Q: When should I see the Doctor if I am not falling pregnant – How long should I wait to see the Doctor….
- Well it is never too early to see the doctor about not falling pregnant. Furthermore it is always better to plan for a pregnancy, rather than falling pregnant unexpectedly. According to the statistics, 80% of couples will fall pregnant within the first 6 months of trying to conceive (having sexual intercourse during the fertile phase of the menstrual cycle – e.g. Day 10-18 of a 28 day cycle).
However, this is a guide and up to 20% of couples may fall in the subfertile or infertile group without knowing. Infertility means not being able to fall pregnant and subfertility is the gray zone between being fertile and infertile.
Unfortunately, subfertility or infertility are silent conditions, that is, you don’t know that you have problems with starting a family until you try or have some specific tests. E.g. blood test for hormones such as AMH (Anti Müllerian Hormones) or pelvic ultrasound or Laparoscopy.
- If you are over 35 years of age, you should consider seeing a fertility specialist by 4 months if you haven’t fallen pregnant. Sooner still if you are over 38 years of age.
Q: “What are things we can try at home?”
(Is there a checklist of things?)
- The best chance of getting pregnant is to have sexual intercourse at your most fertile period of your cycle. The time when you are most fertile vary between each woman.
The rule of thumb is 5 days before ovulation until the day of ovulation – therefore in total there are 6 fertile days in each menstrual cycle.
To work out when your ovulation day falls on, you will need to work out your menstrual cycle length. This is done by counting the days you start your period (when bleeding starts) to the day you start your next period. Once you have worked out your cycle length, then you can work out your ovulation day. You just need to count 14 days back from the last day of your cycle and that is the ovulation day.
In most women, their ovulation day is day 14 if they have a 28 day menstrual cycle.
- Alternatively, you can purchase ovulation kits from the chemist that can pin point the days that you are most fertile. The ovulation kit uses your urine sample to detect LH (luteinizing hormone), which occurs just before ovulation occurs.
There are other lifestyle factors that can improve / reduce your fertility:
What to Stop to Improve Your Chances of Falling Pregnant
- Smoking – The simplest answer is that you should quit smoking. Smoking is not only bad for your health, but can reduce your chance of falling pregnant and potentially affect your unborn child. When you smoke your chance of natural conception decreases. This decrease is persistent even with the use of IVF treatment if you continue to smoke. Smoking can cause restriction in your baby’s growth and can be harmful to the ovaries of the unborn baby girl. As for an unborn baby boy, smoking can be harmful for his sperm count in adulthood.
Alcohol – Most of the data about alcohol use is in relation to alcohol intake during pregnancy. There is no safe amount, no safe time or no safe type of alcohol recommended for pregnant women. As for someone who is about to fall pregnant, it would be advisable to avoid alcohol.
What to Do / Start Getting Right to Improve Your Chances of Falling Pregnant
BMI (Body Mass Index) – You should maintain an ideal body mass index to optimize your chance of falling pregnant. Being underweight or overweight can cause subfertility.
Calculated as follows:To calculate your BMI yourself, the BMI equation is:
Underweight – If you do excessive exercise you can become underweight and therefore cause decrease in your fertility rate. If your BMI <20, you are potentially underweight. If you fall in this category, you should see your doctor to confirm this and work out why it is happening to you. One of the most common reasons is excessive exercise. You should reduce the amount of exercise that you do. You should lesson 5 hours of exercise per week. Overweight – When you are overweight, your hormones can become abnormal. Being overweight can cause your body to produce too much insulin.
This is called Hyperinsulinemia.
Insulin is a hormone produced by your pancreas. Insulin metabolizes carbohydrates in food to produce sugars, which give you energy, or to store glucose for future use.
Being overweight might cause excess androgen (testosterone – male hormone) production. This rise in turn affects ovulation by affecting the hypothalamus and pituitary gland dynamics.
The hypothalamic gland and pituitary glands are important parts in your brain that regulates your ovary function. It is like the “body clock”.
If your BMI is greater than 30, your success rate with fertility treatment will be reduced. This is because your egg quality deteriorates and your endometrium (lining of the womb/uterus) becomes less receptive to the embryo implanting in you.
Being overweight can also increase your chance of miscarriages.
Let’s Talk Diet & Nutrition
Diet – There are no hard and fast rules regarding what is a correct diet for falling pregnant. Some data suggests that if you eat foods with lower glycaemic index (e.g. green vegetables, most fruits, raw carrots, kidney beans, chickpeas, lentils and bran breakfast cereals) that might in turn regulate your ovulation.
Overall a balanced diet such as Mediterranean diet with monounsaturated fats (healthy fats) and animal protein is recommended.
Multivitamin supplements are recommended for example Iron, Calcium, Folate, Zinc and Iodine.
If you have Coeliac disease, you need to see your doctor to make sure its well under control.
Caffeine – You should have less than 200mg of caffeine per day, which is about 1.5 cups of coffee.
For the GUYS
Smoking – Causes decreases in semen quality. Semen quality test measures the semen volume, sperm concentration, total sperm count, sperm movement ability and sperm morphology (shape and form).
Semen quality worsens the heavier you smoke. This in turn will decrease your success rate of any fertility treatment such as insemination or IVF.
Alcohol – Heavy alcohol use by the male partner can cause abnormal testicular function. When the testes stops working properly, your testosterone production decreases, you can become impotent or produce less sperm.
IVF studies have found that for couples in which both partners consumed more than 4 drinks per week, had lower success rates in falling pregnant compared with couples in which both partners drank less than 4 drinks per week.
Diet – There is little information regarding dietary recommendation for men.
Caffeine – For men, caffeine has little or no affects on the chances of conception.
IVF – Your Questions Answered
Q: “Is IVF the only treatment option?”
The short answer is “No – there are several options”.
When you seek help from your fertility specialist about trying to fall pregnant, he or she will look at your particular situation and tailor the best for of treatment for you. The specialist will look at many factors including:
- Your age, your partner’s age
- Past history of both partners, such as underlying pathology, e.g. endometriosis, testicular surgery and occupations
- Fertility history of both partners, e.g. previous pregnancies
Below are some of the options your doctor might suggest to you in order to help you achieve a pregnancy:
Timed intercourse – you will have a blood test in order to pinpoint the timing of your ovulation, so that you will have intercourse at the right time. It is similar to using ovulation urine test kits to test whether you have ovulated. The kits are more convenient, as you can perform the test at home, but blood tests at the end of the day are more accurate.
Artificial insemination (AF) – refers to the introduction of semen (sperm) into the vagina and uterus by a means other than sexual intercourse. This form of fertility treatment aims to improve pregnancy rate by introducing the sperm to the uterus at the most fertile time of your cycle. The steps are as follows:
- You will be given hormone drugs to induce ovulation then blood tests and ultrasounds are done at various stages of your cycle to estimate when the egg is ready to be inseminated.
- When the egg is ready for insemination, the prepared sperm (ejaculate from partner) will be injected into the cervix through the vagina. This is performed in a fertility clinic and does not require any anaesthetic. A speculum is used to perform this procedure. This is similar to the instrument used to perform a pap smear.
- AF helps improve pregnancy rate by optimizing the insemination time in order to increase the chance of conception. Also the sperm concentration is higher than normal intercourse because of laboratory special preparation.
IVF – This process involves the following:
- Administration of hormone drugs in you, to result in production of more than 1 egg during the IVF cycle.
- Your egg growth is monitored by ultrasounds and blood tests.
- Once the egg sizes have reached ovulation stage, then the eggs are retrieved by needle aspiration through the vagina under anaesthetic. The eggs are placed together with the sperm to allow fertilization to occur. In some cases when the sperm numbers re low – ICSI (Intracytoplasmic sperm injection) process will need to be carried out where the sperm are injected into the eggs in order for fertilization to occur.
- Once the embryos (fertilized eggs) are formed, 1-2 embryos will be placed back into your uterus through the vagina. This process does not require an anaesthetic and is done with a speculum. This is similar to the instrument used to perform a pap smear.
There are many factors that determine the pro’s and con’s for each forms of treatment. Your own situations will dictate these factors. Your fertility specialist will be able to take these important factors into account in formulating the best treatment tailored to your needs.
Q: “Is there a best age to have a baby by?”
Is there such a thing as too young? Does a woman’s biology need time to mature or be ready as such? When is too old?? Some women have babies in there 40’s….
- There is no set recommended age when you should get pregnant. Of course adolescence pregnancy (<19 years old) do have increase risks of preeclampsia (pregnancy induced high blood pressure, preterm birth, fetal growth restriction (small babies) and infant deaths.
On the other hand, such things as ‘biological clock’ is absolutely true. Your chance of falling pregnant is highly dependent upon age.
Your chance of falling pregnant following intercourse of the most fertile day of the cycle if you are:
- 19 to 26yrs of age – 50%
- 27 to 34yrs of age – 40%
- 35 to 39 yrs of age – 30%
- Over 40yrs of age – less than 20%
As for paternal age (your male partner’s age) this only plays a minor role. There may be a slight effect on the fertility rate for guys who are over the age of 50 years.
Q: Could my job or my partner’s job contribute to our problems? Stress factors:
Many fertility studies have found that being stressed can reduce your chance of falling pregnant both naturally and with fertility treatment.
Furthermore, when you are stressed your relationship with your partner can be affected as well.
My recommendations are:
- Identify any stressful factors in your life and address them individually.
- If you have had a history of depression or anxiety in the past, you should see your family doctor to look at methods of getting that under control.
- Work out if you are stressed e.g. ask yourself these questions
- Do you feel comfortable being around pregnant women/children or babies?
- Is your sexual relationship satisfying? And if it is dissatisfying, do you feel that your infertility has had a negative impact on your sex life?
- Do you only make love during the fertile times of your cycle?
- Do you feel that you and your partner mostly agree about how to proceed with infertility treatment?
- Do you feel that your partner is supportive of you?
- How is your mood? Are you able to enjoy your usual activities?
- Are you worried? Do you have difficulty concentrating or sleeping?
- Has your appetite changed?
Q: What specific tests would you recommend to diagnose our infertility and what do they approximately cost?
- Female hormones – FSH, LH, Progesterone, Oestrogen – $100-200 (sometimes bulk billed – Medicare only)
- Prolactin (usually bulk billed)
- Anti-Müllerian hormone (AMH) – $60-80
- Thyroid function (usually bulk billed)
- Full blood count (FBC) (usually bulk billed)
- Hysterosalpingogram or Hysterosalpingo-contrast sonography – assesses the fallopian tubes function – performed at a radiology clinic – $150-300 after Medicare rebate
- Laparoscopy and Hysteroscopy – excludes endometriosis or pelvic infection; assess uterine cavity – very reliable:
- Private Health Insurance cover – $500-$1500
- Uninsured (No private health cover, Medicare only) – $3000-$8000
Male test – semen analysis $150-$250
Q: Is it important to get an infertility evaluation now, or should we wait a while a longer?
If you have been trying to fall pregnant for 6 months or more and have been unsuccessful or you are over the age of 33, then you should have an infertility evaluation earlier rather than later.
You can start by seeing your local doctor for a referral to a fertility specialist.
Q: How much will each cycle of treatment cost?
IVF – Approximately $5000
Subsequent IVF Cycle – Approximately $4500
Artificial insemination – Approximately $1000-2000