When pregnancy doesnt happen

How long should we expect to wait? When do I have a problem?

Having made the decision to become pregnant, most of us will have an idea of how long we think that it might take to conceive. This is probably based on what we know from our families and friends or any information we may have gained from books or television. Therefore, to some extent, problems of conception or'infertility'are self-defined by our expectations. John and Rosemary (whose story was in the last chapter) waited 13 years before their baby arrived; other couples are surprised if a baby is not conceived within the first month of trying. Most specialist medical services will have definitions of fertility problems but clearly a simple definition will not work for every couple. A number of factors are relevant for each individual.

Your age

Clearly, your age will affect your view of the situation. If you are 42, you will be very aware of your declining fertility and if you are determined to have a baby, then you are much more likely to want to investigate whether there is a problem as your chances are decreasing. If you are 23 and leading a very full life, you may be quite willing to wait for a few years before you decide that there is a problem.

Readiness to have a family

However, whatever your age, if you are absolutely set on having a baby, then you may see every period that arrives as an unexplainable failure. Many women expect to get pregnant from the first month of trying. Often in a couple one partner is more uncertain about parenthood and therefore may take much longer to be willing to identify a problem.

Gynaecological history

Other factors may affect your view of your potential fertility. If you have a history of any gynaecological problems, a previous sexually transmitted disease, a previous termination of pregnancy or a previous miscarriage or stillbirth, any of these factors may increase your sense of anxiety if conception does not occur immediately. For most women these anxieties are unjustified and may be the result of guilt about some of these past experiences. However, it may be that you need to discuss your particular situation with your GP to sort out the fact from the fear.

Clearly, a number of highly individual factors will contribute to you viewing yourself as having a problem and it is always worth discussing these feelings with someone you trust. A visit to the GP might be appropriate for you but it does also represent the first step in identifying a 'problem', which can increase your anxiety about the situation. Everyone's expectations are different.

Chloes story

As a psychologist I am always interested by the information that is given in the referral letters that turn up before you meet the person concerned. I was particularly intrigued when a GP asked me to see Chloe whom he said was depressed because she was unable to fall pregnant. Chloe was just 17 years old at that time. Chloe said she was desperate to get pregnant, her two older sisters both had children and her house was always full of babies as her mother was a child-minder. Chloe did not have a boyfriend and was still a virgin. Chloe said she couldn't get pregnant because she was 'too fat and ugly'and she would never get a boyfriend.

Chloe seemed to be confusing her own needs for care and attention with wanting to parent a child. She also came from a situation where to have children was the only way to achieve status and respect for a woman. In time, Chloe began to see some of her friends again and started to go out and enjoy herself. Her mother also recognised that Chloe needed extra support at this time. She spoke to her elder daughters and agreed to look after her grandchildren less often so that she could spend some time with Chloe that didn't involve babies and children.

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