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:

• Not ovulating or infrequent ovulation due to issues such as PCOS

• Blocked fallopian tubes
• Uterine problems
• Endometriosis
• 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:

• Lifestyle factors (diet, weight, smoking, alcohol)
• Hormonal problems
• Steroid use
• Blockages in the vas deferens
• 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:

“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.”

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.

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.

The hormone luteinising is released in large amounts before ovulation, Dr. Raewyn explains.  “This is a great and simple way to test for ovulation.”

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.

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 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.”

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.

“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?