Optimising Female Fertility

If you are considering becoming pregnant, and particularly if you are struggling to conceive, ensuring a healthy lifestyle makes good sense. You might be surprised to learn how much your lifestyle can impact on your reproductive health, and the health of a developing foetus.

Diet and Exercise

Optimal wellbeing is essential for overall health and fertility fitness. Following a sensible diet and exercise program can help boost your reproductive health. A healthy diet including whole grains, legumes, fruit, vegetables, nuts and seeds and some good quality protein such as meat, fish eggs or milk is essential for both partners. Also ensure an intake of at least 8-10 glasses water daily

Vitamin Supplements

While vitamin and mineral supplements do not, compensate for poor food choices, they can comprise a useful addition to pre-conception care. Women may wish to take supplements of zinc, vitamin C, B6 and E, as well as magnesium, potassium and zinc. Naturally, folic acid is essential for any woman at least 1 month prior to conception as well as during the first three months of pregnancy, to reduce the risk of having a baby with neural tube defects. If the woman has a body mass index greater than 27kg/m2, diabetes or a family history of neural tube defect or some other conditions she should take 5 mg of folic acid per day. Excess vitamin supplements may be harmful and women should avoid excess vitamin A ingestion prior to pregnancy. Iodine supplement of 150 mcg should be taken around the time of early pregnancy. Vitamin D should be checked and confirmed as adequate.

Weight

There is a clear relationship between a woman’s body weight and fertility. A woman who is markedly overweight or underweight may have difficulty conceiving. As weight moves away from the normal range, fertility decreases and the miscarriage rateincreases. However, a weight change of even 5kg can start to make a significant difference to a woman’s chance of conception

Smoking and Alcohol

Women are advised to cease drinking alcohol prior to trying for a pregnancy, as alcohol can increase the risk of birth defects in babies. The World Health Organisation and National Health and Medical Research Commission advise that there is no safe level of drinking during pregnancy. Aside for the established general risks associated with smoking, women who smoke are 2 ½ times more likely to be infertile than are non-smokers. Women who smoke also have a significantly higher incidence of miscarriage, premature birth and low birthweight babies than do non-smokers. Women who smoke have poorer response to fertility treatment, earlier onset of menopause and a high rate of intrauterine growth retardation, congenital abnormalities and infant death

Drugs and medications

The use of any recreational and illicit drugs should be avoided while trying to fall pregnant, due to the adverse potential effects on the person, as well as the unborn baby. A range of effects are associated with various illicit drugs. Some medications can also have an adverse effect on fertility, as well as the health of the developing foetus. Ensure that you discuss any medications with your doctor prior to trying for pregnancy.

Caffeine

There is uncertainty about the role of caffeine in affecting fertility. Some reports suggest caffeine can have a negative impact on female fertility and increases risk of miscarriage. Remember that caffeine is not present just in coffee, but also in tea, cola, chocolate, and some foods and medicine. Consider caffeine free alternatives while trying for pregnancy, or at least keep your caffeine intake to a moderate level.

Environmental Factors

Certain household products or occupations can expose people to toxins, including heavy metals, chemicals, and organic solvents. It is important that your exposure to these factors is avoided or minimised, as heavy metals such as lead, cadmium, mercury, copper and aluminium interfere with essential enzyme systems important in reproductive health and foetal development. For a full PDF version, CLICK HERE

Oocyte freezing

What is oocyte freezing?

Oocyte freezing is a method of preserving a woman’s unfertilised eggs to be able to have children in the future.

Why is it performed?

Women postpone having children for various reasons such as education or work, but with age, fertility usually reduces and eggs produced are lower in quality and quantity. As a result, women trying to get pregnant in their late 30s or 40s are sometimes faced with infertility, miscarriages or birth defects. Egg freezing gives women the opportunity to store healthy eggs to improve their chances of conception and having a healthy baby.  However, there is no guarantee that frozen eggs will make a baby.

How are the oocytes collected?

Your doctor will give you hormonal medications to stimulate your ovaries to produce eggs. You will be taught how to self-administer the injections daily and will undergo blood tests and ultrasound studies to check how well your ovaries are responding to the treatment. The entire procedure takes about 12 days during which you will have to visit the clinic 2-4 times. You will be able to work during this time but may have to take one day off for oocyte collection, which is performed under anaesthesia or sedation.

Are there any side effects to the procedure?

Following the procedure, you may experience some fatigue, bloating and pain which are usually well tolerated. Rare complications include ovarian hyperstimulation syndrome, ovarian torsion, bleeding and infection.

How is oocyte freezing performed?

Oocyte freezing is performed through a process called vitrification, where the eggs are rapidly frozen with liquid nitrogen. Freezing eggs with this technique prevents ice crystal formation which can damage the egg structure. The eggs can remain frozen for many years.

How are the frozen eggs used when needed?

When you decide to have a baby, the oocytes are thawed and mixed with sperm from a partner or donor. On fertilisation, a resulting embryo is transferred with the help of a catheter into the woman’s uterus where it implants and continues to grow.

How successful is oocyte freezing?

Approximately 80% of eggs survive following the vitrification procedure and the chances of a successful pregnancy and conceiving a healthy child are as good as with natural conception or fresh eggs used during an IVF procedure. Your chances are improved if oocyte freezing is performed at an earlier age (<35 years). Storing more eggs also improves your chances of conception and more than one treatment cycle may be recommended. A 33-year-old woman who stores about 20-25 eggs has a high likelihood of having a live birth.

About the AMH test

What is the AMH test?

AMH or anti-Mullerian hormone testing is a blood test that gives an indication of the remaining eggs or oocytes a woman has within her ovaries, also called the ovarian reserve. Every woman is born with a certain number of eggs. This reserve is gradually depleted with each menstrual cycle as eggs mature and are released. Although ovarian reserve differs from woman to woman, by the mid-30s it is usually low and one may have trouble conceiving. The AMH test is part of the workup performed before undergoing fertility treatments such as intrauterine insemination and in vitro fertilization.

Why is the AMH test performed?

The results of the AMH test give a woman an idea of her chances of conceiving. It also helps decide the dosage of the ovarian stimulating hormones used during IVF treatment and the number of eggs one can expect from a treatment cycle.

What are the limits of AMH testing?

Though AMH testing can give a fair idea about egg quantity, it cannot tell you about egg quality which usually diminishes after the age of 35.

What are the other fertility tests that can be performed along with AMH testing?

Other blood tests that can give an indication of fertility include the FSH (follicle stimulating hormone) and estradiol. The higher the FSH, the lower are your chances of getting pregnant. A transvaginal ultrasound may be performed to count the number of resting follicles (immature eggs) in the ovaries.