Optimising your fertility transcript

Hello and welcome. I’m Caroline West. The Your Fertility campaign aims to give the latest in evidence based information to help people who are wanting to have a child or have a child down the track. So why the Your Fertility campaign? Well around one in seven couples will experience a problem with falling pregnant. Every year in Australia and New Zealand around 35,000 women go through IVF and often there is a tremendous rollercoaster, an emotional rollercoaster that can go along with that. So today we’d like you to have the facts. The facts on the five fertility factors that can really make a difference in optimising your chances of success and it’s not just women who will be involved with this conversation, it’s also looking at men because after all, both men and women’s health is incredibly relevant when it comes to the issues around fertility. Today I have with me an expert, Professor Robert Norman who is going to take us through the key fertility factors. Professor Norman is the director of the Robinson Institute at the University of Adelaide. Welcome Robert. Thank you very much for being with us this afternoon.

Hello Caroline.

Perhaps I could start by asking you straight off, what sort of impact does age have when it comes to our fertility, for both men and women?

I think fertility is one of the greatest gifts that we’ve been given by nature and we can decide whether to use that gift or not but for those that do want to use it and it goes wrong, it can be absolutely devastating. There are a lot of things that we can do to minimise the risk of our fertility going wrong and one of the things is age. We’ve known for many centuries now that the younger you are the better your chance of getting pregnant and as you get older your pregnancy chance diminishes. So between 20 and 30 for a woman, the chances of pregnancy are excellent. They start to reduce somewhat from about 32 and they drop off quite dramatically in your late 30’s and early 40’s. It’s not always possible to arrange your life to have kids early but if you’ve got the choice and you’ve got the chance, that’s what you should do. For men, we’ve always thought men could go on having kids all their life but we are realising more and more that as you get into your 40’s that you are much less fertile than you were when you were in your 20’s and as a result of that again, men should also be aware of the fact that there are opportunities for them to have a better chance of pregnancy earlier in life rather than later. So we can’t control always when we can chose to have a child on our age but if we’ve got the choice we should try and plan to have kids as early as possible whether we are a woman or a man.

What about the question of weight? I guess most people understand that weight can be involved with diabetes and heart disease but when it comes to our fertility, what sort of impact does weight have?

We know a lot about weight and fertility. We know that if you are under or overweight that your fertility is reduced. If you are underweight due to having an eating disorder or being seriously ill, often the periods stop and that’s a really good reason for people not to get pregnant. Being overweight is not always associated with abnormal periods, although it might be and we think that there may be other causes in the reproductive tract why people don’t become pregnant but we do know that the more weight that you put on, particularly if it’s around your tummy, that you are less likely to get pregnant each month and it also has a big impact on the pregnancy that might follow including miscarriage and a lot of complications that occur in pregnancy. So it’s really important I think that we look at our weight and that we try and address that through diet, exercise, sensible eating and just losing a small amount of weight can make a big difference to one’s reproduction and for pregnancy. Now when it comes to the guys, weight is also important and we are understanding more and more that weight can impact on sperm quantity and quality, particularly when we look at the genetic material, the chromosomes within the sperm head, we know that being overweight, that that can have a big impact as well. So overall, as we look at the increase in weight in the Australian population and we understand all the illnesses that can go with that, fertility is another issue that people who have got weight problems need to address and through diet, exercise, lifestyle change, there are lots of things that we can do to get our fertility potential back to normal if we are under or overweight.

When it comes to the lifestyle factors like smoking and alcohol, what sort of advice should we be giving there?

There are many things that we can give advice to people about for fertility and lifestyle. If we start off with smoking, we know that many young men and young women smoke and increasingly we realise that smoking is really bad for fertility. So for instance, a woman who smokes at the age of 30 has the same fertility potential as a woman who doesn’t smoke at 40 and that’s a very significant effect. We also know that smoking leads to an earlier menopause by around about two years. It takes much longer for a smoker to become pregnant and also if she continues to smoke in early pregnancy, that can affect the eggs and sperm of the baby that she has conceived for their future life. For men, smoking definitely affects sperm count and above all, it affects the integrity of the chromosomes and the genetic material in the sperm head so that men who smoke often are responsible in some way for increased miscarriage in their spouses and partners. So smoking is very, very important, utterly proven. Other things that we think about are alcohol. Generally we advise people who are seeking to become pregnant to cut the amount of alcohol back to a minimum and if possible, not to consume any alcohol at all around the time of trying to become pregnant. High levels of alcohol have a very bad effect on sperm, eggs and on the developing baby. There are other things that we are starting to understand as well, like nutrition. We know that a healthy diet, particularly a Mediterranean type diet is associated with a higher chance of getting pregnant and a lower chance of miscarriage. We know that exercise is very good within limits and a reasonable amount of exercise for improving fertility and stress is another big issue that many people face these days. So many people that I see, who come along with infertility, often are so stressed and so busy in their work that they actually see their partner very infrequently and not having sex enough times is a very good reason for not getting pregnant.

What about timing? There are some myths and misconceptions around when is the best possible time to get pregnant.

It’s true that many people don’t understand exactly when they are ovulating and it’s very important if you are trying to become pregnant to understand when it does happen because an egg is only released and survives for about 12 hours and after that it dies. If you are having quite regular cycles it’s easy to work out because it’s usually 14 days before the next period and you can therefore work back and work out when ovulation is likely to happen. If you take 17 days off when your period is due then that gives you a very good indication of when your fertility is starting to increase maximally prior to ovulation. There are many signs that can also be recognised like increased vaginal mucus, sometimes there is increase in pain for two or three hours when the egg is released and for those who measure temperature, they can often find that the temperature drops and then rises. For people who are having irregular cycles it’s much more difficult and that may need some medical help in terms of measuring blood tests or indeed buying some urinary sticks that predict when ovulation is likely to happen. It’s not always necessary to have sex throughout the whole cycle to become pregnant. What is normally recommended is that from three to four days before predicted ovulation and including the day of ovulation is the maximal time in which fertility is available. Sperm are very, very good at surviving for a long time and so you don’t actually have to hit the nail on the head, as long as some of the nails are around when the egg is there.

Well thanks for that Robert. It’s very interesting to hear that those top five fertility factors, age and weight, drinking and perhaps giving up smoking and of course the timing of sex can all have an incredible impact on our success, on optimising our success of getting pregnant. So thanks for joining me today. This programme was proudly brought to you by the Fertility Coalition which is sponsored by the Australian Government, the Department of Health and Aging. If you’d like any more information or resources please go to our website. There is lots for you to explore there at yourfertility.org.au. One more time, that’s yourfertility.org.au. Bye for now.

Your Fertility is brought to you by the Fertility Coalition: the Victorian Assisted Reproductive Treatment Authority (VARTA), Jean Hailes for Women’s Health, Andrology Australia and The Robinson Institute. This Project is supported by funding from the Australian Government Department of Health and Ageing under the Family Planning Grants Program.