Frequently asked questions.
There’s a lot of information out there about fertility challenges and treatment. Sometimes knowing the right questions to ask can seem overwhelming. I always tell my patients, ask me anything! Jot your questions down before you see me and don’t be afraid to whip out your notebook and phone and fire away.
What is fertility and what are the factors affecting it?
Fertility is the ability to conceive. Infertility is classically thought of as the inability to conceive after a defined period, usually twelve months. Broadly speaking, if infertility exists, one third of the time it is related to female factors, one third of the time male factors and one third a combination of both or there are no known factors i.e. unexplained infertility.
Female fertility factors can include age of the patient, tubal disease, endometriosis, uterine fibroids, uterine anomalies and coital issues. Male factors may include abnormal sperm production (including reduced numbers of sperm), reduced motility of the sperm or an increased abnormal shape to the sperm.
The investigations that we undertake are designed to identify the causes of infertility and how they may impact upon your overall success rates. Our advice is always to come in for a chat if you haven’t conceived within six months of trying and we can start initial investigations.
When in your cycle are you most fertile?
In an ideal cycle of 28 days, most women will ovulate around Day 12-14. To maximise the chances to conceive, you should have intercourse three or more times a week from Day 8 through to Day 16 of the cycle. You can use urine testing or an app to help predict the ideal time for ovulation—although many people find the use of devices or urine testing kits kills the spontaneity of sex and can lead to unwanted relationship pressures.
If you are having intercourse two or less times per week then we do see a reduction in fertility. Conversely we do not see an improvement in fertility rates when a couple have intercourse seven times per week as opposed to three times. You should be as spontaneous as possible with your sexual activity as you don’t want to make it a chore that will then upset your relationship!
How long does it take to get pregnant?
When a couple first starts trying to conceive we would expect their chance to be 30%. I.e. there will be a one in three chance the couple will conceive the first month they try. If a couple have been trying for twelve months, their chance to conceive next month is 10%. If they have been trying to conceive for two years, their chance to conceive next month would be 5%. If they have been trying for three years, the chance next month would be 3%.
We would advise getting in touch for a chat if you have not conceived after six months to initiate some initial investigations. Certainly if conception has not occurred by twelve months we would strongly recommend that all couples should have a consultation.
What are the fertility rates in Australia?
In Australia one in seven couples under the age of 40 experience infertility. For couples where the woman is aged 40 and older, one in four couples will experience infertility. Meaning this is a common problem. We always encourage you to contact a fertility specialist if you are having difficulty conceiving as there are a number of different investigations and treatments that can resolve these issues.
It is estimated that in any one class at a school, between 1 and 3 children in that class will have been conceived following medical intervention or assisted reproduction in the form of IVF. If you discuss this topic with colleagues or families, you will find that many of them will have had similar experiences and will tell you success stories of how they have been helped. You should not feel ashamed or be hesitant about seeking treatment for infertility.
How do I improve or increase my fertility?
What you can do to improve or increase your fertility after medical intervention is to be as healthy as possible. General medical advice would be that you should be on a good diet, have a good fluid intake and minimise toxins—including smoking, excessive caffeine intake or excessive alcohol intake.
Supplements that have been scientifically proven to improve fertility include Folic Acid. Other preparations such as anti-oxidants (CoQ10, Melatonin) should theoretically improve fertility but have not been proven scientifically to do so.
In general, a good diet means you can eat as much vegetable and fruit as you like. You should have protein as your chief source of energy. Carbohydrates are important in a diet. Ideally they should be limited in quantity and be complex so as not to produce a sugar hit for the body. It is also important to exercise between half to one hour a day. That exercise does not need to be excessive and can be as simple as going for a brisk walk.
Does my weight affect my fertility?
Ideally weight should be in the normal BMI range of between 18 and 25 to maximise your changes of fertility.
If you are a little overweight you should not be stressed about that. If you are overweight, you do not need to get back to an ideal weight but it is important to diet and exercise so that you are on a reducing weight trajectory.
There is good research that indicates that even very overweight women who are able to lose up to 5kg of weight can normalise their metabolism and result in healthy ovulation and conception. This is an area that we can discuss further during the consultation.
What is IVF and how does it work?
IVF simply means invitro-fertilisation and involves the removal of oocytes from the female ovary and combining them with sperm in the laboratory. The eggs can be inseminated or mixed with sperm—or in the more advanced technique when the sperm is of poor quality, a single spermatozoa can be injected into the oocyte.
Once the oocytes have fertilised, the embryos are grown in the laboratory for a further four days before being returned to the uterine cavity after five days, at the blastocyst stage of development. Typically one embryo is replaced—with the success rates depending upon the age of the patient and the quality of the embryo. Any spare or excess embryos of good quality can be frozen for later use.
How successful is IVF and how much does it cost?
There are many ways to present the success rates in IVF. There are a number of factors that impact, including age (both of the male and female), fertility diagnosis, length of time that you have already tried to conceive and the particular IVF treatment undertaken. The Your IVF Success website is an excellent resource to help you calculate your chance to conceive taking in consideration of these factors.
The cost of IVF is related to the actual treatment undertaken. The treatment cost will vary depending on whether it is a stimulated cycle of IVF or transfer of frozen/thawed embryos. Treatment costs are generally expressed as out of pocket expenses after Medicare subsidies have been taken into consideration and will vary between $1500 and $5,000.
There are many fertility treatments to consider. The best way to find out what’s right for you is to book a consultation with a fertility specialist.