Moving from Contraception to Conception

Written by Dr Juliette Koch
26 Sep

When couples first start trying to get pregnant, they often don’t know where to start, and only a few minutes researching online will deliver a broad range of often conflicting advice. So if you’re just starting out or have been trying for a while, let our combined fertility expertise guide your path to pregnancy.

Sex education in your 30’s

It’s probably been a while since you were at school, and if you remember any of the sex education you received back then, it was more likely around how not to get pregnant. If you need a refresher on the basics, take 40 seconds to watch this video on ovulation and conception.
However, if you only learn one thing when researching how to get pregnant, it should be that timing is everything. This means you need to understand when your fertile window is – the days in your cycle when you are most likely to conceive – and you need to be having regular sex during these days. To make this really easy to work out, we have developed a fertile window calculator.
Finally healthy couples are more likely to produce healthy babies, so brush up on the key health and lifestyle factors that affect your fertility and make some changes if necessary. Women should also book in a visit to your GP who will make sure you’re up-to-date on your pap smear tests, rubella and advise you to start taking folic acid.

Common Misconceptions about Conception

Next we need to set the record straight on some common myths people ask when they come in for their first fertility consultation. 

Myth #1: When we’re ready, it will just happen

As the urge to have a baby increases into a woman’s 30’s there’s a lot of information out there on how easy it is to conceive.  However, in one month of trying, a 25 year old couple has just a 20% chance of conceiving. This percentage decreases as you get older. You can calculate your likelihood of falling pregnant given your own age and some common lifestyle factors using our Pregnancy Predictor.

Myth #2: After being on The Pill for years, I will have lower levels of fertility

If you have been using oral contraceptive pill, IUDs or implants, you should wait for one natural period before you start trying for a baby. But using contraception over any period of time will not cause infertility.

Myth #3: Taking your temperature helps to work out when you ovulate

After ovulation the ovary produces progesterone and this causes a degree rise in basal body temperature, on average 3-4 days following ovulation. Taking your temperature to determine when you ovulate will only be helpful if you use it to look back over the last few months to work out when the earliest and latest ovulations occurred. Then we would recommend regular sex from 7 days prior to the earliest date of ovulation right through to the latest date of ovulation.

Myth #4: If my partner doesn’t ejaculate for a week, he’ll have more potent sperm

Sperm are made in the testes and then stored in the epididymis.  It is here that they are exposed to temperature, free radicals and toxins, so ideally the sperm should only spend 2-3 days here before ejaculation. Sperm can survive in the womb and fallopian tubes for up to 3 days, which is why we recommended having sex every couple of days within the woman’s fertile window to maximise your chance of falling pregnant.

Myth #5: I need to choose between seeing my complementary therapist or a doctor

Some people choose to see a naturopath, acupuncturist or Chinese herbalist to help boost their fertility. If this helps improve your mental and physical health then most doctors will agree that this is a positive step. However, ‘complementary’ by definition indicates that these therapies work best alongside medicine, and only Doctors can give more definitive analysis on basics such as ovarian reserve and semen quality. Particularly for women over the age of 35, it’s important to remember that time may not be on your side, so if you have been seeing a complementary therapist for longer than 6 months, it’s definitely worth also introducing a Fertility Specialist into the mix. Most Fertility Specialists will be understanding of your choice to see both.

If It Still Doesn’t Happen

Unfortunately, for about 20% of couples, they will need some help to get pregnant. But this doesn’t necessarily mean IVF. About half of my patients will get pregnant without the need for IVF because we can start with simpler treatments from ovulation cycle tracking through to ovulation induction and intrauterine insemination (IUI).

Not ready for a baby now but want to preserve your fertility?

If you’re in your early 30s and planning on having a family but it's not on the horizon before 35, you could consider freezing your eggs. The ideal situation would be to freeze 12 eggs before you turn 36. Research data from around the world suggests that women under 35 years of age who freeze their eggs have a better than 50 per cent chance of falling pregnant later in life. Advances in our vitrification freezing process mean that eggs can now be “snap frozen” in liquid nitrogen which preserves the quality of eggs for longer.
If you want some advice it’s important to ask a fertility expert so you can then explore your options.
Read more about Planning for Pregnancy:
Queensland Fertility Group, IVF Australia, Melbourne IVF 


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Conceiving in your 40s, what are the chances?

I was recently asked to comment in a Sun Herald article on 26th August (also published online here: Sydney Morning Herald) on Collette Dinnigan, who pregnant at the age of 46, has called on women not to leave it too long to try for a baby.

It is always news when a high profile personality such as Ms Dinnigan, has a child, particularly when the personality in question is a bit older.  The difficulty is that these occasions, while very happy for the people involved, give a misleading picture of the actual likelihood of conception in these circumstances.  Remember that high profile personalities such as Ms Dinnigan, are human beings who quite rightly value their privacy and so very rarely (quite understandably) talk to the press when things aren’t going so well.  It was therefore, a particularly courageous action of Ms Dinnigan, while celebrating her own happiness, to so publicly, point out the difficulties that may face other women, seeking the same fulfilment.

What then, are the issues for women in their forties who are planning to have a child?

The main difficulty is that conceiving is simply harder at that age and, even once a woman does conceive, the risk of miscarriage is higher.  Surprisingly, although we have very good data about the effects of age on IVF conception (more shortly), we don’t have very good statistics about the effects of age on conceiving naturally. The limited available data about natural conception comes from old population studies or studies of unique populations, such as the Hutterites of North America, who do not use contraception.  Interestingly these data, such as they are, seem to be entirely consistent with the more modern and abundant IVF data.  Generally, in one year of trying, 75% of women under 30 years and 66% of 35-year-old women but only 44% of 40-year-old women will achieve a live baby naturally.

The main explanation for this, is that women are born with a finite number of eggs, and from that moment onwards, the number of eggs is declining all the time, until women go through their menopause at around 50-51.  Nonetheless, women in their 40s do still ovulate each month.  What is it about their eggs that cause all these problems?

A common misunderstanding with some women is that the fact she looks and feels young, and leads a healthy lifestyle, means that her eggs will be healthier. I regularly see women who have taken enormous care with their fitness and their health.  The rest of their body is in great shape, completely fit and ready to carry that longed-for pregnancy.  Sadly, despite this, the eggs still can’t do it.  The effects of time are remorseless and, sadly, there is no wonder drug to fix it.

Scientists have shown that eggs from older women are more likely to have an abnormal makeup making pregnancy less likely, miscarriage more common and increasing the risk of Down Syndrome, a condition where a child is born with an extra chromosome number 21.

Nor is IVF a cure for this problem. For women, in their early 40s, IVF is still a good thing to try and gives significantly higher success rates than trying naturally.    However, IVF success rates fall sharply after the age of 40 and by the time a woman is 45 are close to zero.

So, what’s the good news?  Well despite all of the above, many women do conceive in their forties, either by IVF, or naturally, and have very happy healthy families.  It is obviously better to have your family earlier, if you can, but all hope is not lost, just because you’re past 40.  Conception and early miscarriage are the big problems but, if you do conceive and get past the first few weeks, by far the most likely outcome will be a healthy child.  While the risk of Down Syndrome is increased, most of the other problems that affect young children are not increased by being conceived a later maternal age.

Finally, many women worry that by having their children later, their long term health and emotional development may be affected.  On the contrary, we now know that the children of older mums grow up to be as healthy and bright as any other child.

Snapshot of Fertility in Australia

There have been a number of happy and high profile stories in the press recently about older celebrities giving birth to healthy children. Stories like this used to be extraordinary, but they certainly seem to be on the increase. While this trend is supported by data that shows the fertility rate and numbers of births are increasing for women over 30 and especially for women in their early 40s, women and couples should understand the risks associated with having children later in life.  IVF Australia, Melbourne IVF and Queensland Fertility Group, have teamed up to create their latest infographic - “Fertility and Age in Australia” which explores some of these issues.
 Fertility in Australia infographic

Paternity, Maternity, Equality

Conceiving a baby in a same sex relationship

IVFAustralia, and its partner clinics Melbourne IVF, Queensland Fertility Group and TasIVF, are proud supporters of ‘rainbow families’. IVFAustralia were an Official Supporter of Sydney’s Gay and Lesbian Mardi Gras this year, and we’ve seen the number of same sex couples accessing our donor program double in the last year.
In 2011, a survey of 3,835 LGBT people found 33% of women and 11% of men had children1 - but close to 40% reported wanting to have children or have more children. This so-called ‘gayby’ boom is thanks to changes in community attitudes and laws, including better access to Assisted Reproductive Treatments for lesbian and single women.
So, if you’re hoping to experience the joy of starting a family within a gay or lesbian relationship, what do you need to consider?

How long will it take to conceive?

Generally speaking, we’d expect a healthy woman with no fertility issues to fall pregnant through IVF or Artificial Insemination within six months. You can prepare for pregnancy by improving your diet, doing regular exercise and other lifestyle factors.
When you access the donor program there are a few extra decisions you need to make.
Do you choose a known donor, or an anonymous donor? In a lesbian relationship, do you want to implant an embryo with eggs from one mother into the other? Should you store some sperm from the same donor for later, in case you’d like a related sibling? For two dads, the process of finding a surrogate can also be complex.

How do we choose a donor?

Our fertility clinics offer access to both Australian and US* donor sperm. The access fee for US donor sperm is higher, but the waiting list is also shorter as there is a shortage of local donors (gay men, we’d love to hear from you!)
When you’re using donor sperm or eggs, there are a few legal, emotional and ethical factors to consider and a counsellor will help you work through these concerns so you can make the best decisions for your family’s future.

Are there any legal issues?

Each state has different laws about parental recognition and access, so it’s worth seeking specialist advice before you start.
For example, in Victoria, the Victorian Assisted Reproductive Treatment Act (2008) removed discrimination against lesbian and single women with regard to fertility treatment, recognised parenting status for non-birth mothers and also effectively legalised ‘altruistic’ surrogacy. It also recognises lesbian couples as equal parents of their child or children as long as they were in a de facto relationship.

What else should we be prepared for?

30 years of research2 has shown that the children of same-sex parented families do just as well as the children of heterosexual parents socially, educationally, physically and emotionally.

The issues your children will face as they get older are just the same as the issues facing any children conceived using donor sperm or eggs: Where did I come from? Should I contact my donor? You need to be prepared for these questions at some point.
In the meantime, we hope we can help you fulfil your dream of having a baby, and that you will experience the joys of pregnancy, birth and parenthood.

What should be my next steps?

If you would like to learn more about the fertility treatments available for same-sex couples in your regions, visit one of our websites. 

 * IVFAustralia and Queensland Fertility Group patients only.

1 Leonard et al. (2012) Private Lives 2: The Second National Survey of the Health and Wellbeing of GLBT Australians, The Australian Research Centre in Sex, Health and Society, Melbourne
2Rainbow Families Council of Victoria (2010) Rainbow Families and the Law, RFC, Melbourne, 

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