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You may think that falling pregnant is the easiest and most natural thing in the world, but for many couples it can be a difficult and heartrending process. Family Health Diary reports.

The rate of infertility in New Zealand is steadily increasing each year and one in six of all couples trying to conceive will experience infertility problems at some stage, even after one or more successful pregnancies.

This worrying statistic is not helped by a 26% fall in New Zealand’s birth rate in the last 30 years, less than Australia (29%) but considerably higher than UK (14%), France or Germany (both 15%).

A leading UK fertility expert has issued a warning that infertility rates could double within 10 years in Europe. Professor Bill Ledger from Sheffield University said that the increasing age of first-time mothers, obesity levels, sexually transmitted diseases and declining sperm quality are all taking their toll on the fertility rate.

Social factors, including financial, educational and career issues, are also contributing to the decline.

INFERTILITY IN NEW ZEALAND
Though the accepted definition of infertility is when a couple fails to conceive after one year of trying, in New Zealand couples will seek fertility treatment after just a few months to five years of trying.

It’s not just traditional couples that are seeking IVF treatment: single women and gay partners are also a component of the infertility statistics in NZ.


Dr Mary Birdsall of Fertility Associates
The average age for a first pregnancy in New Zealand is 30, which is the highest in the world. Dr Mary Birdsall of Fertility Associates in Auckland suggests the costs of family life, housing and education is causing couples to delay. Dr Birdsall also points out that more women than men in New Zealand are at an age group and commitment level to start a family.
When Fertility Associates opened 20 years ago the average age of women in the IVF programme was 34, now this has increased to 37. However, a woman’s reproductive age is not always the same as her age in years. Fertility Associates runs an “Egg Check” service that measures hormone levels and ovarian volume to determine the number of eggs left in a woman’s ovaries, and work out her reproductive age and chances of becoming pregnant.

Dr Birdsall points out that spontaneous pregnancy after years of trying to conceive is often just a case of “hitting the jackpot”. By continually doing the right things to get pregnant, chances are you’ll eventually get there, she says.

IS AGE A FACTOR?
Even in a younger woman, 30-40% of her eggs are abnormal, and even in a fertile couple, there’s only a 20-25% chance of becoming pregnant in any one month. However, as a woman ages, the quality of her eggs reduces rapidly until by age 40, 90% of all remaining eggs are abnormal. This reduces her chances of conceiving each month to:
  • 25% at age 34
  • 15% at age 38
  • 4% at age 42
Even if conception is successful, the embryo may be abnormal and spontaneously abort or fail to implant.

 CAUSES OF INFERTILITY

Endometriosis – where the endometrium (lining of the uterus) is found outside the uterus and can cause irritation and scarring. Surgical removal or IVF are the usual solutions.
Ovulation problems – disruption or prevention of normal ovulation caused by hormone imbalance (FSH, LH or prolactin), polycycstic ovaries (ruptured ovarian follicles forming cysts and blocking release of the egg), ovarian cysts (fluid-filled sac on the ovary).
Blocked tubes – fallopian tubes become blocked due to infection (such as chlamydia), which can be treated by surgery.
Uterine fibroids – benign growth in the uterus which can be treated by surgery.
Being underweight – due to excessive exercise and too little body fat can cause hormones to switch off and prevent ovulation.
Being overweight – does not interfere with normal female hormone levels but can reduce chances for conception in women and can cause reduced sperm count in men.
Pelvic Inflammatory Disease – usually caused by infection with a sexually transmitted disease and can cause serious damage to the female reproductive system.


Problems with sperm – includes low sperm count, reduced sperm motility, abnormal sperm or no sperm. Varicocele (swollen veins in the testes) is the most common cause of male infertility (up to 40%) by causing a temperature increase in the scrotum, which is harmful for normal sperm development.
Anti-sperm antibodies – can be produced by men against their own sperm (particularly in men who have had vasectomy reversal) or by a woman against her partner’s sperm in her cervical mucus.
Stress – is a contributory factor to infertility, but understanding its impact on neurotransmitters in the brain and how it affects the physiology of conception is only just beginning.
 

DID YOU KNOW?
  • All a woman’s eggs that she will ever produce are created while she is still in the womb.
  • The number of eggs fall steadily from several million to a few hundred thousand by puberty.
  • The window for conception is only a few days per month and once released the egg must be fertilised within 18-24 hours.
  • Sperm can survive for up to 4 days in the female reproductive tract and therefore intercourse one or two days before ovulation is the most likely time for successful fertilisation.
  • The more sex the better when you are trying to conceive, saving sperm for the special date does not increase chances of success.
  • Sperm counts are dropping in NZ (by 15% in the last 20 years).
  • Infertility is not the same as sterility, as many causes for infertility can be
  • The body needs at least 22% fat for a normal menstrual cycle and at below 17% there is a high risk of menstruation and ovulation ceasing altogether.

TREATMENT OPTIONS
Assisted reproductive technology
  • Fertility drugs release more eggs each month and increase chances of fertilisation.
  • In-Vitro Fertilisation (IVF) (see below).
  • Intrauterine insemination (introducing sperm directly into the uterus).

Natural fertility therapy
  • Acupuncture is used to help couples through fertility problems, possibly by stimulating the release of neurotransmitters and neurohormones in the brain and helping blood flow to reproductive organs.
  • Clinical hypnotherapy is used to reduce stress, increase confidence and instil a sense of control.
  • Naturopathic treatments include using herbs, nutrition, detoxification and stress control to address fertility problems.

How does IVF work and what are its chances of success?
Following hormone treatment to stimulate egg production, eggs are removed from your ovaries and fertilised in a dish containing your partner's sperm (or donor sperm). Once the eggs have developed into embryos, they are then implanted into your uterus.

Dr Birdsall of Fertility Associates says the chances of success increase the more times you try and she sees pregnancy success rates with IVF treatment of:
  • 45% after 1 cycle
  • 70% after 2 cycles
  • 90% after 3 cycles

KNOW YOUR CYCLE
Correct timing is often the key to success when trying to conceive so it is important to understand the menstrual cycle and know how to predict the most fertile days. A full cycle is usually 28 days, which links closely to a lunar cycle. However, all women are different and the length of the menstrual cycle can vary. This is how it works:
  • Day 1 – menstrual bleeding begins
  • Days 7 to 11 – The hypothalamus (brain control centre) causes release of gland (hormone control centre). This triggers the egg to mature and encourages the release of oestrogen.
  • Day 14 (mid-cycle) – As oestrogen levels increase, a surge of LH is released, triggering the release of an egg into the fallopian tube. At this point cervical mucus changes in consistency from sticky to clear and fluid, signalling ovulation.
  • Day 14 to 28 – The egg is wafted down the fallopian tube by tiny hairs and this is where it will meet the sperm and fertilisation happens. If an egg is fertilised it travels down the fallopian tube into the uterus and then implants into the uterine wall.

 

  • Men: Keep cool, don’t get into hot water as this can affect your sperm.
    Women: Use fertility charting and take folic acid to prepare you for a healthy pregnancy.
  • Reduce exposure to toxins including heavy metals, organic solvents (eg. oven cleaners) and dioxides (in paints).
TIPS FOR CONCEPTION
Awareness around pre-conception care is important for taking control of your fertility:
  • If you smoke, give it up! Smoking greatly reduces fertility in men and women.
  • Eat a well-balanced nutritious diet with plenty of fresh fruits and vegetables
  • Keep caffeine and alcohol intake to a minimum as both can reduce your chances of pregnancy.


A NAUTROPATH’S APPROACH
TO INFERTILITY
Naturopath and medical herbalist Rebekah Paddy of the Mother-Well clinic takes a holistic approach to infertility issues by looking at lifestyle, diet, occupation and health issues, such as menstrual irregularities, before offering a personalised regime for helping couples through their individual problems. Over the next three months of preconception care, she helps the couple prepare for pregnancy by getting healthy, charting the woman’s cycle and addressing any emotional issues. Rebekah often refers her clients for acupuncture or hypnotherapy – all therapies, she says, that work well alongside traditional IVF methods.


Rebekah Paddy of the Mother-Well clinic

JANELLE’S STORY
Janelle and Noel wanted to have a baby together and tried unsuccessfully for five years. After undergoing a series of infertility checks, they discovered there was no obvious cause for their inability to make a baby but decided against IVF or fertility medication. Instead, Janelle decided to review her life and take measures to ensure her body was in tip-top condition for conception and pregnancy.

She changed her lifestyle to reduce stress, eat a more healthy diet, cut down on caffeine and alcohol intake, and keep her weight within a healthy range. She
introduced new therapies into her life such as relaxation, acupuncture and herbs, and also took the time to know her own body rhythms, including charting her mucus and temperature changes.

Janelle conceived within a year of this new lifestyle and now has added three
biological children to her and Noel’s family. She has put her own experience to good use and supports other couples through infertility. For more information,
visit her website www.vitalpeace.co.nz.

by Janet Marianne Jackson

LATEST RESEARCH HOT OFF THE PRESS
A revolutionary study has shown that embryonic stem cells may one day be able to help male infertility. Cells isolated from early mouse embryos which had just begun to develop into sperm, were used to fertilise eggs which were then
transplanted into female mice where they developed into babies.

HELPFUL WEB SITES
www.naturalfertility-womenshealth.co.nz
www.mother-well.co.nz
www.fertilityassociates.co.nz
www.fertilitynz.org.nz

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