After years of taking steps to prevent pregnancy, making the mental and physical switch to try for a baby can leave people realising they don’t actually know as much about fertility and conception as they thought.
Luckily, there’s plenty of advice pharmacy teams can give to support them on this journey.
Focus on fertility
Getting pregnant is not always as simple as stopping contraception or having more frequent sex. Although about 84 per cent of couples will conceive naturally within a year if they have regular unprotected sex (every two or three days) – according to NHS data – around one in seven couples may have difficulty conceiving.
Infertility is usually only diagnosed when a couple have not managed to conceive after a year of trying, and there can be a variety of issues that may cause fertility issues in men and women.
The most common causes of infertility in women include:
- Lack of regular ovulation (the monthly release of an egg)
- Blocked or damaged fallopian tubes
- Endometriosis – where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb
- Non-cancerous growths called fibroids in or around the womb, which may prevent a fertilised egg attaching itself in the womb or block a fallopian tube.
The most common causes of infertility in men include:
- A very low sperm count or no sperm at all
- Sperm that are not moving properly
- Abnormal sperm – sperm can sometimes be an abnormal shape, making it harder for them to move and fertilise an egg.
There are also several health and lifestyle factors that can affect a woman’s chances of getting pregnant. For example:
- Having a BMI of 30 or over reduces fertility; and in women, being overweight or severely underweight can affect ovulation
- Sexually transmitted infections, including chlamydia, can affect fertility
- Smoking (including passive smoking) affects the chance of conceiving and can reduce semen quality
- Drinking more than 14 units of alcohol a week can affect the quality of sperm, as well as risk the health of the unborn baby
- Exposure to certain pesticides, solvents and metals has been shown to affect fertility, particularly in men
- Stress may affect ovulation and sperm production.
In the UK, unexplained infertility accounts for around one in four cases where people can’t get pregnant and a cause cannot be identified in either partner.
Thankfully, addressing these points can help people improve their chances of getting pregnant, and pharmacy teams are well-placed to give advice and support here too.
The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility who have not conceived after two years of having regular unprotected sex should talk to their doctor about in vitro fertilisation (IVF) treatment. NHS advice is that people should see their GP if they have not conceived after a year of trying, and women aged 36 and over, and anyone who’s already aware they may have fertility problems, should see their GP sooner.
The period of pregnancy is spilt into three trimesters, which involve different developmental stages for the baby, and a variety of interventions and touch points with healthcare professionals.
The first trimester begins on the first day of the mother’s last period and lasts until the end of week 12. During these three months the fertilised egg rapidly divides into layers of cells and implants in the wall of the womb where it carries on growing. These layers of cells become an embryo, which is what the baby is called at this stage. By six weeks, a heartbeat can usually be heard and by the end of week 12 the baby’s bones, muscles and all the organs of the body have formed.
The second trimester is from week 13 to week 28 – roughly months four, five and six. As well as feeling and looking more pregnant during these weeks, the baby will begin to move.
The third trimester is from week 29 to week 40 – months seven, eight and nine. The baby continues to grow, and the mother will have more checks with their midwife to keep an eye on the baby’s health.
Where to give birth
As well as the common choice of giving birth in a hospital maternity unit, there are other options of where to have a baby, such as giving birth at home, or in a birth centre or unit run by midwives.
There are pros and cons to each, and parents-to-be will need to carefully consider the risks, although some options won’t be available to everyone depending on their specific needs and also where they live. Healthy mothers with no complications are considered low risk and could choose any of these locations, but the NHS recommends those with medical conditions who may need extra treatment during labour are safest in hospital.
Pharmacy teams can support parents-to-be to explore their birthing options by signposting them to talk to their midwife, and they can also get information from children’s centres, their GP, and local maternity units.
More information on how to choose where to give birth is available at: birthrights.org.uk/factsheets/choice-of-place-of-birth.
As is so often the case in community pharmacy, every interaction that teams have with parents-to-be – especially those who are very young and may not already be regular pharmacy customers – is an opportunity to improve outcomes for them, and for their future children.
Miscarriage and stillbirth
An estimated one in four pregnancies ends in miscarriage – the natural death/end of a pregnancy before 24 weeks’ gestation. Most of those happen in the first 12 or 13 weeks of pregnancy, but about two per cent happen between 14 weeks and 23 weeks and six days. A loss after that time is called a stillbirth.
The NHS estimates that around one in 200 births are stillbirths and the charity Sands says 15 babies die before, during or shortly after birth every day in the UK.
Other kinds of loss include:
- Ectopic pregnancy – a pregnancy which implants outside the uterus, most often in a fallopian tube. These pregnancies cannot survive, can be life-threatening and may also reduce future fertility
- Molar pregnancy – a pregnancy with too few or too many chromosomes and in which the pregnancy cannot develop but the lining of the uterus does. There is a risk of these cells causing choriocarcinoma so specialist follow-up is required.
“All of these losses can have significant impact on women and their partners,” says Ruth Bender Atik, national director of The Miscarriage Association. “For most people who have experienced pregnancy or baby loss, being pregnant after loss is almost always a time of very high anxiety. Many will seek advice on over-the-counter medications or supplements they can take before or during their next pregnancy to reduce the risk, and it will be important for pharmacy staff to enquire gently what, if anything, they are taking already and to seek advice from the pharmacist when in doubt.”
NHS advice is that people who are pregnant or trying to get pregnant take folic acid until being 12 weeks pregnant. Nitin Makadia, service development pharmacist, recommends “400mcg as standard, but some women will need the 5mg strength on prescription”.
Miscarriage support and information: