Mistakes I made while trying for a baby
We tried for our first baby for five years, and during that time my understanding of fertility changed dramatically. I knew the mechanics from medical school, but I was still naïve about a number of things that I think cost us time, heartbreak and money.
1. Assuming it was all about the egg
Most women I know have fallen into this too. It's drummed into us from a young age that our fertility has a shelf life, so when conception takes longer than expected, we're primed to believe the reason must lie with us. It Starts with the Egg is a great book, and I'm glad I discovered it a few years into trying, but even its title feeds the idea that the egg is the source of, and solution to, every fertility problem.
In fact, male factors contribute to up to half of cases of infertility. And because sperm are made continuously, taking roughly two and a half to three months to develop, lifestyle changes can have a real, positive influence on sperm quality. Looking back, I wish we'd paid attention to that much sooner. It wasn't until further testing showed raised levels of sperm DNA fragmentation that we took it seriously.
2. Thinking egg quality is fixed
You're born with all your eggs, so surely they're keeping score? Your age, every cigarette you've ever smoked, all those times you enjoyed a double G&T (or three). Some things do leave a lasting mark: smoking, for example, speeds up the loss of eggs. But your eggs aren’t just a passive record of how long, and how well, you’ve lived. They’re living, they’re active, they develop. In the months before ovulation, a maturing egg goes through big changes, and those changes need a lot of energy. That window of three months or so is a time when your diet and lifestyle may help support how well it completes those stages.
One of the frustrating things about egg quality is how difficult it is to assess. With sperm, we can measure things like count, motility, morphology and DNA fragmentation. There's no equivalent set of tests for eggs. If you're trying naturally, you have very little insight into what's happening. Even with IVF, we're mostly looking at indirect clues: how many eggs are collected, how many are mature, how many fertilise and how many develop into blastocysts. And none of those outcomes is determined by egg quality alone. Sperm quality, stimulation protocols and what happens in the lab all play a part.
3. Thinking a low AMH was game over
I was as nervous about my AMH result as I'd been about my A-levels or my degree, and I thought it carried the same weight. So when mine came back low for my age, I went into a doom spiral. Here's what I wish I'd understood at the time: AMH is not a marker of egg quality. Research in women without a history of infertility suggests that a low AMH doesn't mean a lower chance of conceiving naturally, compared with women the same age with a much higher AMH.
AMH does tell us something about egg reserve, but it isn't perfect. I had mine retested a few times and it went up (though presumably my egg reserve didn't!). It's one piece of a much bigger puzzle. It's genuinely useful for doctors planning an IVF cycle, because it helps predict how many eggs you might collect, but it has to be interpreted alongside everything else.
4. Thinking IVF would just work
I held off IVF for as long as I could. I hated the idea of it. But after 36 negative pregnancy tests in a row, I just wanted to be pregnant, and I thought IVF was the surest and quickest way to get there. I think many of us hold IVF in reserve, as the guaranteed backup if things don't go to plan.
What I didn't understand is that a single round of IVF is by no means a sure thing. Some people describe the first round as a bit of an experiment, which I find hard to hear given the cost and the emotional toll. IVF did eventually work for us, and I'm incredibly grateful for it. But heading in, I had no idea it would take six egg collections to have our two children, or how much disappointment, heartbreak and stress (over money, and over who to trust) we'd go through along the way. By the summer of 2020, with the world in lockdown, we'd done four rounds of IVF and had no baby. Our fourth round, in the USA, had finally given us a normal blastocyst, but the pandemic meant we couldn't go back to transfer it or create more embryos. I felt like our time was running out while the world stood still. It was the lowest I have ever been.
5. Assuming all IVF is the same
I assumed IVF was a bit like any other service: you get what you pay for, and results are broadly similar wherever you go. I now know that isn't the case. Clinics really do vary in their approach. At some, we felt the plan didn't change much from one round to the next, and we struggled to get the answers we were looking for. At others, every detail was recorded, reviewed and used to shape the next cycle.
But more cutting-edge doesn't always mean better. Some add-ons are offered before there's good evidence that they help, and the HFEA rates common add-ons by the strength of that evidence, which is a useful place to start. It's a fine line between giving yourself the best possible chance and paying for treatments that haven't yet been shown to work.
6. Expecting someone else to fix it for me
When we started IVF I was exhausted and defeated, so I went into it like a passenger. I put my trust entirely in a clinic a friend had recommended and did very little research myself. That's totally unlike me, but it shows how worn down I was. It was only after the third round failed that I really started digging into the research and looking at treatment options for myself.
However dedicated your clinic team, nobody will ever be as invested in your outcome as you are. Even the best doctors know that not every cycle will succeed. That's why it helps to be in the driving seat: picking at threads, and making sure you get full, satisfying answers about why things are being done a certain way. IVF is still an evolving field, and sometimes the honest answer is that we just don't know yet, or that a technique is still being evaluated. But those honest answers are exactly what you need to make good decisions.
After three rounds, our results seemed to point towards an embryo quality issue. We collected a good number of eggs each time, and many were mature and fertilised, but the drop-off between day 3 and day 5 was huge. So I went digging into embryo quality, egg quality and sperm quality. For someone else, the results might point elsewhere: a lack of mature eggs, fertilisation failure, or lots of good-quality blastocysts but repeated implantation failure.
It really helped me to sit down, think logically about where our drop-off was happening, and then seek out people who were working on those questions. We talked to doctors interested in tailoring stimulation protocols to support egg quality, focused on lifestyle measures for egg and sperm quality, and looked for a clinic with an excellent embryology service, hoping that all of this together would get us over the line.
Of course, it's hard to know how much any one change made a difference, because so much changed between our first three rounds of IVF and last three. But the improvement in our results felt dramatic.
7. Thinking nothing I did would make a difference
I used to regard things like supplements and acupuncture as slightly woo-woo. I thought I was reasonably healthy and ate well, so our struggle to conceive must be down to things outside our control: my age, and lifestyle choices that were already in the past and couldn't be changed.
But my IVF rounds at 36 and 39 years old were far more successful, in terms of blastocyst numbers and babies born, than IVF at 33 or trying naturally from 31. I can't prove exactly what made the difference, and everyone's situation is different. But I believe that what we learnt along the way, and the changes we made because of it, played a real part.
8. Saving sex for the fertile window
When you've been trying for a while, sex can start to feel like another chore to be crossed off the to-do list. Like a lot of couples, we timed it carefully around ovulation, with apps, ovulation tests and an enormous amount of pressure riding on a couple of days each month. It was high stress, and definitely not romantic. And outside that window, it was easy to let things slide. Long working days, tiredness, doom-scrolling and Netflix. I'm sure we're not the only ones.
What I didn't realise is that this isn't actually the best strategy. NICE advises couples trying to conceive to have sex every two to three days throughout the cycle, rather than timing it around ovulation. Pinpointing ovulation is harder than it sounds, and timing sex to a schedule adds a lot of stress. There's an important sperm quality aspect too: studies have linked shorter gaps between ejaculations to lower sperm DNA fragmentation, so long stretches of "saving it up" for the big day probably don't help. Given our own DNA fragmentation results, I really wish I'd known that sooner.
I sometimes wonder how much modern life is making all of this harder. Screens, work stress and endless competing demands on our evenings don't leave much room for intimacy. Widespread availability of smartphones has been mapped onto falling birth rates in many different geographic locations. I don't think there's an easy answer. But putting the phones down, having more boundaries around work and making time for each other is something I wish we'd paid more attention to.
Not everything is in your control, and no amount of research or money guarantees a baby. But asking questions, focusing on both of you and finding people who want to answer your questions can change your experience, and sometimes your results. If you're somewhere in the middle of this at the moment, I hope something in this article helps.