The urge to perpetuate oneself by having children is basic to many people. About 85 per cent of couples trying to conceive, using no birth control methods and having regular sexual intercourse, will achieve a pregnancy within a year. By definition, the remaining 15 per cent have some kind of problem with fertility.

Sometimes the reason for this is obvious: Anthony and Katarina consulted Caroline because they had been married for eight months and were very anxious to have a baby. Anthony and Katarina both come from very religious backgrounds, were virgins when they married and were sexually very naïve. In talking with them, it was soon evident that they had never had full sexual intercourse. Surprising, you may think, in today’s free-and-easy climate, but it does still happen. Caroline found that Anthony’s tendency to premature ejaculation and Katarina’s rather thick hymen (membrane across the vaginal opening), taken together, meant that sperm weren’t getting anywhere near where they should be. What’s more, neither partner was enjoying it much.

So the first (and often overlooked) question is: are you having sex with vaginal penetration by the penis and ejaculation of semen into the upper part of the vagina? If you are not, then that is the first step. And we’re not being trite when we say that Nature intended it to be fun! If you need help or advice about sexual technique or problems canadian pharmacy viagra, it is available from people who are trained and sympathetic — either talk to your family doctor, or see the suggestions at the end of this book.

You also need to be ‘doing it’ at the right time of the month, as Kiri and Alf found.

Kiri’s cycle was dead regular at 28 days, but when her doctor checked that she was ovulating, it became apparent that Kiri always ovulated mid-week. Now this wouldn’t be a problem except that Alf was never home mid-week — he drives trucks and was gone from Monday to Friday. Sperm survive about 72 hours, and the egg is ready for fertilisation for about 12 hours, so by Friday evening of the week that Kiri ovulated it was just too late. Kiri came up with a clever solution: she took the week off from her shop job and went with Alf. ‘It was a holiday with a difference!’ she said. It worked. Little Tess was born nine months after her parents’ trucking honeymoon.

If you have conscientiously tried the above methods, and no pregnancy has resulted, then you need to consider investigation and maybe treatment. We think it’s worth pointing out that this is a good time for both partners to talk frankly with each other about their expectations. Very sophisticated technology is now available to treat many causes of infertility. But success rates for some of these procedures are nowhere near 100 per cent. Today, more couples are also choosing to remain childless. This is a perfectly reasonable choice. Having tried for a while to conceive, and not succeeded, you both might decide not to pursue investigations. It is important, though, that any decision be mutual. If you are going to proceed, have some idea how far you want to go. Infertility treatments can be expensive, time-consuming, painful and in some cases risky, as well as possibly unsuccessful. Having some endpoint in mind from the beginning is a sensible plan.