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Fertility Problems

Healthy Women Medical Centre would like to thank our friends at City Fertility Centre for this information on Fertility. www.cityfertility.com.au

What is infertility?

Infertility is defined as 12 months of unsuccessful conception for women under 35. For women over 35, this decreases to six months of unsuccessful conception. Women with irregular cycles, suggesting a problem with ovulation, can consider evaluation and treatment as soon as this problem is identified. Infertility is not associated with any specific race or ethnicity.

Facts every couple should know

Infertility affects both men and women. Infertility results from a male factor in about 35% of cases, and a female factor in 50%.

About 10% of infertility problems remain unexplained even after complete medical evaluations.

While infertility can be a devastating experience for you and your partner, the good news is that it can be treated.

The relationship between age and fertility

Delayed child bearing is becoming increasingly common in western societies for several reasons: many couples prefer to rear their children only after establishing a stable relationship and financial security, also, there are increasing numbers of late and second marriages.

Conception rates for normal healthy couples are, at best, 20-25% per menstrual cycle. Once a woman reaches the age of 35, her fertility begins to decline. By age 40, it is estimated that her conception rate is in the range of 8-10% per month and at age 43, the pregnancy rate is thought to be as low as 1-3% per month.

The risk of miscarriage is also increased with ageing e.g. the risk of miscarriage at age 25-29 years is 10% while the risk at age 40-44 is 34%. Furthermore, advanced maternal age is associated within increased risk of chromosomally abnormal offspring.

Why does fertility decline with increasing age?

Ageing of the ovaries is the most prominent factor and is part of the normal ageing changes that affect all organs and tissues. Most women have about 300,000 eggs in their ovaries at puberty. For each egg that matures and is released (ovulated) during the menstrual cycle, at least 500 eggs do not mature and are absorbed by the body.

By the time the woman reaches menopause which usually occurs between 50-55 years, there are only several thousands eggs remaining. As the woman ages, the remaining eggs in her ovaries also age, making them less capable of fertilisation and their embryos less capable of implanting.

Fertilisation is associated with a higher risk of genetic abnormalities e.g. chromosomal abnormalities such as Down syndrome with increasing age. The risk of a chromosomal abnormality in a woman age 20 years is 1/500 while the risk in woman age 45 is 1/20.

Investigations of infertility in older women

It is advisable to seek the advice of your doctor / specialist sooner than later so investigations and treatment can be started without undue delay.

Several tests may be useful in assessing the fertility potential in older woman e.g. blood tests to examine the levels of the hormones FSH, LH, estradiol and inhibin on day 3 of your menstruation.

You will be more likely to be counselled about the risk of miscarriage and chromosomal abnormalities in relation to your age. In addition to the potential complications of pregnancy such as high blood pressure, bleeding and diabetes.

Exercise weight and fertility

Couples with infertility often wonder if lifestyle habits might compromise their fertility. Two important lifestyle factors, weight and exercise, can affect fertility.

Low weight or weight loss can lead to a decrease in an important hormonal "message" that the brain sends to the ovaries in women and testes in men.

The degree to which weight loss affects fertility will vary. In mild cases, the ovaries may still -produce and release eggs, but the lining of the uterus may not be ready to receive a fertilised egg because of inadequate ovarian hormone production. In more severe cases, ovulation does not occur, and menstrual cycles are irregular or absent. In men, low weight or weight loss may lead to decreased sperm function or sperm count.

Being overweight or obese can also affect the hormonal signals. Increased weight can also increase insulin levels in women, which may cause the ovaries to overproduce male hormones and stop releasing eggs.

Proper exercise and diet are important for maintaining good health and proper weight. Extreme exercise can, however, lead to reduced sperm production in men and the cessation of ovulation in women by decreasing the brain message to the ovaries and testes.

It is impossible to know how much exercise for any one person is too much. Generally, running more than 10 miles per week is considered too much when trying to conceive. The most effective way to treat reproductive problems associated with excessive exercise is to decrease or modify the amount of exercise.

At Healthy Women Medical Centre any one of our Female Doctors can arrange any appropriate testing and referrals for any Fertility related problems. Again we would like to thank our friends at City Fertility Centre for this information regarding fertility problems.

www.cityfertility.com.au

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