With such a plethora of information available through the Net, our family and friends and well-meaning support groups, is it any wonder the wives’ tales abound when it comes to fertility and falling pregnant. Here, Dr Gary Swift enlightens us on the facts over fiction.
Q. How much can be attributed to the male partner in issues of fertility?
A. Despite an old fashioned view that if pregnancy is not happening the female partner “better get herself checked out “, it is in fact wholly or partly male factors which are responsible in up to 40% of cases. Men can be tested relatively easily with a semen analysis after three days abstinence. If this is normal no more testing may be required. If abnormal we search for elements in the history such as undescended testes, childhood mumps, trauma and toxic exposure. Blood tests can help us identify biochemical, endocrine and genetic causes. In many however no cause is found and timed intra-uterine insemination or IVF with or without ICSI may be required. A good diet, moderate exercise, avoiding cigarettes, alcohol and drugs with a focused multivitamin is the ideal for optimum sperm production. Unfortunately, the reality is you can’t just look at men and presume because he looks OK, his sperm is OK.
Q. When should couples seek help if they are trying to start a family or fall pregnant?
A. We generally consider that 85% of healthy couples should fall pregnant within 12 months of regular unprotected intercourse. If this hasn’t happened at least a basic check up is indicated. However, as advancing female age impacts significantly on fertility, miscarriage and genetic risk, as egg reserve declines, we think a fertility assessment after 6 months is appropriate. This applies to well women with regular painless menstrual cycles and no adverse history. If women have pain with periods or sex or cycles are irregular disorders such as endometriosis and polycystic ovaries may need to be considered. Previous pelvic infection may damage or block fallopian tubes even if only mild with Chlamydia being a particular problem. In these circumstances an earlier check is appropriate and further investigation with blood tests, Ultrasounds, XRays and sometimes a surgical procedure called a laparoscopy may be required.
Q. How much does a woman’s age influence fertility?
A. Advancing female age is our biggest challenge at present. Women are born with all the eggs they will ever have (1 to 2 million). These eggs will “die off” whether cycles are regular or absent until menopause somewhere between 40 and 60 years of age (average 51.7 years). Fertility noticeably declines from 35 years. Success rate with IVF and other assisted reproductive technologies mirrors this decline with results approaching zero at 44 years of age.
The risk of miscarriage and genetic problems such as Downs Syndrome rises also with advancing age. In a perfect world women would have their babies when they are young and fertile to avoid many problems. In reality delaying child bearing for careers, meeting life partners later and many other social circumstances will affect this. Egg freezing and storage under 35 years of age may allow some “insurance”.
Q. How soon can a woman fall pregnant after giving birth?
A. It takes six weeks for the uterus and genital tract to recover after childbirth. If women don’t breast feed they may be fertile again as early as 6 weeks after the birth. If they chose to breast feed the prolactin hormone responsible for milk production suppresses ovulation and gives some intrinsic contraception. It is reliable for 3 months but some women become fertile again despite continuing to breastfeed. By 12 months up to half the women still feeding will resume periods. Progesterone based contraceptive options may be appropriate in this phase as estrogen based contraception will suppress lactation.
Q. Do any home remedies work for helping couples to fall pregnant?
A. Firstly, I am not an expert on these complementary therapies and many will have stories of how they conceived after attending such practitioners. Many therapies which reduce stress, inspire positivity and are not harmful may assist fertility. Research has been done on acupuncture as an adjunct to IVF with positive trends. I tend to take a “live and let live” approach. Complementary therapies will not overcome the big three: no sperm, no eggs and blocked tubes.
As yet we don’t have any solutions for advancing age. As couples who don’t have absolute infertility will always have a monthly chance of success doing anything that may allow a pregnancy to occur. As to standing on your head, it worked for our first child but there is no scientific proof! The vagina is designed to keep sperm near the cervix so avoiding leaping out of bed the moment the magic is over is a good policy!
Q. As well as IVF, what are some options for addressing fertility issues?
A. Lifestyle issues are important. A good diet , exercise, maintaining a healthy body weight and avoiding drugs (including cigarettes and alcohol) and toxic exposures (at home or work) are all important.
Diseases such as endometriosis, fibroids or tubal problems may require surgery. Polycystic ovaries may require ovulation induction. Minor male problems may respond to timed intrauterine insemination. More significant problems may need IVF and the good news is that success rates continue to rise with new scientific advances and are now able to overcome many problems couples face. The cost remains an issue as the technology is expensive, but the rewards priceless.
Q. Why is it vital to see an expert?
A. The main reason to seek a professional opinion is that many problems are not easily diagnosable. We still find 15% of couples have “unexplained infertility” that is no cause can be found. My particular interest in surgical causes of infertility means that I see many women with endometriosis and fibroids who require surgery to normalize their pelvic anatomy to assist pregnancy either natural or with IVF. In general terms any doubts related to fertility issues can be assessed , treated and where necessary assisted.
For more information Tel: (07) 5564 6017.