July 2023

Many people are affected by infertility in their lifetime. According to a new report from The World Health Organisation, 1 in 6 people globally are affected by infertility.

In our latest Q&A, we ask Specialist Obstetrician, Gynaecologist, and Fertility Specialist Dr Andrew Zuschmann, key questions to help better understand infertility and the ways to improve your fertility.

 Q1. WHAT ARE THE CAUSES OF INFERTILITY IN BOTH MEN & WOMEN?

There are many different causes of infertility, and so a comprehensive assessment by a fertility specialist is essential.

For a couple or individual to get pregnant, we need eggs, sperm, and a way for them to get together.

Causes of infertility in men include conditions that impact on sperm production such as sexually transmitted infections, alcohol, smoking, other drugs and toxins, as well as some genetic conditions and varicose veins.

Other conditions affect the delivery of sperm outside a man’s body, and these include erectile dysfunction, retrograde ejaculation, and blockages to sperm leaving the testes.

Age and ovulation problems are the most common causes of infertility in women that I see. Endometriosis is another very important condition to consider. Damage to or blockage of the fallopian tubes is something else we check for, along with assessing for genetic conditions, environmental issues, medications, smoking and other drugs.

Q2. WHAT ARE THE TESTING OPTIONS IF EITHER OF US HAVE FERTILITY ISSUES?

The tests we do centre around confirming ovulation, making sure the fallopian tubes are open, and assessing sperm function.

For women we arrange blood tests to assess ovarian reserve, ensuring ovulation, exclude other medical conditions that may impact fertility, and check chromosomes along with other basic blood tests. We arrange a pelvic ultrasound to assess the uterus and ovaries, and confirm the fallopian tubes are open. If a woman’s history suggests endometriosis, we would talk about the potential benefits of keyhole surgery to diagnose and treat this condition.

Assessment of fertility in a man starts off with a sperm test where we look at 3 parameters- number of sperm, percentage of moving sperm, and percentage of normal looking sperm compared to reference ranges.

We can also check chromosomes, and hormone levels if we find a variation in sperm parameters. Sometimes we’ll also arrange an ultrasound to make sure there aren’t any varicose veins around the testes which can impact sperm production.

 

Q3. HOW CAN I IMPROVE MY FERTILITY AND WHAT LIFESTYLE CHANGES COULD HELP IMPROVE IT?

There’s no surprises about what lifestyle changes can improve the chances of pregnancy!

Stopping smoking and vaping, minimising alcohol, and limiting caffeine to one or 2 cups of coffee (or equivalent other drinks) will help. Stopping other drugs and minimising environmental toxins is also important.

Eating well and exercising to maintain weight in the normal Body Mass Index range will also improve the chance of pregnancy.

Everyone seems to be under stress these days, but if you’re trying to get pregnant and it’s not happening stress management is something else to consider

 

Q4. HOW LONG SHOULD WE BE TRYING FOR A BABY BEFORE TAKING ACTION?

The first person you should see is your GP who will be able to arrange some initial investigations and refer you to a fertility specialist for further evaluation. If you’ve got regular periods and no other medical conditions, you’ve got a 60% chance of being pregnant after 6 months, and 80% after 12 months, so we’d normally suggest giving it that year.

But if you’re over 35 we would normally start our workup after 6 months, and after 3 months over 40. If your cycles are irregular, seek review after 3 months.

If you know about any specific medical or genetic conditions, it’s important to see a specialist before you start trying.

 

Q5. WHAT FERTILITY OPTIONS ARE AVAILABLE?

The first step is to optimise what we can… work on the lifestyle factors I’ve mentioned, sometimes we’ll need the assistance of dieticians, exercise physiologists, and psychologists. We also need to make sure any medical conditions are well controlled and that any medications are pregnancy-suitable.

The actual fertility treatments we have are small in number, but broad in their application.

• First off, it’s important to diagnose and treat endometriosis. If a woman isn’t ovulating, we can use tablets or injections to help nature along.
• Next in complexity is Intra-Uterine Insemination, where we monitor for ovulation, and transfer a cleaned up and concentrated deposit of sperm into the uterus. From here the sperm will find their way into the fallopian tubes where fertilisation actually occurs.
• Finally we have IVF which stands for In Vitro Fertilisation were eggs and sperm and combined in the lab to create embryos which are then transferred into the uterus. It’s preferable for the sperm to fertilise the eggs on their own, and we simply call this IVF, but if sperm numbers or function are lower we’ll select individual sperm and inject these into each egg- this is called ICSI (Intra-Cytoplasmic Sperm Injection). IVF usually works over a menstrual cycle. Early on we use injections to provide extra stimulation to the ovaries so that we get more than the one egg that is usually released in a natural menstrual cycle. We then monitor by blood tests and ultrasounds for progression of egg development, and when the follicles that contain eggs get to the right size, we use a trigger injection to mature the eggs. We collect the eggs under anaesthetic, with fertilisation and embryo development occurring in the lab until embryo transfer.

We also have the option to test embryos for genetic conditions before we use them.

Q6. HOW MUCH DOES IVF COST & WHAT IS THE SUCCESS RATE?

The actual cost for an IVF cycle varies based on medications used, and lab techniques, but a typical first IVF cycle at a full service IVF clinic is around $7,000 out of pocket (after medicare, extended medicare safety net, and health fund rebates)in Australia. There are also low cost and public IVF clinics.

The federal government funds a website Your IVF Success https://yourivfsuccess.com.au/estimate that estimates your chance of getting pregnant based on your age and reasons for not getting pregnancy, and is a resource I use with my patients all the time to help them understand what their realistic chances of pregnancy might be. 

                                                                                                                              

Dr Andrew Zuschmann has been working in women's health for over 20 years. He is a specialist in obstetrics and gynaecology, and infertility, Dr Andrew has the additional qualification of Masters of Reproductive Medicine (UNSW). His practice is Anaria in NSW.