Most of us assume that when we’re mentally ready to conceive, our body will follow suit. Unfortunately, that’s far from the case. DR GILLIAN LOCKWOOD outlines the facts about fertility, so you can make informed choices.
In a recent survey, 92 per cent of people aged 18 to 23 said that they wanted to be parents, and 56 per cent said they wanted at least two children. However, one in seven of all couples seek medical help because they cannot become pregnant, and the latest data suggests that a quarter of women in Europe will hit the age of 45 and be involuntarily childless. Many couples struggle to achieve a first pregnancy and later find they cannot have a second child.
Our parents’ generation worried about having children before they were ready to, or having children they couldn’t afford, but our generation is more likely to worry about not being able to have children at all.
Whatever a woman’s age, there are three components to maximising the chance of conceiving successfully; information, lifestyle and nutrition.
Today’s women must become ‘fertility aware’. We are used to doing extensive research when we are choosing a career, buying a house or even booking a holiday, but information about our fertility potential is much more important.
Fertility runs in families through the female line. if your mother and grandmother had an early menopause (before 45) the impact on your fertility future could be very great. An early menopause in the family isn’t a problem if you plan to have your babies early, but you can’t risk waiting until your mid-thirties. Endometriosis is a common fertility suppressing gynaecological problem that can make it progressively harder to conceive as the years go by. So if you have sisters or cousins with endometriosis and your periods are heavy and painful then you may have endometriosis too and might have problems getting pregnant.
One-third of all fertility problems diagnosed in clinic are male-factor in origin and virility is no guide to fertility in men. If your partner had undescended testes as a baby, mumps as an adolescent or has dabbled with bodybuilding steroids, there may be a male-factor problem.
A quarter of adults in the developed world are obese and a significant proportion of would-be parents are reducing their chances of a successful pregnancy simply because they are overweight. The overwhelming evidence is that obese women take longer to conceive, are more likely to miscarry and have problems in pregnancy (such as diabetes and high blood pressure). We must get ‘fit to be pregnant’ and so, when planning a pregnancy, make sure you leave time to get fit and lose any extra weight. If your man has developed a ‘spare tyre’ then he should join you on the diet and exercise regime as overweight males have lower sperm counts.
Smokers go through the menopause earlier (by two to three years), are 50 per cent more likely to miscarry, twice as likely to have an ectopic pregnancy and only half as likely to succeed if they have IVF. Smoking is bad for sperm too, so you should both quit before trying to conceive.
It is an ‘urban myth’ that more babies get made because of alcohol than because of abstaining from it. Modern studies have shown that even very moderate drinkers take longer to get pregnant and are more likely to miscarry than non-drinkers. There is also good evidence that drinking more than two large cups of strong coffee (or equivalent in tea or cola) per day decreases fertility and increases the risk of miscarriage.
‘We are what we eat’ is more true in pregnancy than at other time in life. Extreme anaemia due to iron deficiency is rare, but can cause sub-fertility and is sometimes seen in women on strict vegetarian and vegan diets. The only source of vital minerals such as iron and calcium for the developing baby come from maternal stores, which, in turn, rely on good nutrition, which can be supplemented by pre-natal vitamins. A healthy diet with plenty of fresh fruit and vegetables and a minimum of highfat and high-sugar processed foods should establish a healthy nutritional environment for pregnancy.
When should you seek help, and where?
So you have done your fertility research, you have adopted a healthy lifestyle, you are the right weight, have de-stressed and are making sure you are having lots of sex during the ‘fertile window’ (cycle day seven to 15 for women with a regular 28-day cycle), but after six months you’re still not pregnant and starting to worry. When you should seek help and where depends, like so much else in the field of fertility, on your age and your medical and family history.
If you are in your twenties, the statistics tell us that you have an 85 per cent chance of becoming pregnant during the first year you try, so the best advice is to try not to worry as stress can make ovulation erratic. However, if your periods are irregular or very heavy and painful, if you have had surgery on your pelvis, like an appendectomy, or if your partner has medical problems or a history of surgery in the groin, then see your GP and ask for some basic tests to be started.
If you are in your early thirties, it is also reasonable to wait a year before starting investigations, unless there are clear risk factors for sub-fertility. If you have been pregnant before and are finding it difficult to get pregnant again, think back to how you were when you conceived successively before. If you weigh two stone more and are often ‘too tired’ for sex then you know what to do!
If you are in your mid to late thirties, your biological clock is starting to run down quite fast and it is important to ask for referral to a specialist fertility centre when you have been trying for six months and not achieved a positive pregnancy test. Early miscarriages are unfortunately quite common in this age range and, although deeply disappointing, a miscarriage should be interpreted positively – it means that the fallopian tubes are functioning and the sperm has fertilising capacity.
By 40, time is of the essence. As soon as you know you want to get pregnant (especially if you have been ‘trying’ for a while), ask for a hormone test, an ultrasound pelvic scan and a semen analysis for your partner. If you have any risk factors for damage to the fallopian tubes, such as pelvic infections or surgery, you need a test of tubal patency. The chance of IVF working drops by half every year over the age of 40 so, if this is a route you are prepared to take, don’t delay.
Everyone’s fertility journey is different and it is very important that you don’t blame yourself for ‘leaving it too late’. If the fertility prognosis seems hopeless, then choosing not to have treatment can be empowering and, remember, there are other ways to have children in your life without being a biological parent, such as fostering and adoption.
Dr Gillian Lockwood is Medical Director of Midland Fertility Services and a member of the Pampers Village Parenting Panel. Visit www.pampers.ie for more information.