One of the things for ladies with irregular periods or oligomenorrhoea is that it becomes very stressful for them to try and work and that I think just complicates the whole issue in terms of tracking. For some ladies it is very easy if they have a 28 or 30 day cycle and it’s very consistent, they can pretty well mark on the calendar their ovulation day and pick a fertile window around that. The ladies who have quite erratic cycles, they have no idea whether they’re going to be ovulating a little bit earlier or normal sort of time, average time or much longer than that. So there’s a cost involved in terms of those extra monitorings of urine testing that they have to do but I think also emotionally it’s quite challenging because the partner gets drawn into this as well and people juggling their working lives and their home lives and in the middle of that, they’re trying to work out when that day is and it’s stand by your beds and hope for the best on that particular occasion and I think, I’ve had lots of conversations over the years with couples to try and just step back a little bit from that. I mean, it’s difficult if you have very irregular cycles, you want to try and target this and that’s the right thing to do but it can become the sort of focus of everything in that couple’s life and I think that in itself that can cause issues, it can cause problems with relationships and increase stress levels. So I think, again, it’s in that kind of couple from a medical perspective I would be keen on trying to understand and help them in terms of trying to confirm or refute whether ovulation is occurring and they’ve been in that sort of situation I’d be more than happy to start investigating that sooner than the arbitrary 12 months that we discussed in terms of allowing an appropriate amount of time because I think it is very wearing and it almost removes some of the romance from the scenario which should have some of that left in it and not just left to a timing exercise. It’s unfortunate because of the short duration that a newer site lives post ovulation you have to try and target it and if ladies have no real clue when that’s going to be at the beginning of any one menstrual cycle then, it’s difficult and it’s challenging and I think we have to support them through, that pathway as well. As I say perhaps try and confirm if ovulation has occurred that may mean several blood tests in different stages of the menstrual cycle to try and capture that ovulatory blood level but I think, again, it’s helpful for couples to know and then sometimes I’ve said to them look why don’t you have two or three months where you’re not using ovulation prediction kits and let’s let’s make it that your ovulation window let’s broaden that out a little bit and let’s say look if you have intercourse twice a week covering those weeks, then you’re going to cover your potentially fertile period but rather than having to do urine sticks all the time – just ease back for a few months, de-stress away from that and see whether mother nature helps you out. I think people get awfully stressed about it and I understand that it is very stressful but sometimes I think that’s not helpful. Sometimes, we can help by perhaps just widening as I say widening that window and just saying look why don’t you have a few months where you have a slightly more relaxed plan about this and then if you’re not lucky, we take it forward and we move forward down that infertility pathway.
