Fertility

What is Fertility?

Fertility is the term applied to the ability to reproduce; men who are fertile are able to father children, and fertile women are able to get pregnant and carry their baby to full term, resulting in a live birth.

Fertility can sometimes be a problem. During our late teens and early 20s, our sex drive and fertility levels peak. As we age, our fertility starts to decline.

This is especially applicable to women; pregnancy rates for natural conceptions, and after infertility treatments, drop drastically after the age of 35. Other factors include increasing obesity, diet and the rise in sexually transmitted disease. Around 10% of couples starting a family face problems with their fertility. This may be due to a problem with the male partner or the female partner, or a combination of the two.

When am I most fertile?

Women

During ovulation is the time when a woman is most fertile, and it is this time in which the sperm must fertilise the mature egg in order to become pregnant. A mature egg only survives for approximately 24 hours after you have ovulated, but sperm can survive for up to 7 days in your vagina, uterus, or fallopian tubes. This means that you have an average fertile window of about 6 days, up to and including the day of ovulation, in which to copulate and get pregnant.

During menstruation, the beginning of your ‘cycle’ is considered to be the first day of the menstrual period. The ovulation period is usually considered to occur between day 10 and 19 of your 28-32 (on average) day cycle, or roughly 12-16 days before the next period is due. The easiest way to tell if you are ovulating is to keep track of your periods and look out for the physical and hormonal changes in your body.

Men

Men are considered to be fertile from the time they enter puberty throughout life, without having a specific ‘fertility window’. While that is so, a man’s fertility does start to decrease with age past approximately 40 years.

How can I tell how fertile I am?

Women

There are various methods of testing for fertility in women, for both general fertility and the time during a woman’s cycle when she is considered to be ‘most fertile’, or her ‘fertile window’.

If you are trying to find your fertile window during your cycle, ways that you can asses your fertility at home include;

• Stretch Test: Cervical mucus will become clear and elastic during the fertile window, to aid sperm in surviving and travelling through it.
• Ovulation Prediction Kit: Ovulation prediction kits are antibody tests that check for luteinising hormone in the urine, which is most highly concentrated at the time of ovulation. Some tests also monitor estradiol.
• Cervical Position: You can check your cervical position. Your cervix will become soft, high, open and wet during the fertile window.
• Basal Body Temperature: Basal Body Temperature (BBT) can be measured using a BBT thermometer kit, which you can purchase from chemists and supermarkets readily. A difference in BBT for 3 days running indicates ovulation, and thus fertility.
• Calendar Method: Because the fertile window arrives at approximately the same time each month, you can calculate your fertility by charting your cycle.

If you are trying to ascertain your general fertility, there are various tests that can be carried out to do so. These include;

• Anti-Mullerian Hormone Testing: An anti-mullerian hormone test will allow the estimation of ovarian reserve. This means the test can give a fairly accurate indication of the fertility opportunities that a woman has remaining.
• Follicle Stimulating Hormone: Tests for follicle stimulating hormone establish whether or not a woman will ovulate in any given month. This test is typically carried out on day 3 of the menstrual cycle.
• Hysterosalpingography: Hysterosalpingography involve the inspection of the fallopian tubes and uterus, by the injection of a radiocontrast agent, to ensure the egg can pass down the tube without obstruction, and to identify uterine abnormalities.
• Ovarian Ultrasound: Ultrasound scans of the ovaries may be conducted to establish the development of ovarian follicles. This can be useful particularly in the diagnosis of polycystic ovary syndrome.
• Hysteroscopy: Hysteroscopy is used to diagnose the presence of a number of conditions that may affect fertility, such as uterine fibroids, Asherman's syndrome, and bicornate uterus. It involves the insertion of an endoscope to produce images of the inside of the uterus.
• Laparoscopy: Laparoscopy is used to examine the interior of the abdomen. It can be used to establish patency of the fallopian tubes, and is especially suitable for the diagnosis of endometriosis.

Men

Men are considered to be fertile from the time they enter puberty throughout life, without having a specific ‘fertility window’. Fertility testing for men involves semen analysis, hormone evaluation, physical examination and genetic testing.

• Computer Assisted Semen Analysis (CASA) : A computer assisted semen analysis (CASA) will test for sperm count, sperm motility, pH, sperm morphology, volume, fructose content, and acrosome activity.
• Genetic Testing: Genetic testing and chromosomal analysis can rule out some other causes of male infertility, such as Kleinfelter's syndrome.
• Hormone Evaluation: Testosterone, and multiple hormones made in the brain, control sperm production. However, hormones are not the main problem in 97% of infertile men. Experts disagree as to how big a search should be done for hormonal causes of infertility.
• Physical Exam: A good physical exam can detect varicoceles and give clues to hormone problems. Testicular size can be measured. The physical exam should ideally be performed by an urologist

How can I increase my fertility?

There are a number of fertility treatments currently available to Australians.

Fertility drugs:

Fertility drugs increase the levels of certain hormones within the body.

For females, fertility drugs can aid in maintaining regular ovulation. Some female fertility drugs can result in severe side effects, and/or a higher chance of a multiple pregnancy.

For males, fertility drugs can aid in the production of sperm and testosterone. Some men will also be prescribed non-hormonal drugs (like antibiotics) to aid in infertility caused by infection or injury, rather than hormones.

Intrauterine insemination:

Intrauterine insemination, or IUI, is when your doctor places washed, prepared sperm directly into your uterus at the time of ovulation, and is a form of assisted conception. It is commonly used if you are unable to have sex, due to disability, injury, a physical or psychosexual issue, illness (such as HIV), are a single woman looking to start a family on your own, or you are part of a same sex couple wanting to start a family. IUI is often used alongside fertility drugs.

Surgery:

Blocked tubes, endometriosis, fibroids and ovarian cysts can all play a part in fertility problems and surgery may be an option for treatment. Some of the conditions that may be treated with surgery can also be bypassed by using IVF.

Assisted Conception Treatments:

Assisted Conception Treatment is the term used when fertility drugs and other treatment options are implemented alongside high-tech procedures like egg collection, to treat male and female fertility issues. These high-tech treatments include IVF, intracytoplasmic sperm injection, using donated sperm, eggs, or embryos, and surrogacy.

Natural methods to increase fertility

There are a number of natural ways to boost fertility that you can try out at home.

Women

You can boost your fertility by keeping active and maintaining a moderate level of exercise. Consuming a healthy balanced diet rich in ‘B’ vitamins, selenium and folate as well as full fat dairy has been shown to increase chances of pregnancy. Cutting down on caffeine, drinking more water and quitting smoking also help to increase fertility.

Being aware of your body’s fertile window and ovulation cycle and having sex at the right time is a sure fire way to boost your fertility. You should also consult your doctor about any medication that you are taking to find out if it might be limiting fertility, and if there are any alternatives that may not do so.

Men

You can boost your fertility by consuming a healthy, balanced diet. Foods rich in zinc, selenium, and ‘B’ vitamins are widely considered to be beneficial in increasing fertility in men. Cut the amount of foods high in trans-fats, and increase whole grains, protein rich food and as much unprocessed foods as possible.

Avoid overheating around the testicles by wearing loose fitting clothes and underwear, and by avoiding very hot spas and baths.

How does past use of contraception affect fertility?

There are a lot of different theories about how long you should wait after ceasing contraception before you start trying to conceive. While most information will tell you that it is best to wait until you have experienced at least one regular period after stopping contraception, it is not dangerous or detrimental to baby if you do happen to get pregnant straight away. Your body will have a different reaction to anyone else’s while regaining its natural hormonal balance, just as your body would have had a different reaction when beginning it. Depending on the type of contraception you are using you may take up to a few months to return to your natural menstrual cycle.

If you are considering a reversal of sterilisation in order to conceive, it is possible but can be difficult, expensive and ultimately unsuccessful. Sterilization can damage fallopian tubes and be considered irreversible. A clip sterilization has better odds of successful reversal with 9 in 10 women becoming pregnant post-reversal. A sterilization reversal is considered a major operation.

Men’s sterilisation, or vasectomy, can be reversed also. In men it is not uncommon to develop ‘sperm allergy’ after a reversal, wherein their body produces antibodies that kill their own sperm. In these cases it is still possible for them to fertilize an egg via fertility treatments. The rate of pregnancy post-vasectomy reversal is directly related to how many years have passed since the original vasectomy procedure, with fewer years between procedure and reversal indicating a higher success rate and resulting pregnancy.

What affects fertility in women?

• Medications: Some medications, such as decongestants, can be inadvertently lowering fertility in women as a side effect.
• Congenital or physical abnormalities, scarring or tube blockage: Eggs and sperm need a relatively clear path in order to meet. If a female has fibroids or polyps, endometriosis or scarring in the reproductive organs, there may be an obstruction in the path of the sperm and egg.
• Age: By the time a woman is in her mid-30s, many of her viable eggs have been depleted due to menstruation and natural attrition. While a woman can remain fertile enough to conceive later in life, after the age of 35, the chances of producing a child with chromosomal abnormalities is significantly increased.
• Irregular ovulation: Irregular ovulation can be caused by various conditions; such as polycystic ovary syndrome (PCOS), both hyper- and hypothyroidism, hormonal imbalances, being over or underweight, stress, poor nutrition and perimenopause. Irregular ovulation can affect fertility by making it difficult to time your sexual interactions in order to conceive.
• Smoking: Smoking causes a more rapid egg depletion in women, and alters estrogen production. Nicotine is passed from the estrogen into the cervical mucus, and can kill sperm resulting in fertility problems.
• Weight: Being both over and under weight can affect fertility in women. Being underweight can affect ovulation, and overweight, hormonal balances.
• Stress: High stress can cause a woman to experience hormonal changes that can prevent regular ovulation.
• STIs: Untreated STIs can cause scarring in the fallopian tubes, uterus, uterus and ovaries which can cause blockage and prevent sperm from being able to reach the egg, or the fertilised egg from travelling to the uterus.

What affects fertility in men?

• Heat: The enzymes that are required to produce sperm are sensitive to heat, and extended overheating may prevent sperm production.
• Medications: Some medications, such as heart medications, can cause males to have a lower sperm count, low sperm motility, or cause production of sperm to cease entirely.
• Congenital or physical abnormalities, scarring or tube blockage: Sperm needs to make it into the ejaculate to begin the process of reproduction. If a male has a condition such as a missing vas deferens, or scarring in the reproductive organs, there may be an obstruction in the path of the sperm to the ejaculate.
• Age: Although men can father children into old age, the risk of having a child with chromosomal abnormalities increases after the age of 35.
• Varicoceles: Varicoceles are varicose veins present in the scrotum, and is the most common cause of male infertility. The varicose veins enlarge and cause blood to pool in the scrotum, which causes the temperature to rise and the excess heat to affect sperm production.
• Alcohol and smoking: Alcohol is a ‘gonadotoxin’ and can adversely affect sperm production. Smoking can result in abnormal sperm production in men.
• Weight: Both being over and under weight can affect fertility in men. Being underweight can affect testosterone levels, and being significantly over- or underweight has been linked with low sperm counts.
• Stress: High stress has been shown to lower sperm volume and raise the chances of producing abnormal sperm.
• STIs: Untreated STIs can cause scarring in the ducts of the epididymis, vas deferens, and ejaculatory glands, and can cause obstruction in the path of the sperm to the ejaculate.