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Fertility

Judith is part of the Number 1 Fertility team across Melbourne and Geelong with Dr Lynn Burmeister. Click on the logo below to visit the Number 1 Fertility site to find out more information on the Fertility work they do and book an appointment:

 

 

Conceiving a baby can be a fine balance of variables. If you find conceiving naturally isn’t working, we can perform some tests and make some changes to increase your fertility and your chance of falling pregnant.

Making babies requires several factors to be in alignment. Good eggs need to be released, good sperm needs to be delivered, the timing must be right and the tubes need to be open to allow the best meeting of sperm and egg – all of this needs to happen in a uterus that is receptive to developing an embryo and grow a baby.

To begin our journey, an initial investigation into your fertility will involve a blood test to assess your hormone levels, which will indicate if an egg has been released. This process is best practiced on a certain day in your unique menstrual cycle. It is best to test if an egg has been released seven days before your next period, or seven days after your last ovulation. Which could be day 21 in a 28 day cycle, or day 28 in a 35 day cycle, for example. If required, tube testing can be conducted through a detailed ultrasound scan (performed at Gynaecology labs) or though a Laparoscopy procedure. Both involve flushing the tubes with either a foam or dye solution. Generally, simple mucous plugs or fine adhesions can be cleared, improving fertility by 25%. If a more serious blockage is discovered, the options for conceiving naturally reduce, leaving IVF as the best course of action.

For the males, a semen abnormality test is conducted. For best results, this test should be done within specific time frames of collection, delivery and testing.

Figuring out your most fertile time according to your cycle can often be identified by using a phone app where you can log your cycle (several months of data will be required). This will help you identify when the ideal time to conceive is, for you. Another option are ovulation prediction kits, which will notify you when a hormone surge occurs, usually initiating ovulation.

Once the female releases an egg, it lasts for 12 hours. Male sperm can live for up to 72 hours after being released into the female, so timing sex around a hormone surge is the best, most fertile, time to conceive. It is also recommended to stay in bed for at least 30 minutes after having sex.

If you would like to make an appointment with me, you can find the details for phone, email or faxing through your referral on our Contact page.

 

Why can’t we conceive?

Below is some information on the potential reasons for conception barriers:

When females are born, they have the maximum number of eggs available in their lifetime, although they only start maturing during puberty. By 20 weeks’ gestation, a female’s eggs are formed; by the time they are born, the number of eggs they have is halved and they continue to lose eggs at a rate of 10-15 a month (after puberty). When they go through menopause, there are no more eggs to be released.

Generally, the process of conception from a female’s perspective involves only one or two eggs maturing into follicles and then 14 days before a period, the egg will release into a tube where it will wait to be fertilised. If all goes well, the now embryo will continue its journey down the tube for a few days before attaching in the uterus.

During our assessment for potential IVF stimulation, it is possible to measure how many eggs are being released, which will give us an indication of your remaining egg reserve. We do this by testing the AMH hormone found in some follicle cells. What we don’t know, is the quality or the potential fertility of the remaining eggs.

IVF stimulation doesn’t cause you to lose more eggs but encourages more than the standard one or two eggs to mature during each cycle.

When it comes to male fertility, there are many factors that can affect sperm counts. Age, diet, weight and temperature are all variables that can contribute to low numbers or abnormal sperm production.

The quality of sperm is known to reduce after the age of 45.

Low sperm production could be linked to reduced Testosterone levels. This can occur for a few reasons – being overweight, which can see Testosterone be converted to Oestrogen; chronic ingestion of alcohol; or overheating sperm on heated car seats or in hot baths (on a long-term basis).

Abnormal sperm can be a by-product of smoking, which can damage sperm DNA. Having abnormal sperm won’t conceive an abnormal baby, but it is highly un-likely that it will fertilise an egg.

To help improve your sperm count, production and quality, living health for at least three months prior to conceiving is important because it takes 90 days for sperm to develop.

Diagnosing Polycystic Ovarian Syndrome (PCOS) via an ultrasound is fraught with mis-diagnosis. Between 8 and 13% of women of reproductive age have PCOS, being more common in indigenous women, at 21%.

PCOS can’t be diagnosed by an ultrasound alone if you haven’t had periods for more than eight years. Many young women are told they have PCOS after receiving a scan, when in fact they actually have active ovaries. If you have had periods for less than eight years, then it may look like you have PCOS because your ovaries are the opposite of active fertile ovaries.

One common way to diagnose PCOS is through the Rotterdam criteria, where you require two out of three of the following criteria to be considered:

  • Few or infrequent periods (cycles greater than 90 days or where an egg isn’t released from the ovary)
  • Increased Androgen levels
  • Polycystic ovaries identified on ultrasound (after eight years or more of periods)

Increased Androgen levels, or Hyperandrogenisation can show symptoms of increased hair growth, an increase in weight and difficulty losing weight, and the presence of acne.

The presence of PCOS can also lead to other factors during pregnancy like Gestational Diabetes as well as increase your general risk of cardiovascular disease, depression, anxiety and Endometrial cancer.

There is no specific treatment available for PCOS. The course of action is to manage your symptoms using a few of the follow methods:

  • Reducing your weight by 10% or more (naturally, through Metformin or Bariatric surgery)
  • Reducing your waist measurement
  • Aiming for a BMI of <25
  • Stopping smoking
  • Regular sugar level checks (every two to three years)
  • Using Ovulation induction to encourage eggs to be released

Miscarriage is unfortunately quite common and most often, not properly diagnosed. In the past, at-home pregnancy test weren’t an option so, women didn’t necessarily realise they were experiencing a miscarriage. Paired with a general knowledge gap and a quiet culture, a late and heavy period went unnoticed.

Modern medicine now affords us relatively accurate, at-home urine test kits so many women now know that they have conceived a pregnancy which has unfortunately not continued. Now, as a result it is hard to not grieve for the loss of a pregnancy, not matter how early it is lost.

Nature does have a way of allowing pregnancies to fail because of low hormone levels, or a lack of placenta formation, so heavy periods may be the result. If this is the case and you experience a failed pregnancy, then it may take anywhere between a day and a few weeks for the pregnancy to miscarry. Depending on the gestation length, the bleeding pain and duration will vary and can be especially heavy after seven weeks gestation.

Misoprostil tablets can be taken in early pregnancies (less than seven weeks), to induce a contraction that encourages the miscarry to occur and the products of conception to pass. For pregnancies over seven weeks gestation, a D&C procedure is performed in a few minutes, under general anaesthetic, in hospital as the amount of tissue to pass is larger and the amount of bleeding is heavier. Tissue taken in this procedure is sent to a pathology lab, but it generally doesn’t provide any data on the reason for miscarriage.

It is normal to bleed after a miscarriage for up to a week, but it shouldn’t be overly heavy. The hardest part about miscarriage is coming to terms with your loss. People around you might try to support you by saying things like ‘you’ll have another’, or ‘there was something wrong with it’ but what you really wanted was that pregnancy to succeed. If there is a reason for miscarriage, we can often diagnose this and provide treatment.

If you have experienced a miscarriage and you are part of the Rh– blood group, then you should have an Anti D injection as soon as possible after the miscarriage. Attempting another pregnancy can ideally happen after experiencing one normal cycle to allow the uterus to return to normal, or whenever you are ready to conceive.

Fortunately, you are much more likely to have a normal pregnancy after a miscarriage.

There is some comfort in knowing you aren’t alone and there are support groups of people in similar situations, we have listed a few links below.

Working with patients for Gynaecology, Fertility, Abnormal Smears, Contraception and more, Dr Judith Fleming is available for consultations, surgeries and treatments at Epworth Geelong, St. Vincent’s Werribee; and Colac Area Health.