INFERTILITY
About Infertility
Infertility is defined as not being able to conceive despite having frequent unprotected sex for a period of 1 year. General advice is to seek treatment after one year, however, you should seek help earlier if any of the following apply to you:
-
Over the age of 35
-
Diagnosed with endometriosis
-
Have irregular or painful periods
-
Have had multiple miscarriages
-
Have undergone treatment for cancer
While there are many causes of infertility in women, the most common factor is age. The quality of a woman's eggs declines with age, most rapidly after the age of 35, and the incidence of chromosomal irregularities which causes a pregnancy to fail, is much higher. Male fertility also declines with age, affecting sperm quality.
Other causes of infertility include: hormonal imbalance, issues with the uterus or ovaries, issues with the testes, or male reproductive tract, or issues with sperm mobility, chronic and sexually transmitted disease. In about 15% of cases, infertility is unexplained. That is, investigation finds no abnormalities. It is likely that some abnormalities do exist in these cases, but cannot be detected by current methods. Infertility may be primary or secondary infertility. Primary whereby pregnancy has never been achieved, secondary whereby a pregnancy has previously been achieved.
-
Age is the single biggest factor affecting a woman’s chance to conceive & have a healthy baby.
-
A woman’s fertility starts to reduce in her early 30s, and more so after the age of 35.
-
The risks of pregnancy complications increase as women age.
-
Male age over 45 years increases the risk of miscarriage, and the child’s risk of mental health and developmental disorders.
Source: Better Health
The success rate of assisted reproductive technologies also declines with age. For a woman aged 35 success rate is approx 30%, but by age 45 this drops to approx 3%.
Treatment Options
Various treatment options exist for infertility including:
-
Medication to induce ovulation (e.g. Clomid)
-
Intrauterine insemination (IUI)
-
In vitro fertilisation (IVF)
-
Donor egg, embryo, or sperm
Clomid
Clomiphene citrate, sold under brand name Clomid, is a medication that is commonly used to treat women who are having difficulty ovulating, including in cases where infertility is caused by polycystic ovarian syndrome. Often it is used hand in hand with IUI. Clomid works by stimulating an increase in hormones responsible for follicle stimulation and egg release.
IUI
Intrauterine insemination is a process whereby sperm are inserted directly into the uterine cavity. IUI using a sperm donor is an option for single women or same sex couples. IUI is also often recommended in the setting of short-term unexplained infertility or sexual difficulties as an initial treatment before moving on to more complex fertility treatments such as in vitro fertilisation (IVF).
It can also be used when semen has been frozen prior to a male partner's chemotherapy or radiotherapy treatment. One benefit of IUI is that it provides the option to either undergo treatment during the woman's natural cycle with no medication, or to use medication to stimulate the ovaries for ovulation.
IVF
In Vitro Fertilisation is when a woman's eggs are fertilised and the embryos grown in a laboratory, then an embryo is transferred into the woman's uterus. For most of the large fertility clinics in Australia, it is common practice to only transfer one embryo at a time. This is because of risks for both mother and babies that are associated with multiple births vs singleton births. The remaining embryos are usually frozen, and can be used for later treatments.
IVF has had its share of controversy in Australia:
-
An ACCC investigation in 2016 into IVF success rate claims concluded some information provided was likely to lead to consumers being given a misleading impression about the rate of success.
-
A 2019 survey conducted by the ABC showed an overwhelming number of people who had undergone IV treatment stated they had 'felt like a number'.
-
Monash IVF has been at the centre of a class action in the Australian Supreme Court.
Filed in March 2021, the case sought compensation for financial loss and psychiatric injury. It alleged some patients had their embryos classified as abnormal and unsuitable for transfer as a result of niPGT-A genetic testing. The claim alleges that niPGT-A testing should not have been provided by Monash IVF, because there was a substantial risk, not disclosed to patients, that the testing might produce false positive results, and therefore an erroneous determination that an embryo was abnormal and not suitable for transfer. Monash IVF has now ceased conducting this particular type of genetic testing. IVF has provided the opportunity for many couples to conceive who were otherwise unable to. Seek the advice of your specialist in deciding whether IVF is right for you. Further reading comparing IVF vs IUI can be found here.
According to the US CDC the average percentages of assisted reproductive technology (ART) cycles that lead to a live birth range from 31% in women younger than 35 years of age to 8% in women aged 41 to 44.
Donor Egg, Embryo or Sperm
It has been recognised in Australia there has been a gap in services and framework to support those seeking a donor egg or donor sperm. Unfortunately, it is illegal in Australia to sell or receive payment for any human tissue, including eggs or sperm. However, there are egg donor programs available whereby women donate for altruistic reasons. Usually the recipient of the eggs covers the cost of the donor's treatment cycle when the eggs are retrieved. The Victorian Government recently announced its intention to set up the first such public egg and sperm bank of its kind in Australia. The Victorian Assisted Reproductive Treatment Authority (VARTA) provides information, counselling and support services for donors, donor-conceived people, recipient parents and relatives or descendants. The world egg and sperm bank based in Phoenix, Arizona, is now also delivering services to several countries including to Australia.
SURROGACY
In Australia it is legal to become a surrogate for altruistic reasons. Surrogates can legally be reimbursed for medical expenses, lost earnings, health premiums, and other out of pocket expenses.
egg freezing
If you are not in a position to conceive yet, but are concerned about a potential decline in your fertility, you can choose to freeze your eggs. From an egg quality standpoint the earlier you freeze your eggs the better, however, it is often women in the 30-35 age bracket who are choosing to freeze their eggs.
Some substances and chemicals are known to disrupt the human endocrine system which controls and maintain hormones in the body. When the endocrine system is disrupted, hormonal imbalance and reproductive implications arise. If you are trying to conceive, or having difficulty conceiving, it may be of assistance to minimise the risk of hormonal imbalance caused by exposure to endocrine disruptors.
Below is a list of substances known to disrupt human endocrine function:
-
Phthalates
-
Organophosphate pesticides
-
BPA in plastics
-
Heavy metals including lead and mercury
-
Glycol ethers
Full list here
One of the most common ways we are exposed to chemicals is through personal care products and household products that come into contact with our skin. These are generally items we use often, so exposure tends to be repetitious and continual.
Refer to my avoid list for more information on chemicals found in personal care products.
The Fertility Diet Pattern
Published by a team of Harvard researchers in 2007, the "Fertility Diet" study found women with ovulatory infertility who followed this eating pattern had a 66% lower risk of ovulatory infertility and a 27% reduced risk of infertility from other causes than women who didn't follow the diet closely.
Women following the "fertility diet" chose:
-
Less trans fat and more monounsaturated fat (from foods such as avocados and olive oil)
-
Less animal protein and more vegetable protein
-
More high-fiber, low-glycemic carbohydrate-rich foods (including whole grains)
-
More vegetarian sources of iron and fewer meat sources
-
Multivitamins
-
High-fat dairy instead of low-fat dairy
A review of past studies conducted by researchers from the Harvard T.H. Chan School of Public Health and Harvard Medical School found that for women trying to become pregnant naturally (without "assistive reproductive technologies" such as in vitro fertilization), the following vitamins and nutrients were linked to positive effects on fertility:
-
folic acid
-
vitamin B12
-
omega-3 fatty acids
-
healthy diets (such as the Mediterranean diet)
On the other hand, antioxidants, vitamin D, dairy products, soy, caffeine, and alcohol appeared to have little or no effect on fertility in this review. Trans fat and "unhealthy diets" (those "rich in red and processed meats, potatoes, sweets, and sweetened beverages") were found to have negative effects.
Studies of men have found that semen quality improves with healthy diets (as described above), while the opposite has been linked with diets high in saturated or trans fat. Alcohol and caffeine appeared to have little effect, good or bad. Importantly, semen quality is not a perfect predictor of fertility, and most studies did not actually examine the impact of paternal diet on the rate of successful pregnancies.
For couples receiving assisted reproductive technologies, women may be more likely to conceive with folic acid supplements or a diet high in isoflavones (plant-based estrogens with antioxidant activity), while male fertility may be aided by antioxidants.
In general, eating more vegetables and a variety of types, eating healthy monounsaturated fats instead of saturated and trans fats, making at least half your grains whole, and getting enough calcium-rich foods — including dairy — will help you meet nutrient needs and promote a healthy weight.
Source: Eat Right, Academy of Nutrition and Dietetics
Top 5
-
Age is the single biggest factor affecting a woman’s chance to conceive and have a healthy baby.
-
Male age over 45 years increases the risk of miscarriage, and the child’s risk of mental health and developmental disorders.
-
There are various treatment options for infertility, including IVF, IUI and hormone stimulting drugs. However, none of these treatments can turn back the clock: egg quality declines after age 35 and sperm quality after age 40-45, which exponentially increases the risk of chromosomal irregularities, and in turn, miscarriage.
-
If you are trying to conceive, or having difficulty conceiving, it may be of assistance to minimise the risk of hormonal imbalance caused by exposure to endocrine disruptors.
-
Choose a balanced diet, with nutrients including folate, omega 3, and iron from various sources, and to limit alcohol, caffeine, food additives, sugars and processed foods.