Fertility Challenges

A woman’s age is the single most important factor affecting her chances of having a baby.

Women are born with all the eggs they will ever have. Research tells us that female fertility declines slightly at 30, with a significant decline in a woman’s late 30s and early 40s. As a woman ages, her egg quality declines. This leads to a higher chance of miscarriage. It also increases the risks of having a baby with a genetic abnormality.

Understanding how age affects fertility can be a great motivator. It means you might decide to talk to your partner or doctor about having a baby sooner rather than later. If now’s not the right time for a baby, you may want to consider freezing some eggs for use down the track.

Encouragingly, IVF can increase a woman’s chance of pregnancy as she gets older. The use of genetic screening—including Preimplantation Genetic Testing (PGT), P reimplantation Genetic Screening (PGS) and Non-Invasive Prenatal Testing (NIPT)—can also increase a person’s chance of having a baby.

PCOS is a hormonal condition that’s surprisingly common. It affects up to one in five women of childbearing age.

What is PCOS?

Simply put, polycystic ovaries results in lots of cysts appearing on the ovaries. PCOS affects hormones, meaning women produce higher levels of insulin and testosterone. This can lead to one or more symptoms like:

• irregular periods
• excess hair growth (usually on the face, stomach or back)
• acne
• weight gain
• mood problems
• fertility issues

Unfortunately, the cause of PCOS is unknown. It could be genetic or result from lifestyle and environmental factors.

How is PCOS diagnosed?

Our specialists diagnose PCOS using a combination of ultrasound, blood tests and by reviewing your medical history.

In order to be diagnosed with PCOS, most women need to meet at least two of the following criteria:

• 12 or more follicles are visible on one ovary, or one or both ovaries have increased in size
• there are high levels of ‘male’ hormones (androgens) in the blood, and associated symptoms like excess hair growth or acne
• irregular or no periods (menstrual dysfunction)

If you think you might have PCOS, we suggest talking to your fertility specialist about getting a fertility health check. A round of simple tests will determine whether or not you have the condition. Knowledge is empowering: it will be a relief to know one way or the other.

What’s the difference between PCO and PCOS?

PCO and PCOS are commonly confused, but there’s a crucial difference.

PCO refers to having polycystic ovaries that can be identified via ultrasound.

PCOS is a syndrome, where you experience two of the three symptoms outlined above.

While the names are similar, PCO doesn’t affect fertility like PCOS. In fact, PCO is really quite common, affecting up to a third of women of childbearing age. It’s often not diagnosed as there are no other symptoms.

How does PCOS affect fertility?

If you are diagnosed with PCOS, it may be harder to fall pregnant. However, please take heart—there are still treatment options open to you. We have helped many women with PCOS go on to have beautiful, healthy babies.

PCOS often causes irregular periods, which can affect ovulation. This makes it harder to calculate your fertile window. Essentially, this means fewer chances each month to get pregnant than if you had a regular cycle. Women with PCOS may also struggle to control their weight, as the hormones that control hunger may not be regulated as effectively. This can lead to weight gain and difficulty in losing weight.

What to do after a PCOS diagnosis

As we mentioned above, there are avenues available to help you have a baby. Treatment options can include:

• reducing your BMI through weight loss
• drugs to induce ovulation, such as Clomid
• insulin-sensitising medications
• IVF or another assisted reproductive treatment

We suggest talking to your fertility specialist about the best way forward for you.

Haven’t been diagnosed with PCOS, but still concerned about it affecting your fertility? Then why not book a free chat with one of our experienced fertility nurses to discuss next steps? Sometimes, having a plan in place is the best medicine of all.

Fallopian tubes connect your ovaries to your uterus. They have 20-25 finger-like structures on their ends that hover just above the ovaries. These tentacle-like structures work to sweep the mature eggs when they’re released into the fallopian tubes, where fertilisation occurs.

If your fallopian tubes are damaged or blocked, however, sperm might not be able to reach the egg.

Blocked or damaged tubes can be caused by:

• a blockage from birth
• accidental damage from surgery
• infection
• having your tubes tied (tubal ligation surgery)

Diagnosing blocked or damaged fallopian tubes

Your fertility specialist can check the health of your fallopian tubes through:

• laparoscopic surgery
• x-ray
• ultrasound
• a tubal patency test (a dye test)

We offer the tubal patency test at Monash Ultrasound for Women and Sydney Ultrasound For Women (part of the Monash IVF group).

Sometimes, surgery isn’t a viable option to fix damaged or blocked fallopian tubes. In this case, your fertility specialist may suggest IVF as a possible treatment option for you.

Talk to our fertility nurses

Remember, our experienced fertility nurses are just a phone call away. Why not book a free chat to talk through your situation? They may suggest you make an appointment with one of our expert fertility specialists as the logical next step.

Endometriosis is a relatively common condition, affecting up to one in 10 women at some point during their fertile years. While a third of women with endometriosis may experience fertility issues, treatment is readily available.

The good news? There’s no reason you can’t go on to have a perfectly healthy baby.

What is endometriosis?

Endometriosis occurs when the lining of the uterus - the endometrium - starts growing outside the uterus. This causes scar tissue.

Endometriosis can affect fertility in different ways. In more severe cases, the scar tissue may damage the fallopian tubes and the ovaries. This will significantly reduce a woman’s ability to conceive, as it alters the usual movement of the egg and the sperm.

Even if the fallopian tubes and ovaries are not damaged, endometriosis can still affect:

• the movement of the sperm
• the tube’s pick-up of the egg
• egg fertilisation
• embryo growth
• implantation

The cause of endometriosis isn’t entirely known and can vary between women. However, we do know that if you have a close relative with endometriosis, you’re up to 10 times more likely to have it.

What are the symptoms of endometriosis?

The symptoms of endometriosis vary. Some women may experience incredibly painful periods, while others may not discover they have endometriosis until they have difficulty falling pregnant.

Common symptoms include:

• painful periods
• premenstrual bleeding
• pelvic pain
• pain during sex

If your fertility specialist suspects you have endometriosis, they can perform a laparoscopy (a simple keyhole procedure) to confirm the diagnosis.

Will endometriosis affect my fertility?

About 30% of women with endometriosis will experience infertility. This is likely due to:

• scarring of the fallopian tubes or ovaries
• poorer egg quality
• damage to the uterus, affecting the embryo’s ability to implant

Please remember—not all women with endometriosis will experience infertility. Some women with endometriosis will have no trouble conceiving naturally. Many of our patients go on to have a successful pregnancy and an uncomplicated birth.

Can endometriosis be treated?

Yes! Depending on the type and severity of your endometriosis, treatment may include:

• some simple medication
• laparoscopic surgery to remove the endometriosis. Many women conceive naturally after the surgery. However, IVF is a common option if infertility continues.

What’s next?

It’s a good idea to talk to a fertility specialist about treating your endometriosis.

Haven’t been diagnosed, but concerned endometriosis may be affecting your fertility? We suggest you book a free chat with one of our friendly fertility nurses. Talking through your options is a great place to start.

Unfortunately for some women, miscarriage is a part of their fertility journey. It’s a heartbreaking part of life that isn’t often talked about. Happily, many women who miscarry will go on to have a perfectly healthy baby naturally.

A miscarriage is defined as a pregnancy that ends on its own before a woman has been pregnant for 20 weeks. However, it’s most likely to happen in the very early stages of the pregnancy; miscarriages are uncommon after 10 weeks.

If a woman miscarries two or more times without any successful pregnancies in between, this is called recurrent miscarriage. Recurrent miscarriage is incredibly distressing. So please - reach out to our counsellors if you need some extra support.

If you have experienced recurrent miscarriage, it is also important you talk to a fertility specialist about potential causes. The sooner you have a treatment plan in place, the greater your chances of taking home your longed-for baby.

What causes a miscarriage?

Common causes of miscarriage include:

• genetic or chromosomal abnormality in the embryo
• an abnormal uterus
• hormonal disorders
• infections and diseases
• lifestyle factors such as smoking, alcohol or drugs
• maternal age (unfortunately, women over 40 have a higher chance of miscarrying than of having a live birth)

Sometimes, there is no clear reason why a miscarriage occurred.

Coping with miscarriage

Miscarriages are deeply distressing - no matter where you are at on your fertility journey. If you miscarry during the course of your treatment, Monash IVF counsellors are on hand to support you through this difficult time. Rest assured, our counsellors are experienced at dealing with miscarriage, so they understand the many emotions you may be experiencing. These emotions don’t always have a clear end date. That’s why our experienced counsellors offer unlimited support and follow-up.

What’s next?

If you have experienced recurrent miscarriage, your fertility specialist may recommend Advanced Embryo Selection treatment. They may also suggest Genetic Carrier Screening, including Preimplantation Genetic Testing (PGT), Preimplantation Genetic Screening (PGS) and Non-Invasive Prenatal Testing (NIPT).

Fibroids are benign growths or lumps of muscle tissue that form on the walls of the uterus. Reassuringly, fewer than 3% of women will experience infertility because of fibroids.

Most women with fibroids don’t experience any symptoms. However, the most common symptoms are:

• abnormal bleeding
• frequent urination
• pressure or pain (due to the size and position of the fibroid)

Treatment options usually include hysteroscopy or laparoscopy surgery. Your fertility specialist will talk you through your options in greater detail.

The most common cause of male infertility involves problems with the sperm. This could include:

• not enough sperm being produced
• the sperm not being healthy (motile)
• the sperm not forming correctly
• sperm antibodies being present

When no sperm is present in the male’s ejaculate, it’s known as azoospermia. This can be caused by genetic abnormalities or a lack of sperm production. It can also occur after a vasectomy.

Blockages in the vas deferens or other tubes can be caused by a number of factors. These blockages may be present from birth (congenital), or as a result of surgery like a vasectomy. They can also result from severe trauma or infections. Thankfully, some cases can be fixed or reversed. It may be possible to surgically retrieve sperm to use in IVF treatment.

Some men experience difficulties having regular ejaculatory sex. Men with diabetes, spinal cord injuries, who take certain medication or with unexplained problems may have trouble ejaculating during penetrative sex. In these instances, IVF is an effective option.

While sperm quality decreases with age, it doesn’t affect fertility to the same extent as female age. However, if the male is over 45 it does increase a woman’s risk of miscarriage. Older males also have a greater chance of conceiving children with autism, mental health problems and learning difficulties.

Male infertility can be diagnosed in a number of ways. Your fertility specialist may recommend a physical examination, a semen analysis test and/or a testicular biopsy.

Happily, the most common causes of male infertility are easily diagnosed and treated. Fertility treatment such as IVF with Intracytoplasmic sperm injection (ICSI) can be a good option in many cases.