While we talk openly about motherhood and parenthood, very little is discussed about conceivinghood, the life phase of trying to conceive. Women's experience of trying to conceive can vary greatly and can be difficult to discuss openly.
The average age of women entering the conceivinghood phase is increasing
It is now well-established that women in developed countries are increasingly delaying pregnancy until they reach a period in life when raising children is consistent with their career and life goals (Mills et al, 2011), or more commonly, because they have not found a partner with whom they wish to have a family.
This trend of delaying pregnancy has meant that many women start the journey to conception when their fertility is already in decline (Mills et al, 2011; Bellieni, 2016). Furthermore, with increasing age, there is a higher risk of developing a disorder that can affect fertility, such as uterine fibroids and endometriosis (American College of Obstetricians and Gynecologists, 2018) or concurrent medical diseases.
In the UK, one in seven couples have difficulty conceiving; for those who have been trying to conceive for more than three years without success, the likelihood of conceiving naturally within the next year is one in four or less (NHS UK, 2020). For these couples, the journey to conception can be incredibly stressful; yet, as a society, we do not talk openly about this phase of life.
When women decide that the time is right for them to try to conceive, most wish to do so quickly, leading to disappointment if it does not happen as fast as expected (Bunting and Boivin, 2007; Bellieni, 2016). This reflects the profound desire that many of us share from childhood to become parents one day. When confronted with the possibility that this might not be fulfilled, it can challenge our very identity.
As a result, fertility clinics no longer see couples presenting with two or more years of sub-fertility only. The concern that arises when conception does not occur quickly appears to be growing, reflecting a greater awareness of the impact of age on the likelihood of conceiving both spontaneously and with fertility treatments. However, the good news is that most people who want to have children can achieve this and usually without medical interventions. When help is required, modern fertility treatments can be very effective.
Lifestyle practices during the conceivinghood period
Of note, lifestyle practices during the period of conceivinghood are also important determinants of fertility as well as the health of the baby. Many studies have demonstrated the impact of smoking on male and female fertility (Harlev et al, 2015), miscarriage risk (Hassan and Killick, 2004; Pineles et al, 2014) and fetal development (Centers for Disease Control and Prevention, 2019). Additionally, studies have also shown links between diet and reproductive outcomes (Olafsdottir et al, 2006; Paknahad et al, 2019), and we are now understanding the mechanisms that underlie these. Conceivinghood is therefore also a time of great opportunity to take proactive steps that can lead to healthy motherhood and childhood more quickly.
Effective campaigns
In recent years, a number of professional organisations, including the Royal College of Obstetricians and Gynaecologists (RCOG), and the British Fertility Society (BFS) have launched public-facing initiatives to increase awareness among the general public of fertility and its determinants. The industrial sector is providing support for these initiatives in various ways. In addition to providing financial support for the RCOG/BFS projects in this area, Clearblue® has launched a campaign named Conceivinghood to promote and raise awareness of the pre-pregnancy life phase experienced by all women trying to conceive. Their campaign highlights the real-life experiences of women around the world, and aims to provide information (facts and figures) and advice related to conception.
The Conceivinghood campaign also aims to reassure women that they are not alone in their journey to conception and that there are many women having similar experiences. It has been reported that there is a lack of knowledge among both men and women regarding fertility (Bunting and Boivin, 2008). This may indicate that a level of awareness of basic fertility information is likely beneficial in helping women and/or couples to make more informed decisions regarding conception and when they choose to start their journey to motherhood (Fertility UK, 2019). I hope that alongside already established initiatives, this campaign – from a company that is active and innovative in the field – can further encourage and empower women as well as couples to have open discussions about fertility, which may enable them to seek advice and information during their conception journey.
What can we do as healthcare professionals?
There are a number of ways that all healthcare professionals can support women/or couples during the phase of conceivinghood. In addition to asking about the plan to conceive regardless of the clinical context in which patients present, they can provide general pre-conception health advice. There are a number of resources available to support this and while most are currently directed at couples facing sub-fertility, the Clearblue® campaign provides additional access to advice that can address the most common questions that tend to be asked by all in the conceivinghood period (Table 1).
| Examples of commonly asked questions |
|---|
|
|
All healthcare professionals can help generate advice for women and men, and we should work in partnership with the industry to raise awareness of things to do during conceivinghood.