Saturday 19 January 2019

Dear Dr Nina: We are desperate to add to our family

Photo posed
Photo posed

Nina Byrnes

My wife and I have been trying for a baby for over a year but nothing has happened. We have two older children who are seven and five and we never had any trouble conceiving them, so I can't understand what might have changed. My wife says she's raised it with her doctor but he says that she's only in her early thirties and there's plenty of time yet and so not to be worrying. But I'm concerned that there'll be too big of an age gap between our older two and the youngest if we wait any longer. And we've always wanted a big family. What should we do?

Dr Nina replies: Studies suggest that up to one in nine couples will have fertility problems and after investigation there is a rule of thumb that states one third of causes will be male, one third female and one third unknown. Genetic factors are only a small percentage in each of these cases.

The actual definition of infertility is failure to conceive after 12 months of REGULAR unprotected intercourse. Simple things like a partner being away for long periods or older children sharing their parents' bed can reduce the frequency of intercourse so much that chances of becoming pregnant are low.

Many couples trying to conceive resort to buying ovulation predictor kits and focusing intercourse on the pronounced 'fertile days'. The use of ovulation kits is not routinely recommended. Having intercourse roughly every two to three days all month maximises the possibility that viable sperm will be around when ovulation occurs. Sperm can live for up to 72 hours in the female genital tract but need up to 24 hours to recover.

Lifestyle factors are really important. I advise couples to act as if they are pregnant when trying to conceive. This means stopping smoking, reducing alcohol and caffeine, having a body mass index between 20 and 25, and reducing stress. These things all do make a difference.

Healthy lifestyle can sometimes go out the window in busy houses with young children. If this is the case, getting your lifestyle back on track is important.

Age also plays a factor. A woman's fertility peaks in her twenties and the biological clock is a true phenomenon. Fertility starts to decline from mid-thirties but declines rapidly after 40. It's not recommended to undertake any investigations in couples under 35 who are trying less than a year. However, in those over 35, investigations are undertaken after six months.

The fact that you have two children conceived naturally previously is very positive. I would advise making sure you are having regular intercourse and that your lifestyle is healthy.

If there were changes to be made, I would try this for a few more months but if nothing is happening despite these changes then a visit to your GP for a chat, exam and some simple tests could point to a number of possible causes.

Beyond this, further investigations become quite invasive and referral to a specialist unit is likely.

With all the talk of infertility, one could begin to wonder how people manage to conceive at all. Women are born with all the eggs they will ever have but only 12pc remain by the age of 30; meanwhile, only about 20 to 25pc sperm actually swim in the right direction.

However, up to 80pc of couples WILL conceive within two years of unprotected intercourse.

The average woman in Ireland today has her first child at the age of 31 and plenty of women are having healthy babies late into their thirties and early forties.

For those who do need help, assisted reproduction is progressing all the time. Maybe future studies will reveal previously unknown factors but in the meantime it looks like being healthy is your best friend in fertility.

Q. My two-year-old’s toes are strangely curled under. They don’t seem to bother him in any way, but they do look odd. Will they grow to be straighter or should I get them looked at?

Dr Nina replies: Curly toes is one of the more common conditions of the foot that affects infants and children. It is present from birth but may become more noticeable as a child begins to walk. It tends to involve the third and fourth toes of both feet. This condition runs in families and is normally passed via autosomal dominant gene transmission, meaning each child has a 50pc chance of inheriting this from a parent. You will likely find that you or your partner have a similar condition.

The toes curl under because the tendons that bend the toes are too tight and pull one toe under the next toe, curling it towards the underside of the foot. The appearance may cause concern but in many cases curly toes don’t cause any symptoms. If symptoms do occur they may include flattening or thickening of the toenails, pressure sores or blisters and pain, or discomfort with some activity. Certain styles of shoe may be more difficult to wear.

It’s important to know that curly toes are within the realm of normal and in most cases they don’t require any treatment. Appearance of toes does sometimes improve as the child grows up to age five. Taping was popular in previous generations but it doesn’t help and is not recommended. It is important that comfortable shoes are worn with good space for the toes.

If toes are causing problems beyond the age of five, then you could ask your doctor to refer your child to an orthopaedic doctor who specialises in foot and ankle problems. They will advise you as to the best options. Surgical treatment to cut the tight tendon can be performed. This is generally a successful procedure. It does however require a general anaesthetic so talking with an expert is the best advice.

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