Is 2020 your baby year but struggling to conceive? Let’s discuss your fertility health

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. 

Interestingly, research from the ABS (Australian Bureau of Statistics) shows that in 2011 a record 12,800 babies were born to women in Australia over the age of 40 – an increase from 7,100 babies born ten years previously.

While this number continues to increase, it’s important to understand that evolution is still yet to catch up with the social realities of this day and age. While a woman’s likelihood of becoming a mother can be delayed due to career aspirations, or taking the time to find ‘the one’, we are still wired to breed in young adulthood.

As we get older, the chances of successfully conceiving decrease.

Studies show that by the time you reach 36, your likelihood of conceiving naturally is half that of a 20 year old. By the time you’re at the age of 41, your chances of natural conception have reduced to just 4%.

Why is this?

While a woman is born with 2 million eggs, these are the only eggs she will ever have. By the time she hits puberty that number has already dropped to 400,000. And as age progresses, the egg quantity and quality continues to decline.

Men are at less of a disadvantage when it comes to age and infertility, but should still be aware that there is a relationship between the two. The fact is, male factors contribute to over 40% of all infertility cases. While some of these issues can be lifestyle related, abnormalities and low counts caused by other issues can play a role, including age.

While we can’t stop or reverse the ageing process, there are positive steps both genders can take to boost fertility and a successful pregnancy.

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.

UK scientists will examine the effects of a Mediterranean diet rich in omega-3 fish oil and vitamin D on fertility for women and couples undergoing In Vitro Fertilisation (IVF).

Common sense would suggest that preconception health of both women and men could play a role in the Assisted Reproductive Technology (ART) treatment outcome. We all know that a healthy lifestyle and good nutrition influences the quality of egg and sperm in the preconception period, therefore increasing the chances of a successful pregnancy.

What is a Mediterranean diet?

The Mediterranean style diet is high in fruits, vegetables, fish, wholegrain, nuts and seeds. It is limited in red meat, dairy, alcohol and processed foods such as cakes and mayonnaise²

In 2010 a Dutch study showed that preconception Mediterranean style diet in couples undergoing ART treatment increases chances of achieving pregnancy by 40% ².

More evidence of Mediterranean diet’s benefits

Omega-3 fatty acids are derived from oily fish sources such as salmon, mackerel and sardines, nuts and seeds. Omega-3 serves as a precursor to different prostaglandins (PGs) that are important in the menstrual cycle, growth and development of eggs and initiation of the ovulation. PGs also play a role in fertilization of the embryo in the uterus.²

Vitamin D is derived from dietary oily fish and eggs. It appears to impact IVF outcomes by boosting levels of progesterone and estrogen, which regulates menstrual cycles improving the chance of conception.

You may be thinking what about men? Vitamin D also benefits semen quality and count in males. Additionally, it increases levels of testosterone, boosting libido. ³

Current guidelines suggest to prescreen all women before IVF. Optimal vitamin D levels are considered to be 75m/mol or above. We commonly prescribe vitamin D doses ranging from 1000-5000iu a day. Dosage recommended in infertility depends on the  blood levels. If you are very deficient it may be hard to obtain sufficient amounts of Vitamin D from the diet alone and supplements are highly recommended.⁴

But, do these positive results from dietary omega-3 and vitamin D, translate into positive results from supplementation?

The answer is we don’t know yet. Vitamins and minerals absorb more effectively from food sources. There are other co-factors in food that increase vitamin and nutrient activation in the body. Nevertheless, both omega-3 and vitamin D supplements have a low side effects profile and are safe before, during and after (breastfeeding stage) pregnancy.

One other likely benefit of the Mediterranean diet to fertility is its high vitamin B content. Vitamin B6 and B12, as well as Folate, is required to breakdown homocysteine, a naturally occurring amino acid found in blood plasma. Elevated levels of homocysteine are associated with adverse reproductive and pregnancy outcomes. This is why adequate intake of Folate, B6 and B12 is recommended for women who are trying to conceive either spontaneously or via IVF. In another blog I will discuss the significance of homocysteine pathway and its link to the quality of sperm and egg.²

What does this mean if you’re undergoing IVF?

Following a Mediterranean diet may increase your chances of achieving pregnancy through IVF. Omega-3 fatty acids and vitamin D play an important role though further research is still required to confirm this link.

Currently there are no specific guidelines on what constitutes a Mediterranean diet and optimal quantities of certain foods in order to make a routine recommendation. IVF patients may benefit from a nutrition assessment by a clinical dietitian or a naturopath who can review their dietary habits and develop a food plan.

In the case of Vitamin D, given the current prevalence of deficiency in sub-fertile women and men, and difficulty deriving enough from diet alone, supplementation alongside ART treatment may be recommended in most cases.

References: 1, Mediterranean diet trial targets IVF boost. The Australian. 25 Mar 2014. Available: [http://www.theaustralian.com.au/news/latest-news/mediterranean-diet-trial-targets-ivf-boost/story-fn3dxix6-1226864778849].  Accessed:  [27 Mar 2014]. 2, Vujkovic M, De Vries JH, Lindemans J, Macklon NS, Van Der Spek PJ, Steegers EA, Steegers-Theunissen PM. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the change of pregnancy. Fertility and sterility Vol. 94, No 6, November 2010. 3, Lerchbaum E, Obermayer-Pietsch B. Vitamin D and fertility – a systematic review. European Society of Endocrinology. 24 January 2012. 4, Australian Health Ministers’ Advisory Council. Clinical Practice guideline: Antenatal Care – Module 1. Australian Government Department of Health and Aging, Canberra. 31 August 2012. Available: [www.health.gov.au/antenatal]. Accessed: [27 Mar 2014].

Has following a Mediterranean diet worked for you?

Many people use complementary or alternative therapies to improve their overall physical and emotional health. Some women also consider using these therapies to prepare their body for pregnancy or support them through fertility treatment.

Why are women turning to Acupuncture while undergoing IVF?

Acupuncture has grown in popularity in Australia as an adjunct to IVF treatment and is claimed to reduce stress, improve the quality of life while you’re undertaking treatment, and stimulate blood flow to the uterus influencing menstrual cycle and ovulation.

Some limited studies have shown that acupuncture on the day of embryo transfer, within an IVF cycle, may improve implantation rates although it should also be borne in mind that some recent studies have not found acupuncture to be effective.

Background on the current study into IVF and Acupuncture

The clinics within the Virtus Health group, including IVFAustralia, Melbourne IVF and Queensland Fertility Group, are continually investing in research projects that seek to improve health and reproductive outcomes for patients. In some cases this involves working together with complementary therapists to maximise patient fertility. An example of this is the relationships that have been setup between acupuncture clinics in Sydney’s Eastern Suburbs and the Bondi Junction IVFAustralia clinic.

A current research project that IVFAustralia and Melbourne IVF are involved in is a national multi-centre randomised controlled acupuncture trial in conjunction with The University of Western Sydney. The purpose is to formally investigate the effectiveness, or not, of acupuncture in improving the proportion of live birth rates for women undergoing in vitro fertilisation (IVF).

What are the expected outcomes of this trial?

This study will determine the cost effectiveness of IVF with acupuncture, assess the personal and social context of acupuncture on IVF patients and identify other effects of acupuncture.

It will add significant knowledge to defining the exact role of acupuncture in the management of IVF from a clinical and cost effectiveness perspective. Any way that we can reduce the number of cycles it takes for our patients to achieve a healthy pregnancy, is likely to have a positive emotional and financial impact on that family.

However, regardless of the outcome of this trial, while improving your general health and wellbeing is clearly beneficial, acupuncture is not for everyone and varied opinions reflect the limited evidence on its effectiveness.

Who is eligible to take part?

We are currently recruiting IVF Australia and Melbourne IVF patients interested in taking part in the trial.

To participate you must: be less than 43 years of age, be undergoing a fresh IVF or Intracystoplasmic sperm injection (ICSI) cycle; and not be undergoing a pre-implantation genetic diagnosis (PGD) cycle.

Participants in the trial will receive their treatments on the day of embryo transfer – administered by experienced acupuncturists – at research partnered IVF units in clinics across Australia.

If you want to find out more or register for the trial, contact IVF Australia or Melbourne IVF.

Read more: Complementary Therapies for Pregnancy (NSW), Adjuvant Therapy & IVF Treatment (Melbourne), Complementary Therapies & Fertility (QLD)