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A fertility assessment is a comprehensive process designed to help individuals and couples wishing to conceive to understand their fertility, including potential problems.
This important first step on your journey to parenthood involves taking a comprehensive medical history and a series of investigations for any causes of infertility. These results inform an appropriate treatment plan and can help to guide expectations.
Infertility or subfertility is usually defined as the inability to conceive after 12 months of having unprotected sexual intercourse in a woman under 35 years of age, or after 6 months in a woman over 35 years of age. Infertility is surprisingly common, affecting one in six Australian couples.
Fertility problems can be caused by a variety of factors, and sometimes there is more than one reason. Around one third of couples struggling to conceive will be affected by both male and female factors.
In couples experiencing difficulties falling pregnant, female fertility problems account for approximately 30%.
The most common cause of female infertility is advancing age. As a woman gets older, the number of eggs remaining in her ovaries (known as ovarian reserve) decreases. With increasing age, the quality of these remaining eggs also deteriorates, making successful conception and pregnancy more difficult to achieve.
Other causes of female infertility include:
Similar to female factor infertility, male fertility problems contribute to 30% of couples facing infertility.
Causes of male infertility include:
10% of couples will not have any identifiable cause for their fertility challenges, a situation known as unexplained or idiopathic infertility. Although this diagnosis can be discouraging and frustrating, there are still avenues for building your family.
A fertility assessment with Dr Huang starts with an initial consultation to review your medical history, lifestyle factors, and any previous pregnancies or attempts to conceive. This conversation lays the foundation for an evaluation plan tailored to your situation. If you are building your family with a reproductive partner, both partners are recommended to attend the first consultation.
Your fertility assessment will include a comprehensive medical history and lifestyle review to discuss pre-pregnancy screening and address any underlying medical issues. Dr Huang will also review your lifestyle factors, physical exercise habits, and nutrition to determine if there are any obvious factors impacting your reproductive health.
Fertility testing for men is primarily focused on semen analysis, which examines sperm count (amount), motility (movement), and morphology (shape), all critical factors in male fertility. Depending on these results, Dr Huang may also order a hormone analysis or ultrasound imaging of your reproductive organs.
Lifestyle factors such as what you eat, how you move, and even how you manage stress can affect your chances of falling pregnant. Some lifestyle factors, such as smoking and other illicit drugs, have very clear evidence of harm on fertility and pregnancy and should be avoided while the impact of other lifestyle choices are less clear cut.
We all know that what we put into our bodies can influence so many aspects of our health. Generally, what is good for general health will be good for fertility health.
There is no universally accepted theory about diet and fertility. The reality is that everyone is different and the individual must be taken into consideration, including how your body responds to certain nutrients, your culture, and even your taste preferences. There is not one single diet that will suit all. However, general consensus leans towards what is known as the Mediterranean diet as this typically includes many of the fertility-friendly principles.
The general principles of eating for fertility includes a well-balanced diet, high in fresh vegetables and fruits, choosing wholegrains over refined carbohydrates, low in processed sugars, minimal animal-derived fats (except fish), and higher in good proteins and fats, like nuts and fish oil.
If you have concerns about your diet or wish to look more closely at what can be supplemented in your diet, you can see your GP, dietician, or nutritionist to discuss further.
Coffee has become an integral part of many of our lives, and is a topic of great concern to many while trying for pregnancy.
The more reliable data so far suggests that excessive caffeine intake can prolong the time to pregnancy and increase miscarriages and stillbirth. This seems to be a dose relationship, where drinking more coffee can lead to more negative effects.
Caffeine can affect women’s hormone level and men’s sperm health. One study reported that women who drink less than one cup of coffee per day have double the likelihood of falling pregnant with each attempt compared to women who drink more than one cup a day. Another study noted that men who take more than two cups of coffee a day have a higher miscarriage rate in their partners compared to men drinking less than two cups a day.
The link between caffeine and fertility is far from clear, but with the potential for negative effects, the safest thing to do is to stop drinking coffee while trying for pregnancy. If abstaining completely is not possible, the recommendation is to limit your intake to one cup or less per day for women, or two cups or less for men.
The current national guidelines for safe alcohol intake is no more than 10 standard drinks a week, and no more than four at one sitting. When you are trying for pregnancy, an even lower intake is advised. Overconsumption of alcohol can negatively affect reproductive health in women as well as the development of the baby, and can also be detrimental to sperm count in men.
There is no established safe level for alcohol consumption while trying for pregnancy and during pregnancy. This means that there is no consumption level above which we know is bad and below which is acceptable. Therefore, it is best to avoid alcohol while you’re trying for pregnancy or during pregnancy, if you can.
If you can’t maintain abstinence from alcohol, then risk minimisation and moderation is the key. If you have any concerns about your alcohol intake and what you can do about it, see your GP to discuss this further.
Mental health is an important factor for both our fertility and general health. Stress is typically a normal part of life, resulting in observable and measurable changes in the body. While women under stress can still fall pregnant, these physiological changes can affect how easy it is for you to conceive.
Rather than trying to eliminate stress entirely, learning how to cope and regulate your response to inevitable stressors is a more realistic approach. Remember to lean on the support you have available around you, including your GP, a counsellor, psychologist, partner, family, and friends.
While planning for pregnancy and before trying to conceive, it is a good idea to see your GP for a general health check, including a mental health review.
Unfortunately, 10% of couples will experience unexplained infertility, which can be greatly frustrating. Despite being unable to pinpoint a root cause of your difficulties conceiving, many of these couples go on to have a successful pregnancy and live birth with the help of assisted reproductive technologies such as IVF or IUI.
General guidelines recommend that if you are a woman aged 35 or under and have been trying to conceive without success for at least 12 months, or are aged over 35 and it has been six months of no success, you should come under the care of a fertility specialist. However, based on the current evidence, it would be reasonable to seek fertility advice even after six months for women under the age of 35, or after four months of trying for women over 35.
General practitioners play an important role in guiding and advising couples during the preconception stage and in ordering preliminary fertility assessments. Your GP may organise basic fertility tests for you such as a semen analysis, blood test, or ultrasound, but for more in-depth assessment, such as hysteroscopic or laparoscopic assessments, or for complex cases, you will need referral to a fertility specialist or gynaecologist.
Collaborating with the world-class technology and innovative research of fertility network Genea, Dr Alice Huang offers comprehensive fertility care for individuals and couples at all stages of their family-building journey.
Her Melbourne fertility clinic is easily accessible at Epworth Freemasons Hospital in East Melbourne.
Contact Dr Huang’s rooms today to take your first step towards parenthood.
