What is Infertility?
Infertility refers to an inability to conceive a pregnancy. In Australia, 85% of couples having regular intercourse will have conceived within a 12 month period. The remaining 15% are infertile or sub fertile. Globally about 80 million women and a similar number of men suffer infertility.
How do I assess my fertility?
The best confirmation of fertility is conceiving and giving birth to a healthy baby but up until that point if you want to have your fertility “checked” there are simple tests you can have to give you a guide. For women this involves seeing your doctor or health practitioner and having a blood test and an ultrasound. For men a simple sperm test is a good place to start.
What are the male and female infertility factors which could prevent pregnancy?
For women, ovarian ageing is a very common reason for seeking fertility treatment but conditions such as Polycystic Ovarian Syndrome and Endometriosis are common causes of female infertility. Tubal blockage usually from a previous pelvic infection and other causes of ovulatory dysfunction besides PCOS can occur as well. Sometimes we are not always able to establish a cause very easily - so called “unexplained infertility”.
For men it’s all about being able to produce good quality sperm in sufficient concentration, strong fast swimmers and enough normal looking sperm to get the job done. For couples trying naturally men also have to be able to get the sperm where it needs to be, so issues like low libido and erectile dysfunction can have an impact here.
What is IVF?
IVF stands for “in vitro fertilisation” and it refers to a technique whereby eggs are matured in the female body using medication and collected via a minor surgical procedure. They are transported to the IVF laboratory in an incubator where they are allowed to combine with freshly produced or previously frozen and thawed sperm. Sometimes an individual sperm is actually injected into the substance of the egg to assist fertilisation - this is a technique known as “ICSI”. Once the eggs are fertilised they are now embryos - and embryos are grown in the laboratory for about five days. At this stage they are ready to implant and thus able to be placed back in the uterus in a simple medical procedure that requires no anaesthetic. Usually one embryo is replaced and any additional good quality embryos can be frozen for use at a later date.
When is IVF needed?
The original indication for IVF was when a woman had both tubes blocked and this is still a reasonably common reason for undergoing IVF. However there are now many other reasons couples may require IVF. If we have serious problems with sperm quality that are not amenable to lifestyle changes or other treatments, then IVF with ICSI is the best approach. If we need to test embryos before implantation to rule out genetic or chromosomal abnormalities then we can use IVF for this indication. IVF is also recommended when other fertility treatments have not been successful or if a combination of factors mean simpler options are unlikely to succeed.
How should you prepare for pregnancy?
Aiming to be in the great shape prior to conception is a good idea but this doesn’t mean striving to be perfect. If you are a woman, make sure your Pap smear screening is up to date and see your doctor or health professional for an “antenatal screen” - a series of tests including those that ensure you have immunity to - or no previous infection with - some important infectious diseases that can have a serious impact on pregnant women and their babies.
We recommend people optimise their weight prior to pregnancy but discourage women from rapid weight loss to get to an “acceptable” BMI. This just encourages unhealthy eating habits and yo-yo dieting with re-gain of all the weight lost in pregnancy and beyond.
Definitely give up smoking and stop using recreational drugs. There are reams of evidence showing the deleterious effects of smoking on fertility, pregnancy and children’s health and there are no recreational drugs that are acceptable in pregnancy. Limit caffeine to two cups a day.
Cut down on alcohol intake. We say there is no safe level of drinking in pregnancy.
Watch your stress levels and observe how you manage stress at work and in the rest of your life. Try to factor in ways to mitigate stress like mindfulness, yoga or meditation.
Watch your sleep patterns and try to ensure you get a good 7-9 hours per night.
For women who are taking regular medications, see your doctor about what is safe to continue and what might need to be changed. Certain medication such as some antihypertensive medication and anticonvulsant medication can be very dangerous in pregnancy.
Women planning to conceive should be taking Folic Acid 400mcg/day up to 5mg/day depending on their history, for the month prior to conception and the first twelve weeks of pregnancy. We generally recommend a pregnancy-specific multivitamin, as general multivitamins can have the wrong balance of vitamins and minerals for pregnancy.
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