Trying to get pregnant can be both exciting and stressful. There are many factors that influence fertility and if you’re planning a pregnancy, we recommend you prepare yourself.
Here are some of the things you should take into consideration. Some will help you in reaching your goal of pregnancy and others are preventative measures to ensure the health and safety of your baby.
With today’s busy lifestyles, many couples plan carefully to ensure the time is just right to achieve pregnancy and start a family. For the vast majority of couples, pregnancy occurs naturally within 12 months of trying to conceive.
However, for up to 20 per cent of couples it is a different story. They keep trying and nothing happens, or they achieve pregnancy only to miscarry.
Infertility is defined as the inability to carry a pregnancy to a live birth.
There are many possible causes of infertility among males and females:
- 30% of infertility is due to female factors alone
- 30% of infertility is due to male factors alone
- 30% of infertility is due to both female and male factors
- Up to 10% of infertility remains unexplained
There may also be male or female genetic factors that affect an embryo’s ability to develop causing infertility or repeated miscarriage. In some cases, genetic factors may not prevent pregnancy and birth, but the child may have disabilities such as Down syndrome.
The effects of age on fertility
Both men and women have a reproductive lifespan.
As women are born with all the eggs they will ever produce, age becomes an issue. Female fertility declines slightly at 30 years and there is a significant decline around 37 to 38 years of age. By the time a woman is 40 years old her fertility is a quarter of when she was 30. The miscarriage rate increases with age from about one in seven for women aged less than 25 years to about one in two at 40 years of age.
There is a marked lack of understanding of the effects of age on a man’s fertility. Male infertility accounts for approximately 30% of all cases treated at Monash IVF.
Fertility and phases of the menstrual cycle
There are many charts and tests that may aid in understanding when a woman is ovulating and include temperature charts, blood tests, urine ovulation predictor kits and saliva kits. It is recommended you speak to your clinician before using them. To determine your cycle’s length, simply count the days from the first day of your period up to, but not including, the first day of your next period. The average woman’s menstrual cycle lasts about 28 days but it is perfectly normal for your cycle to last anywhere from 24 to 34 days. On average, ovulation occurs 14 days before the start your period. However, it is normal for a woman to ovulate anywhere from 12 to 18 days before menstruation.
A healthy diet includes fruit and vegetables each day and a good quality protein, such as in lean meat, fish, eggs, pulses (e.g. beans, lentils). In addition, complex carbohydrates, whole grains and plenty of calcium (preferably in the form of low fat dairy products) is recommended. It is best to avoid excessive additives such as colours, flavours and preservatives.
Keep to a relatively low fat diet and include mainly healthy fats such as olive oil. Fish oil or flaxseed oil supplements can be good for both fertility and pregnancy, and may reduce the risk of post natal depression.
Weight issues are important for both men and women when considering fertility. Obesity increases the risk of heart conditions, diabetes and hormonal imbalances, which can lead to infertility. If you are overweight, your body mass index (BMI) will be > 25. The closer to BMI 25, the better, and remember any weight loss in this situation will improve your fertility. See a dietician for expert individualised advice. Rapid or extreme weight loss is not good for your fertility but may be alright for a quick “kickstart” before you start trying for pregnancy.
Women who are underweight (BMI<20) are also at risk of reduced fertility. If you are underweight and your period cycles are long or irregular, a small weight gain may be beneficial, or cut back on strenuous exercise.
You will benefit from being fit prior to pregnancy.
For women who are unfit, developing at least a moderate level of fitness is advisable. Perhaps build up to 45 minutes brisk walking 5 days per week. If you are very unfit, start with 10 minutes twice a week at a moderate pace, and each week increase the time and frequency of your exercise. It is best to limit intense or high impact exercise, and no more than 4 hours high intensity exercise per week is recommended.
Men should also aspire to a reasonable level of fitness.
Both men and women should stop smoking. Smoking can affect the fertility of both males and females, causing erectile dysfunction and increased DNA damage to sperm and eggs.
Women must stop all alcohol while trying to conceive and during pregnancy, while men should aim to keep to current “safe drinking guidelines” – average 2 drinks/day maximum, with several alcohol free days each week and no more than 4 standard drinks in one session.
Certain drugs have been found to adversely affect male fertility, including:
- Recreational / illicit drugs
- Psychotherapeutic agents
- Chemotherapeutic agents
- Hormones (anabolic steroids)
Effects can include:
- Direct gonadotoxic effects which means direct harm the testes
- Alterations in the production and release of hormones
- Erectile dysfunction
- Direct effects on libido
Both men and women need to aim for <200mg of caffeine a day, which equals a maximum of 1-2 coffees or glasses Cola/energy drinks, or 2-3 teas, and not too much chocolate either! If you need to cut down, do so slowly to reduce the impact of withdrawal symptoms.
It is best to avoid excessive heat from saunas or spas when trying to conceive and during pregnancy. Men should also avoid situations where their scrotal area is unable to keep cooler than the rest of the body. Keep laptops on the desk and off the lap!
Folate supplementation is recommended at least 1 month prior to pregnancy and for 3 months into the pregnancy as this reduces the chance of the baby having a defect in the neural tube, such as spina bifida. Folate can be taken alone or in combination with other prepregnancy supplements.
A blood test can show if you are immune to rubella. If not, immunisation will be recommended. Similarly it is recommended that women preparing for pregnancy have a blood test to check their immunity to varicella. If you are not immune, you can be immunised to reduce the risk of infection in pregnancy.
Be sure to update your smear test if it is nearly due. It is better to have one a bit early than be due in the middle of a pregnancy and find out that you have an abnormality on your smear that may need attention.
Sexually Transmitted Infections
Sexually transmitted infections may impact a couple’s fertility.
Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium, Chlamydia trachomatis. In women, untreated infection can spread into the fallopian tubes and cause the tubes to become blocked at the very ends. This is known as hydrosalpinx.
They can also develop scar tissue around the fallopian tubes that makes it more difficult for the tube to “pick up” the egg at the time of ovulation. This can lead to infertility and an increased risk for ectopic (tubal) pregnancy.
In men, if the infection is left undetected and untreated it can cause epididymitis – an infection in the ducts of the testicles where sperm mature. Epididymitis can manifest in shrinking of the infected testicle, abscesses, and infected sores in the surrounding scrotum area. This can ultimately lead to infertility.
Other infections that may impact fertility include:
- Genital warts
- Hepatitis B
Maintaining a positive state of mind also improves your health and well-being, and your chances of a successful pregnancy. A degree of stress in life is inevitable, but how you deal with it is important. At Monash IVF we provide counsellors for individuals and couples. Our counsellors have extensive therapeutic experience and have specialised skills and knowledge in the field of infertility.
Not getting pregnant?
Women aged 35 or over shouldn’t try too long before getting expert advice about fertility and we recommend you seek advice if you have not been successful after 6 months. Women under 35 should seek advice if they have menstrual problems or are not pregnant after 12 months of trying.
For more information or to discuss your concerns about getting pregnant, feel welcome to have a chat with one of our fertility nurses. Nurse chats are available by calling 1800 628 533 or making an online enquiry via our website.