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Dr Andrew Cary's picture

Fertility Forensics : Understanding your own fertility

Last month, the National Health Service (NHS) in a Scottish county banned access to publically funded IVF treatment for couples who are overweight or who smoke.  In the UK, the number of government funded IVF cycles available to couples varies from region to region, and the waiting lists can be three years or more.  Not surprisingly, the news was not well received by those who can’t afford expensive treatment through private clinics.

The NHS decision is no doubt based on evidence that weight and smoking reduces the likelihood of pregnancy success.  But like other lifestyle factors such as diet, caffeine, alcohol, recreational drugs and exercise (or lack thereof), most people don’t think twice about their lifestyle choices and how that links to their fertility, until they start seriously thinking about starting a family.

It’s one of the most common questions I am asked; what impact has my lifestyle had on my fertility?  It’s a difficult question to answer, as there are many variables that can impact a person’s fertility.  And unfortunately, how young you look or feel does not correlate to how fertile you are, or how quickly you will conceive.

There are however simple ways to assess the current fertility status for both men and women.  For a woman, a blood test to measure her hormone levels will determine whether she is ovulating (producing an egg) every month is normally the first step.  A pelvic ultrasound may also be performed to check the condition of the endometrium (the lining of the womb) and diagnose any polyps or fibroids.

If a couple has been trying to conceive for six months or so, your GP may also recommend a semen analysis for your partner, which will determine the number of sperm (stated in millions per ml), the motility of the sperm, and their size and shape.

These basic fertility assessment tests are designed to ensure that a viable egg and sperm are available at the right time to fertilise in the right environment, so that the couple can conceive naturally.

For couples where there may be other factors that could influence their fertility, an advanced fertility assessment by a fertility specialist may be appropriate.  This may be suitable for women who are of advanced maternal age (over 35 years of age), where previous fertility surgery has been performed, where there is a pre-existing medical condition (eg endometriosis or PCOS), or where the couple have been trying to conceive for six months or more without success.  Further blood tests such as an AMH test, specialised ultrasound and tubal assessment, and in some instances a laparoscopy may be recommended.

AMH is a relatively new test that has attracted media attention for its ability to predict the number of eggs available.  Women are born with all the eggs they will ever have, and these reduce in number and quality as she gets older, particularly over the age of 35.  If the AMH test shows that the ovarian reserve is diminished, it will be harder to fall pregnant naturally and may also increase the risk of miscarriage. The AMH test is useful therefore to help women decide whether to start trying for a baby sooner rather than later, or look into fertility treatments such as IVF. And while the test will give an indication of the number of eggs available, it won’t provide any information about the quality of the eggs, and this is where factors such as your lifestyle come in.

The AMH test is a blood test that costs around $60 - $70, and can be requested by your GP, but is best interpreted by a fertility specialist, normally in conjunction with an ultrasound.

So, what’s my advice to anyone wishing to start a family now or in the future?  Consider a fertility assessment to check everything is in place for a natural conception.  In the meantime, consider making a few smart choices now to help you conceive later. Both partners should stop smoking, have a healthy BMI, minimise alcohol and caffeine intake, exercise regularly, and have a balanced diet.  Women should also take 500mg of folic acid daily for at least 3 months prior to conception.   And when you are ready to conceive, it’s generally recommended you have sexual intercourse every couple of days in the lead up to ovulation, doctor’s orders.

Comments

Hello Dr Cary
Thank you for sharing such pivotal information -albeit disappointing to people wanting access to IVF treatment whilst obese or smokers.
When working at an IVF clinic in Victoria I used to personal train women whose BMI was >35. My goal was to get their BMI <28 so they can commence therapy - a result that I am proud to say I achieved every time. I also found that when BMI was lowered and healthier lifestyle chouices were being made, there was a natural progression to minimising and giving up smoking. It becomes an organic process.

What are your thoughts (or any experts thoughts) on Bio Age testing? I am interested in any views or experience in lowering your bio age and the effects it has on reproductive health

In gratitude,
Helen

Dr Andrew Cary's picture

Thank you Helen for your insightful comments. You have obviously assisted many couples by improving their health & fitness which then improves fertility.

You are correct that healthier lifestyles and improved BMI then becomes a cascading effect that results in further lifestyle improvements and hopefully avoiding or quitting smoking. Bio Age testing is very useful to demonstrate to a person where they are in terms of overall health and therefore where they need to get to to be healthy and fit cardiovascular and respiratory wise.

This would all be important to a person’s long term wellbeing. However from a fertility view we can simplify a little bit (because time is of the essence) and focus on lifestyle, BMI, smoking and other recreational agents doing harm.

Thanks for your response and interest. Keep up the good work.

Andrew