Infertility: what is it and what causes it?
Infertility is a deeply personal experience often kept close to the chest. But it’s something that affects about 15 in every 100 Australian couples of reproductive age. So whether you’re trying to conceive, thinking about conceiving, or having a bit of trouble, we’ve spoken to Fertility Specialist & Gynaecologist Dr. Raewyn Teirney, so she can shed light on exactly what infertility is and what causes it.
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What is infertility?
“Infertility is defined as not conceiving after 12 months of trying,” explains Dr. Raewyn. “It can be Primary Infertility where the woman has never conceived before or Secondary Infertility where a woman has conceived a child and is having difficulty conceiving again.”
At what stage of trying to conceive should you assess your fertility?
Dr. Raewyn says that preparation is key when it comes to maximising your chances of conceiving. Given that your preconception health (including lifestyle factors like smoking, alcohol consumption, weight, eating patterns, exercise and sleep) have an effect on fertility, she recommends a preconception plan as a starting point.
“On average a couple should have a 70-80% chance of conceiving by 12 months of trying,” explains Dr. Raewyn. “We do recommend couples try for 6-12 months first unless there is a known fertility issue. Women thinking of or embarking on conceiving need to check in with their GP and have an antenatal screen which checks for rubella, chicken pox immunity, full blood count to rule out anaemia, Hep B, C and HIV and syphillus serology.”
And if you’ve already been trying for 12 months? “Couples should seek help by a fertility specialist and have their fertility assessed when they have been trying unsuccessfully for 12 months, or unsuccessfully for six months if the woman’s age is 35 years or over,” says Dr. Raewyn.
How can you test your fertility?
There are a number of tests that both partners can have done to find any factors that might potentially reduce the chances of conception. There are several hormonal assessments a woman can have done, as well as a pelvic ultrasound and tests on the fallopian tubes. For men, the easiest assessment is a semen analysis test. “[These] fertility tests range from simple to complex, and your doctor will determine the appropriate testing,” advises Dr. Raewyn.
What are the causes of infertility?
Causes in women
The main cause that Dr. Raewyn finds for women is increasing age. “The average age now for a first time mother is 31.5 years,” she says. “With increasing female age the egg ages as well and the egg pool/ovarian reserve depletes with time.” In fact, Dr. Raewyn says that a woman is born with her largest pool of eggs (about two million) and by the time she is 31-years-old, the pool has dropped to around 100,000.
Other causes include:
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Not ovulating or infrequent ovulation due to issues such as PCOS
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Blocked fallopian tubes
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Uterine problems
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Endometriosis
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Recurrent miscarriage
Causes in men
Dr. Raewyn explains that for men, infertility generally comes down to the amount or quality of sperm. “There may be low sperm numbers and their swimming may be slow – reducing the chance of sperm being able to swim to and fertilise the egg,” she says.
Causes include:
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Lifestyle factors (diet, weight, smoking, alcohol)
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Hormonal problems
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Steroid use
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Blockages in the vas deferens
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Increasing male age
What can you do to increase your chances of falling pregnant naturally?
Be ‘Fertility Fit’
Dr. Raewyn suggests you be in your best health (in other words ‘fertility fit’) by being an ideal body weight, stopping smoking and eating healthy nutrient-rich food.
Know your cycle
“Studies shows that women who track and are aware of their fertile day have a much higher chance of conceiving,” explains Dr. Raewyn. There are a number of ways to tell if you are ovulating:
Track your cycle
“If you have a regular menstrual bleed/cycle then it is a good sign that you are ovulating,” says Dr. Raewyn.”Generally women who do not ovulate do not have periods.”
Blood test
A blood test can be performed after ovulation (in the luteal phase of a cycle) to “check for a high level of the secreted hormone progesterone, indicating ovulation has occurred,” says Dr. Raewyn.
Basal Body Temperature
Dr. Raewyn explains that your basal body temperature rises and stays high after ovulation, so if you measure your temperature over the period of time that you think you might ovulate t and it’s high, that’s a good sign.
Urine test
The hormone luteinising is released in large amounts before ovulation, Dr. Raewyn explains. “This is a great and simple way to test for ovulation.”
Monitor body for post-ovulation signs
You can check for mittlesmertz pain (the release of the egg from the ovary, which can sometimes be felt as a sharp pain or cramp), acne, breast tenderness and mood changes.
Invest in a fertility kit to help you out
A conceiveplease™ Fertility Kit is a holistic pregnancy planning kit made to support those wanting to start a family through natural conception. The Fertility Kit addresses many of the factors involved in tracking your cycle above, containing specially-formulated vitamins for men and women, five ovulation tests, a digital thermometer to measure basal body temperature, a fertility calendar, two pregnancy tests, a fertility book, and an instructional DVD and booklet.
Be aware of factors that can inhibit conception
Increasing female age
“Increasing female age and delaying motherhood/parenthood is one of the biggest infertility factors,” explains Dr. Raewyn. “It’s important for women to understand this and not delay.”
Poor diet & body weight
A poor diet that is high in saturated fats and body weight can also both impact on fertility. Dr. Raewyn says that both having a low BMI (less than 18) or high BMI (greater than 30) can affect ovulation and therefore your chances of conceiving naturally.
Smoking & alcohol
“People who smoke take twice as long to conceive than people who don’t,” Dr. Raewyn advises, as smoking impacts both the egg and the sperm quality. Similarly, high alcohol intake can also affect a person’s fertility.
Dr. Raewyn suggests having an antenatal assessment done by your GP. “[They] can organise screening tests and review any medications [as some medications can impair infertility], help with smoking cessation and review alcohol intake,” she explains.
Have you experienced infertility? Do you have any advice for people who may be going through it now?
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I really feel for those experiencing fertility issues. It can be so demoralising.
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I feel sorry for anyone who really wants children and can't conceive easily. I was in my early 40s when hubby and I decided to have a child and I fell pregnant immediately so there were no fertility issues there. We didn't put any pressure on ourselves to have a child, we just decided if it was meant to be then it would happen.
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I have some friends who are struggling to conceive, so sad for them
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Thanks for posting such an informative article Beautyheaven. This is a subject that’s close to my heart, I suffered with infertility issues for so long, over a decade! I think being able to talk about it does help people around us understand and hopefully will treat the situation with respect and support. It’s a very sensitive subject so I do get why people keep their struggle behind closed doors. I hope that if anyone is reading this article does seek help, find someone they can talk to that won’t judge you. Much love and gentle hugs to all our beauties dealing with this xx
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With my first born I fell pregnant easily , a honeymoon baby . After my son was 2 years old we planned a second pregnancy . I had so many issues and miscarriages and at one point I thought that's it for us and we are meant to have only one so we stopped trying . Seven years latter fell pregnant and now we have out wonderful second born son and the two brothers have such a big age gap but I cherish them and happy to have them in my lives.
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I’m so happy that it all worked out for you in the end Moonlight sak, such a wonderful blessing xx
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I don't have children but would like to in the next few years if I meet someone.
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So hard for people who want kids so badly.
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I think that overall in the Western world there are a lot of assumption of fertility in women rather than infertility, which is why infertility can be so difficult and stigmatising.
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I don't have children by choice but feel for those who desperately want a family and are unable to fall pregnant.
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This is tough to go through. :(
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It's a sensitive and sad topic - so sorry that it has to exist for those who have to go through this. I have know some who have had this issue and it's been so hard on one of them that she wrote a book about it.
I am way passed this era now and luckily was blessed with three gorgeous girls who are an ongoing blessing every single day to me. Love them to bits!
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I know two women married to Army boys who were exposed to radiation (yet another factor of male fertility) one of them managed to conceive and the other one is still trying.
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I feel for anyone having this issue. A family members baby is due in June and all the signs are there that she had IVF so I'm happy her pregnancy is going well.
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Even 30 years ago, you assume you will fall pregnant when ready to start your family, so it's a shock when this isn't the case. I had no problem getting pregnant, but would miscarry before the end of the first trimester.
End result (after 6 miscarriages) is 3 amazing adult children and it's something I truly hope my 2 daughters don't have to endure. Heartbreaking.
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Even though I am now in my 60's I have never forgotten my battle with infertility, how alone I felt and the horrible procedures and tests I endured. My heart aches for couples who have to deal with all of the emotional and physical aspects.
I had blocked Fallopian tubes and initially underwent microsurgery at the Royal Women's Hospital in Melbourne as at that time there was little that could be done. IVF was very new in Australia but there had been some success in England. I went on the waiting list and on my fourth time through - success and I became the very proud mum of twin boys, now 31. I was then overjoyed 3 years later to fall pregnant naturally with my other miracle son.
I feel so very blessed every day Xx
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I feel for those that had fertility issues before the advent of IVF. I'm so glad that things worked out for you!
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