Not all fertility problems mean IVF treatment

Many couples find becoming pregnant and starting a family is not as straightforward as they hoped or assumed. It may take longer than expected or it may be that these difficulties reveal a known fertility or health problem with one or both partners.

Age is a crucial factor in fertility, and with couples starting families later than was the case a few decades ago, infertility is on the increase. But it can affect men and women of all ages.

What is infertility?

Infertility is defined as an inability to conceive after one year of trying, or an inability to carry pregnancies to a live birth. Infertility affects about one in five couples of childbearing age in New Zealand, and one in eight require some form of medical assistance to achieve a pregnancy.

Many couples with an initial fertility problem do still become pregnant without undergoing fertility treatment. These couples with 'relative infertility' are far more common than the 5% of couples who have complete infertility.

What causes infertility?

There are quite a number of reasons for infertility. In about a third of cases, the man alone has the problem and in another third, the woman alone. Sometimes, both have a fertility problem and sometimes the problem remains a mystery despite testing.

Some of the possible medical causes of infertility can only be overcome with in vitro fertilisation (IVF) treatments. But for many couples, education from a fertility specialist, lifestyle changes and, if needed, less complex (non-IVF) treatments, can be enough of a helping hand – about one in three fertility clinic patients do not require IVF-based treatments.

How can we improve our chances of pregnancy?

Healthy eating and healthy lifestyle advice is recommended for all sorts of reasons – and maximising fertility by removing any modifiable fertility risk factors is one of them.

There are many ways you can improve your diet and lifestyle when trying to get pregnant, but some of the big ones include:

For women 

• Stop smoking
• Cut out alcohol completely
• Cut down on caffeine from tea/coffee, soft drinks and chocolate
• Reduce stress – extreme stress can interfere with ovulation
• Avoid (or at least get treatment for) any sexually transmitted infection – there's a one in 10 chance a chlamydia infection leads to fertility problems
• Keep to a healthy bodyweight - women should have a body mass index between 19 and 28 for maximum fertility; if overweight, weight loss is often advised before other approaches to improve fertility 
• Check with your doctor that any medications you are using are compatible in pregnancy: whether prescription, over-the-counter or complementary
• Eat a nutrient-rich and antioxidant-rich healthy diet (including lots of vegetables – not necessarily “organic” – of all colours, fruits, cereals, nuts and seeds)
• Cut out hydrogenated trans-fats (eg, biscuits and cakes), which may lower fertility
• Take a 0.8mg folate supplement (women) from two months before and up to 12 weeks into pregnancy
• Do not consume more than the recommended amount of any vitamin – particularly excess vitamin A, which can be harmful in pregnancy
• Include oily omega-3 rich fish in your diet but avoid larger fish species (eg, shark, marlin) that have higher levels of mercury
• Try to avoid some toxins (eg, heavy metals, solvents, paints, ammonia-based and oven cleaners)
• Moderate exercise is a good thing for weight loss (and reducing stress) but beyond that its effects on fertility are unclear.

For men

• Stop smoking
• Keep alcohol to a minimum
• Eat a nutrient-rich and antioxidant-rich healthy diet
• Take extra vitamins C and E, selenium and zinc for healthy sperm
• Keep your bodyweight in a healthy range, through diet and exercise, to maximise your sperm count.

Can a woman measure her own fertility?

Even with all this good advice in mind, women in their 20s and 30s are often naturally anxious about not leaving starting a family too late. Until recently, there was no easy blood test a woman could have to find out about her “biological clock”.

AMH testing
AMH is a new fertility test for women - it helps to predict their ovarian reserve. This blood test for anti-Mullerian hormone (AMH) is available through fertility clinics such as Fertility Associates.

The hormone AMH is made by small follicles as they grow in the ovaries. This test is more convenient and less expensive than the tests like “Egg Check” because it uses a simple blood test rather than ultrasound scanning, and can be done at any time in the menstrual cycle. Like Egg Check, an AMH test can pick up who might lose their fertility more quickly but it does not show who is more fertile than average.

AMH does not predict ovarian reserve in women older than 40 or those with polycystic ovaries (PCO).

Before an AMH test, you will need to have a consultation with a fertility specialist who will go through your medical history and answer any questions you have. It’s a great way put your mind at ease and get answers to those important questions about your fertility and the options open to you.

What if it turns out I have low ovarian reserve?
If you discover your AMH test indicates lower than expected ovarian reserve, a fertility specialist can explain what this actually means to you as an individual or couple. It does not necessarily mean your only option is an expensive course of IVF. Trying for a family earlier than you were planning may be all that is needed.

Low tech options

Managing your diet and lifestyle may be the best first approach, while continuing to regularly have sex. Other simpler, non-IVF treatments, such as ovulation induction and/or intrauterine insemination are sometimes the next approach.

Ovulation induction
Ovulation induction is usually used for women with irregular ovulation. The most common approach is to take an oral medicine called clomiphene, and in some instances hormone injections. Blood tests and ultrasound scans allow doctors to check how well the medicine is working, and help couples time their attempts at becoming pregnant.

Intrauterine insemination (IUI)
IUI is often an option where the cause of infertility is mild or moderate. It offers a cheaper and easier first approach before considering IVF. Usually, it combines mild stimulation of the ovaries with placing washed sperm directly into the uterus around the time of ovulation. As for ovulation induction, blood tests and ultrasound scans are used to monitor progress and time treatment.

Full range of options

Every couple is unique, and specialist clinics know through many years’ experience what is likely to be the best approach in your situation. They also recognise the frustration and stress felt by couples facing fertility problems.  If you are concerned, the most important thing is to find out what your options are, so you can make the most of your potential at the pace at which you are comfortable.

Article written by everybody, based on materials provided by Fertility Associates. Updated April 2009.