the best position (if you'll pardon the pun) to conceive a baby?
Steps to ensure you're in the best position to conceive
Medical history and physical examination
"It's important to start with a thorough medical history and basic physical examination," explains Dr Janet Cole, a gynaecologist in private practice in Cape Town. "If a woman suffers from a medical condition such as asthma, diabetes, depression or epilepsy, you need to manage the condition as well as possible and ensure any medication she's on is compatible with pregnancy.
Being overweight, smoking, drinking and recreational drug use
"Perhaps the two most important considerations are being overweight and smoking," says Dr Cole. "Women don't seem to realise being overweight not only makes it more difficult for them to conceive, but also puts them at risk of diabetes and high blood pressure during pregnancy. Alcohol is also out, and recreational drug use is an absolute no-no."
Dr Cole also routinely checks that her patients are immune to rubella (German measles), which can cause congenital malformation if contracted during pregnancy. Acquiring immunity is as simple as getting vaccinated, after which you should wait three months before trying to conceive.
Get tested for HIV and anaemia
"I also suggest patients get tested for HIV if they're not sure of their status," says Dr Cole. "And it's also worth testing for anaemia. If a woman is a vegetarian and has heavy periods, there's a good chance that she will be iron deficient and it's better to sort this out sooner rather than later."
What can help boost fertility
Eat good food
In his book 100% Health (Piatkus), nutritional guru, Patrick Holford, writes: "One cause of infertility is inadequate nutrition. In one study at the University of Surrey, infertile couples eliminated from their diet alcohol, refined foods and foods to which tests had shown they were allergic; they also supplemented vitamins and minerals in which tests had found them deficient.
After this 81% conceived and went on to give birth to healthy babies. There were no miscarriages, premature births, or children born with deformities. Of course, these vitamins and minerals also help the body make and use hormones, a deficiency of which can result in infertility."
Dr Marilyn Glenville, a Fellow of The Royal Society of Medicine, says alcohol is also a major factor in determining fertility. According to her, one study showed women who drank less than 5 units of alcohol a week (equal to 5 glasses of wine) were twice as likely to fall pregnant within 6 months, compared with those who drank more.
Drinking alcohol also appears to cause a decrease in sperm count, an increase in abnormal sperm and a lower proportion of motile sperm. This could be because alcohol lowers the body's ability to absorb zinc - an important mineral in male fertility.
Cool it on caffeine
Caffeine, it seems, is a conception killer. "Drinking as little as 1 cup of coffee a day can halve your chances of conceiving," says Dr Glenville. "One study showed that problems with sperm - sperm count, motility and abnormalities - increase with the number of cups of coffee consumed each day."
You may also have to put the brakes on fizzy drinks, chocolate and black tea.
X to xenoestrogens
No thanks to the increase in the plastics, pesticides and petrochemical industries, there are more environmental oestrogens (xenoestrogens) floating about than ever before. Because conception relies on balanced hormones, anything that might interfere with your hormones is bad news.
Top of Holford's comprehensive list of how to avoid hormone-disrupting chemicals is to eat organic, avoid heating food in plastic products and filter all drinking water.
What's to say? There are no benefits to smoking, so find an effective way to stop.
De-stress and homeopathy
Dr Colin la Grange, founder of the La Grange Institute for Equilibrium (LIFE) in Westville, just outside Durban, belives in homeopathy.
At his holistic centre, integrated therapies such as homeopathy, Chinese and Western herbal treatments, laser treatment and light therapy are on offer. "Some of these are subtle energetic approaches, but I think it's better to start off subtly before you bring in the big guns," he says.
Dr La Grange believes our crazy lifestyles - and the resultant hormonal imbalances - make conception difficult.
"Most people live at an incredible pace and this puts us under long-term stress," he explains. "When this happens, the hormone cortisol kicks in. It's made from progesterone, which is also needed for the manufacture of oestrogen and testosterone. Your body then does a series of trade-offs that allows it to keep feeding your cortisol fix, but at the expense of your fertility hormones.
"We get so used to high stress-hormone levels that we become habituated to them, so the stakes keep getting raised."
- Take time out for yourself. Even if you have to schedule an appointment.
- Get to bed early. And not for sex, but rather to balance your hormones (sorry).
- Cut wheat and sugar from your diet. Dr La Grange says wheat forms sugar, and sugar forms acidity, which negatively impacts on hormone receptors and gives cortisol an unwanted boost.
- Breathe properly. Sit up straight. Breathe in for five counts, hold for four and breathe out for five.
Nutritionist Dr Marilyn Glenville recommends drinking lots of fluids and eating plenty of:
- Fruit and vegetables
- Complex carbohydrates - wholegrains like brown rice, oats, wholemeal bread
- Organic foods phytoestrogens, including beans such as lentils, chickpeas and soya products, oily foods including fish, nuts, seeds and oils fibre.
- You should reduce your intake of: saturated fat from dairy products, caffeine and alcohol.
- And avoid: additives, preservatives and chemicals such as artificial sweeteners, sugar - on its own and hidden in foods.