The monthly cycle
A woman's fertility and her ability to conceive are related to the changes that occur during her reproductive cycle €“ changes that are controlled by various hormones. A typical menstrual cycle lasts about 28 days, but may vary between 21 and 40 days. Day one of a woman's cycle is the day she starts her period. At this point, a number of eggs start to develop in the ovaries due to a hormone called follicle stimulating hormone (FSH).
As her cycle progresses, the eggs continue to grow and one (or occasionally more) will reach a point where it's mature enough to be released. Meanwhile, levels of the hormone oestrogen are rising and this causes the lining of the uterus (the endometrium) to thicken in anticipation of a pregnancy.
Regardless of the length of a woman's monthly cycle, ovulation €“ when the egg is released from the ovary €“ occurs 10 to 16 days before the start of her next period. What varies is the time between the woman's last period and ovulation. This is why calculating the optimum time to conceive is not always straightforward. Ovulation is triggered by a sudden rise in another hormone €“ luteinising hormone (LH).
During ovulation, the ovary releases an egg which enters the oviduct and travels towards the uterus (womb). At this time, the hormone progesterone prepares the lining of the uterus so that it is spongy, thick and rich in nutrients. If the egg is fertilised by sperm, it is implanted in the wall of the uterus and pregnancy begins.
At this time, another hormone is produced €“ human Chorionic Gonadotrophin (hCG). This is the hormone that is detected by pregnancy tests. If the egg is not fertilised, it passes through the uterus and out through the vagina. Hormone levels drop and the lining of the uterus is shed. The woman gets her period and the cycle begins again.
Occasionally, an egg may be fertilised and instead of implanting in the uterus, it implants in another area such as the oviduct or even in the abdominal cavity. This is called an ectopic pregnancy and, unfortunately, because the embryo cannot develop in this location, the pregnancy can't proceed.
Reflective exercise
Emma, 31, tells you that she has been trying to conceive for the past three months. She has a daughter aged three who was conceived within a month of trying. Emma is interested in hearing about lifestyle advice and home ovulation tests that could help her get pregnant.
What would you recommend?
Suggest that Emma comes to a quiet area of the pharmacy or to the consulting room. Check whether she has any medical conditions, including any gynaecological issues such as irregular periods or endometriosis. If not, explain that although she conceived within the first month last time, this is very quick and for most couples it takes a little longer. Only 20 out of 100 couples will conceive within a month, but 85 per cent conceive within a year. Reassure Emma and warn her that she may need to be patient. Explain how ovulation tests work, talk Emma through the different types available and encourage her to read the instructions carefully.
What lifestyle advice would you give?
It is important that Emma and her partner have a healthy diet and lifestyle. Emma should be taking 400mcg of folic acid daily. Folic acid helps prevent neural tube defects and is beneficial in the very early stages of pregnancy, often before the woman even realises she is pregnant. Emphasise the importance of eating plenty of fruit and vegetables, and limiting foods that are high in trans fat, sugar and salt.
What if:
Emma tells you that her partner is a bodybuilder and he occasionally takes something to boost his training. Ask Emma to find out exactly what he is taking. As a bodybuilder, he may be taking anabolic steroids, which can affect sperm count and mobility if used long-term.
What if:
Emma returns to the pharmacy after six months to say she has been using the kit but has still not conceived. Check that Emma is following the instructions properly and suggest she tries for another three months before going to see a GP.
What if:
A month later, Emma comes to the pharmacy again to ask for a pregnancy test. She tells you her period is due in three days, but she's feeling nauseous and tired. All pregnancy tests detect the level of hCG in the urine. Levels of this hormone rise when a fertilised egg is implanted in the endometrium. Although it may be possible to detect hCG three days before Emma's period is due, if she waits another three to four days, any hCG will be more easily detected.