Understanding Your Path to Parenthood

Fertility assessment is a comprehensive process designed to help individuals and couples who wish to conceive to understand their fertility and potential fertility issues.

This important first step on your journey to parenthood involves a comprehensive history and a series of investigations for the causes of infertility.  This will facilitate our following discussion of your expectations and an appropriate treatment plan

Who Should Consider a Fertility Assessment?

80 to 90% of couples trying for pregnancy normally conceive within the first 12 months of attempted conception. The likelihood of conception decreases overtime and with advancing age.

Couples unable to conceive after a period of time of regular unprotected intercourse. In women under 35 years old, up to 4 in 5 couples should conceive within the first 6 months. Therefore it is reasonable to seek fertility advice and/or investigations after 6 months of unsuccessful trying for conception. In older women, Dr Huang advises seeking fertility advice and /or investigations after 4 months of trying.

Individuals with a known medical condition affecting fertility, including polycystic ovary syndrome (PCOS), endometriosis, irregular menstrual cycles, or previous cancer treatments.

Anyone interested in their fertility status for future planning. This includes single individuals or those in a relationship not currently trying to conceive but who wish to understand their reproductive health and faciliatate informed fertility planning.


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.
The likelihood of conception is highest in the first 3 months of trying, and then decreases. In women under 35 years old, up to 4 in 5 couples should conceive within the first 6 months. Therefore, it is reasonable to seek fertility advice and/or investigations after 6 months of unsuccessful trying for conception. In older women, Dr Huang advises seeking fertility advice and /or investigations after 4 months of trying. A study has suggested that after 6 months of trying for conception, 1 in 2 of the remaining couples who fail to conceive may need fertility assistance. Therefore, Dr Huang advises a discussion with your General Practitioner (GP) or a fertility specialist after 4 to 6 months of trying for conception, depending on your age and individual situation, to consider starting investigations.

What’s Involved in Fertility Assessment?


The fertility assessment process is a comprehensive process involving a review your medical history, lifestyle, and any previous pregnancies or attempts to conceive. This conversation lays the foundation for a tailored evaluation plan, which typically includes:
  • Medical history and lifestyle review: to discuss pre pregnancy screening and address any underlying medical issues. Lifestyle factors, exercise and dietary habits are reviewed to determine if there are any obvious issues that could be addressed to enhance your fertility.
  • Diagnostic tests for females may include: Blood tests, imaging studies or further surgical procedures to rule out pelvic and uterine pathologies that may compromise your chances to conceive
  • Diagnostic tests for males may include: Semen analysis, examining sperm count (amount), motility (movement), and morphology (shape) – which are important factors in male fertility.

Causes of Infertility

Female Factor – 30%
The most common cause of female factor infertility is advancing age. There may also be an ovulation dysfunction, which may be related to abnormality in hormones released from the brain, or hormones from the ovary such as polycystic ovarian syndrome or ovarian failure. Other causes of female factor subfertility include blockage of fallopian tubes or pathology in the uterus including polyps and fibroids. Pelvic endometriosis is another common cause that may compromise fertility. It is found in approximately 30% of subfertile women who experiences no other symptoms of endometriosis, and in 85% of subfertile women who experiences pelvic pain during their periods or at other times. Other conditions which can also compromise fertility include thyroid dysfunction or cancer chemotherapy treatment.

Male Factor – 30%
Causes can include dysfunction in production of sperm, or the delivery of sperm. Other causes such as overexposure to certain chemicals and toxins can also compromise fertility. These include heat, chemicals, tobacco smoke, alcohol, marijuana, and steroids (including testosterone). Treatment for cancer can also impair sperm production.

Combined Female and Male Factor – 30%
It can be a combination of the above mentioned causes.

Unexplained Subfertility – 10%
Infertility where no cause is found.


  • Diagnostic tests for females: These may include
    • Blood tests to measure your hormone levels and determine if you are ovulating.
    • Ovarian reserve quantification (looking at quantity of eggs in the ovaries) can also be performed.
    • Imaging studies such as a pelvic ultrasound or hysterosonography may be performed to obtain a detailed view of your uterus, ovaries and sometimes fallopian tubes.
    • Hysteroscopic evaluation involves operating with the aid of a thin long camera through the cervix into the uterine cavity, in order to look for pathologies such as polyps or fibroids in the uterus.
    • Laparoscopic evaluation involves operating with the aid of a thin long camera through small incisions in your abdomen, in order to look for pathologies such as endometriosis and adhesions in the pelvis.
    • Other tests to rule out underlying medical conditions that may compromise your chances for conception.
  • Diagnostic tests for males:
    The main test is semen analysis, examining sperm count (amount), motility (movement), and morphology (shape) – which are important factors in male fertility.

    If there is sexual dysfunction, further hormonal and imaging studies can be done.

  • Genetic screening:
    This may be appropirate in certain cases to identify genetic conditions that may impact fertility.
  • Preconception genetic carrier screening:
    This test is not specifically looking for causes of infertility, but should be considered at the time of fertility assessment, if not already done. This test determines if you or your reproductive partner carry any inheritable conditions that may impact on your babies health, providing important information for informed fertility planning.

Lifestyle Factors

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 ilicit drugs have very clear evidence of harm on fertility and pregnancy and should be avoided. Other lifestyle factors are less clear cut.

Other Lifestyle Factors


We all know that what we put into our bodies can influence everything we are and become. Generally, what is good for general health will be good for fertility health.

There is no universally accepted theory about diet and fertility. There are just too many different dietary regimes to date that suggests possible benefits on fertility. The reality is that everyone is different and the individual must be taken into consideration. There is not ONE diet that will suit all.

The general principles of eating for fertility includes a well balanced diet, high in fresh vegetables and fruits, whole grain better than refined carbohydrate, lower in processed sugars, lower in animal derived fats (except fish) and higher in good proteins and fats, like nuts and fish oil.

The general consensus leans towards the Mediterranean diet – high in fresh vegetables and lower in animal fats and higher in good plant and fish fats.

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 or a dietician or nutritionist to discuss further.


Coffee has become an integral part of many of our lives, and is a topic of great concerns to many while trying for pregnancy.

There is so much inconclusive and conflicting information that care needs to be taken about drawing definitive conclusions.

The more reliable data so far suggests that excessive caffeine intake can increase time to pregnancy and increase miscarriages and stillbirth. This seems to be a dose relationship, where more coffee drinking can lead to more negative effects.

Caffeine can affect women’s hormone level and men’s sperm health. A study found women who drinks less than 1 cup of coffee a day are twice as likely to fall pregnant each time they try, when compared with women who drank more than 1 cup a day . And the more coffee she drinks, the less likely she is to fall pregnant. So while this study may raise concerns about coffee drinking while you’re trying to fall pregnant, it does also show that women who drink coffee moderately can still fall pregnant in the normal span of time.

Another study found men who drink more than 2 cups of coffee a day are found to have a higher miscarriage rate in their partners.

In summary, the link between coffee drinking and fertility is far from clear, but there may be negative effects. Therefore the safest thing to do is to stop drinking coffee while trying for pregnancy. But if you can’t stop, it is good to limit to no more than 1 cup of coffee a day for women and 2 cups o coffee a day for men.


The current national NHMRC guidelines for safe alcohol intake is no more than 10 standard drinks a week, and no more than 4 at one sitting. When you are trying for pregnancy, an even lower intake is advised. Overconsumption of alcohol can negatively affect your health as well as the development of the baby. It can also affect sperm count in men.

There is no established safe level for alcohol consumption while trying for pregnancy and during pregnancy. What this means is that there is no consumption level above which we know is bad and below which is ok. Therefore, it is best to avoid alcohol while you’re trying for pregnancy or during pregancy, 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, you can see your GP to discuss this further.

Mental Health

Mental health is very important as part of general health as well as fertility health.

You should see your GP before you are ready to try for pregnancy for a general health check up, including a mental health review.

Many women are concerned that it is their very high stress levels that may be stopping them from getting pregnant. Whilst women under stress can still fall pregnant (if we think of the women in war torn countries where they are under unbelievable amount of stress), stress can still affect fertility. We know that there can be observable and measurable changes in the body when we are under stress.

However, it may not be productive to be told to “Just relax” or “don’t stress”. Sometimes the stress of trying not to stress ends up being worse than the initial stress to being with.

Dr Huang advises all of us should aim to moderate stress in our lives rather than eliminate stress. If we are kind to ourselves and others, it is a good place to start. If you feel you need extra supports, remember there is help out there. You can see your GP or a counsellor, and don’t forget your partner, family and friends.

Next Steps

Starting your fertility assessment is a significant step towards understanding and potentially overcoming any fertility challenges. Understanding your fertility situation can make all the difference. It’s about feeling empowered. The results of your fertility investigations will facilitate the conversation regarding your next steps and development of a personalized treatment plan.

Remember, while fertility challenges can seem overwhelming, there are numerous paths to explore with a range of treatment options available.


Fertility Specialist

Dr Alice Huang is a Melbourne Gynaecologist and Fertility Specialist, who has undertaken sub-specialised training in infertility and assisted reproductive technologies, such as IVF and ICSI.

She holds a Masters of Reproductive Medicine degree and welcomes both general gynaecological patients, as well as fertility patients.

Dr Huang offers fertility treatment through Genea Melbourne City, which is affiliated with Genea. Genea is an industry leader in the provision of fertility medicine services, and consistently achieve IVF success rates that surpass the national average across all recorded measures.


Compassionate, Holistic care and treatment.

Contact us today to schedule a consultation and take the first step towards realising your parenthood goals.