FEMALE INFERTILITY
THE IMPACT  OF AGE

Female age is one infertility factor we can do little to combat. While Hollywood might be telling you a different story, conceiving and giving birth using your own eggs after the age of 45 is extremely rare.

Now that’s obviously the upper end of the age conversation and you might be thinking, “I’m 10 years younger than that so I’m fine”. Unfortunately, and we’re not trying to be alarmist when we say this, fertility actually peaks at 22 and gradually declines from then on. The decline picks up pace and begins to be an issue from 33 or so, falling even more dramatically after 35.

Age works against fertility in several ways. It increases the likelihood you’ll suffer from problems with ovulation or your cycle and it also impacts on the health and number of eggs you have.

As your age advances beyond approximately 33, it’s more and more likely that your aging eggs will let the side down when it comes to conception. At first this will just be sporadically, but eventually it will be so thorough that you’ll essentially be sterile. And that can happen years before menopause. You see, the issue is that you are born with all of the eggs you’ll ever have – approximately two million and by the time of your first period, that number will have dropped to approximately 300,000. Not only is the number of eggs you have falling as you get older but the quality of the ones you have left also diminishes.

Through research we’ve found that many couples wait for more than two years before seeking fertility treatment. The problem with that is that if you’re 36 and you decide to wait for the average time, you’ll be 38 by the time you seek treatment and your chances of conceiving could have declined.

The bottomline is – don’t wait!

IMPACT OF AGE ON FERTILITY

As you can see from the graph below, by the time you’re 36 your chance of conceiving per month is decreased by half – and that’s if there are no other factors at play. The downward slope continues until by age 45 the average natural fertility rate per month is approximately one per cent.

 

OVULATION TRACKING

Many couples, understandably, want to know what they can do to improve their chance of conceiving. Before jumping into fertility treatment, consider ovulation tracking as a first step. It is after all a simple option that helps you understand your natural fertility and help you plan when to have sex to maximise the potential of getting pregnant.

Knowing when you or your partner ovulates will help you time intercourse to increase your chances of conception. As sperm can live at their healthiest inside a woman for two to five days, you’re more likely to conceive when you have intercourse on, or around one to two days before ovulation.

LIFESTYLE/WEIGHT

The links between being overweight or obese and an increased risk of chronic diseases, such as heart disease and diabetes, are well known – we read about them all the time. But what’s less well publicised is that an unhealthy weight – in either partner – can also have a significant impact on your ability to conceive.

Being overweight or obese not only reduces the chances of a couple conceiving naturally, but also means fertility treatment, such as IVF, is less likely to be successful. So you may need to consider a diet for conceiving success and to improve your pregnancy health. Eating a healthy diet can actually increase your fertility. During pregnancy, being overweight can also lead to complications including gestational diabetes and an increased risk of miscarriage, stillbirth, birth defects and obstetric complications.

Being underweight can also harm a woman’s ability to conceive.

The main effect of weight on fertility in women is due to a failure to ovulate – anovulation. There are also other more subtle metabolic effects due to elevated insulin. Women with a Body Mass Index (BMI) of 25-30 are 50 per cent more likely to have anovulatory infertility than women with a normal BMI. This rises to 300 per cent for women with a BMI over 30. Unfortunately, IVF success rates may be reduced by as much as 25 per cent in obese patients and 50 per cent in very obese patients.

The good news is that weight loss itself can be an effective fertility treatment and many patients conceive naturally after focusing on their diet and trying to exercise more.

POLYCYSTIC OVARY SYNDROME

Around 11% of women around the world suffer from Polycystic Ovary Syndrome (PCOS) although the fact it’s often misdiagnosed or even goes undiagnosed means numbers are probably even higher.

The name – Polycystic Ovary Syndrome – refers to the multiple, mini “cysts” which form on the ovaries of some women who suffer from the condition. These cysts are actually egg sacks or follicles and instead of growing and releasing an egg through ovulation as they normally would, they stall, instead releasing relatively higher male hormones into the blood, causing a range of health problems.

It’s a complex condition that can be related to elevated cholesterol, an insulin imbalance and a tendency to unwanted weight gain. However, significant metabolic shifts can still occur even if you are slim.

PCOS is one of the leading causes of subfertility or infertility but fortunately it doesn’t mean that you can’t conceive!

A combination of blood tests will be organised to assess your hormone levels and a pelvic ultrasound to look at your ovaries to see if the “cysts” or follicles are present. There’s currently no cure for PCOS but we can help you successfully manage the syndrome by making changes to your diet and exercise routines and, in some cases, medical intervention.

If your weight is already in the normal range or losing weight doesn’t help you conceive, there are a range of other treatments on offer to help you such as medication to increase ovulation, hormonal treatments and surgical options. IVF may be needed if there are other factors involved, such as poor sperm quality, so it’s important that you and your partner are assessed together to decide on the best treatment options.

ENDOMETRIOSIS

Endometriosis is a common condition, affecting at least one in 10 women at some point during their menstruating years. It’s a condition that can affect you anytime from when your periods first start right up until the time you enter menopause. It involves tissues that normally line your uterus (the endometrium) growing in abnormal places around your pelvis and, more rarely, other parts of your body.

Endometriosis is a common cause of infertility. That’s because the more severe cases of the condition can distort the ovaries and fallopian tubes and can cause the body to resist or reject foreign material – such as sperm. We also know that the growths produce a whole series of chemical substances (called cytokines or interleukins) that are thought to contribute to infertility. Under the influence of these chemicals, ovulation and egg quality may be impaired, sperm may not function so well and embryos can find it harder to implant.

Basically, endometriosis doesn’t make for a fertility-friendly environment.

While women with endometriosis in their ovaries may be diagnosed through an ultrasound, a definitive diagnosis of endometriosis can only be made with a laparoscopy or less commonly open surgery.

If surgery to remove endometriosis doesn’t lead to pregnancy, women in this situation tend to decide to move straight onto assisted reproduction, usually through IVF.

With so many factors to consider, we aim to provide the best treatment option for each individual patient.

MISCARRIAGE

Heartbreaking as they can be, sadly miscarriages are not uncommon. While we realise it’s of little comfort, if you’ve lost a baby through miscarriage, you are not alone. Approximately 15 to 20 per cent of all pregnancies end in miscarriage – often in the first trimester. The Australian Longitudinal Study on Women’s Health found for every three women who have given birth in their early 30s, one has had a miscarriage, and these figures increase with age.

Miscarriage is the spontaneous loss of a pregnancy before 20 weeks and most miscarriages can’t be prevented. Most of these babies will have already died in the uterus before the miscarriage occurs – unfair as it seems sometimes it’s nature’s way of ending a pregnancy that isn’t developing as it should.

The loss of a pregnancy, at any stage, can be an extremely difficult and emotional time for many couples, particularly if it happens repeatedly or following infertility. But most miscarriages are what we call a single pregnancy loss – an isolated instance of miscarriage that conversely enough actually shows your body’s reproductive system is working. Most women who miscarry can conceive again and go on to have a baby. While talking about it with your family and friends is a good idea, miscarriage myths can be emotionally damaging so try not to take the old wives tales to heart and read our advice on what’s right and wrong.

However, some women devastatingly experience more than one miscarriage. We call this recurrent pregnancy loss or recurrent miscarriage and while still not unusual – one in 20 couples experience two miscarriages in a row – it is obviously a sign that something isn’t working and it’s time for some help.

FEMALE FERTILITY TESTS

There are a number of different tests you’re likely to need to undergo such as an AMH test, and most of them require a simple blood test.

  • Follicle-stimulating hormone (FSH)
    Follicle-stimulating hormone (FSH) helps control a woman’s menstrual cycle and the production of eggs. Testing your FSH levels helps evaluate your ovarian reserve or egg supply and the test will most likely be done on the third day of your menstrual cycle.
  • Luteinizing Hormone (LH)
    Luteinizing Hormone (LH) is linked to ovarian hormone production and egg maturation. Which is used to test if you are ovulating and also to help measure your ovarian reserve.
  • Oestradiol
    Oestradiol is an important form of oestrogen (the primary female sex hormone). An oestradiol testis used to measure your ovarian function. It’s also likely to be done on the third day of your menstrual cycle.
  • Progesterone
    Three weeks after your period, we may test your progesterone levels. Progesterone is the hormone which is produced by your ovaries when you ovulate. It triggers the endometrial lining of the uterus to thicken, making it a more receptive environment for a fertilised egg. So therefore, a progesterone test is used to find out if you’re ovulating.
  • Prolactin
    Probably best known for its role in human milk production, prolactin is also key to our immune system and is involved in cell growth. In terms of your fertility, we will use a prolactin test to help find out why you’re not menstruating.
  • TSH/Thyroid antibody
    Every cell in your body depends upon thyroid hormones for regulation and good thyroid function is necessary for fertility. We might test the level of your Thyroid Stimulating Hormone (TSH) and also test your antibody values to see if they are both in normal range.
  • Ultrasound scan
    An ultrasound helps to check the health of the lining of your womb (called the endometrium) as well as check for fibroids or polyps or ovarian cysts. It may also be used to check that your fallopian tubes are open.
  • Female Fragile X carrier test
    There are some reports that women who carry the gene that can cause Fragile X syndrome in their offspring, can suffer from premature menopause. The laboratory can conduct a Fragile X test that is available for the most common gene size.
  • Blood chromosome test
    Sometimes, even if you’re perfectly healthy, you might carry structural chromosome rearrangements in your genes (eg reciprocal translocation) that can cause difficulties in getting pregnant, can cause miscarriage, or can result in the birth of a child with abnormalities.