We need to talk about infertility

Written by Dr Joseph Sgroi
25 Sep

It’s time to ditch the stigma on something that affects one in six couples.
 

 

At a glance:

  • 15 per cent of couples have difficulty conceiving, with most cases able to be helped by some form of fertility treatment like simple investigation, ovulation induction or more complex fertility treatments
  • Infertility can be caused by a range of issues, including irregular ovulation, badly timed sex, poor sperm quality and abnormalities of the uterus
  • If you’re over the age of 35 and have been struggling to conceive for six months, it’s a good idea to see your GP or a fertility specialist
  • Seeing a fertility specialist doesn’t necessarily lead to IVF, with a host of other treatments often offered before IVF is necessary

From the amount of pregnancy announcements on social media, you’d think conceiving a baby was as simple as doing the deed, peeing on a stick and posting a carefully curated ultrasound picture. Yet with 70,000 IVF treatment cycles performed in Australia and New Zealand each year, this perception is far from reality. So, why aren’t we talking about it? 

Melbourne-based obstetrician, gynaecologist and fertility specialist Dr Joseph Sgroi says it stems from our deep-rooted discomfort around talking about sex and intimacy. “We often feel fear and embarrassment when talking about things that should come quite naturally,” he says. “For a lot of couples anything to do with that whole spectrum – ectopic pregnancies and miscarriages for example – are sensitive topics that are not often discussed.”

Which is a shame, considering that with the odds of a fertile couple conceiving each month only one in five, so many of us are in the same – often isolating – boat.

Identifying the cause

The good news is that with so many different treatment options available, even with unexplained infertility, seeking out treatment is often the key to success when it comes to conception. If you’re under 35, Dr Sgroi says it’s OK to wait 12 months before seeking the advice of a general practitioner or fertility specialist. However if you’re over the age of 35 – when a woman’s fertility experiences a significant decline – it’s best not to leave it for more than six months.  

Dr Sgroi talks to his patients about six things that can impact fertility:

  • Sex: “It’s very common for people to not know when to have sex during the menstrual cycle. Having regular sex is particularly important – we recommend 3 times a week during the fertile part of the month.”
  • Sperm: “We like to take a look at the swimmers and make sure they’re indeed swimming; you need good numbers to fertilise the egg.”
  • A receptive uterus: “If the uterus has a structural abnormality – endometriosis or fibroids for example – it can impact a woman’s ability to carry a pregnancy.”
  • Ovulation: “Some women don’t ovulate regularly, such as women who might have PCOS [polycystic ovary syndrome].”
  • Open tubes: “If you’ve had things like chlamydia or sexually transmitted infections in the past – and your tubes are blocked – there is no chance of pregnancy, as the sperm can’t meet the egg!”
  • Patience: “I’ve had people come and see me after only two months of trying and I say, ‘It may take a little bit of time!’.”

IVF isn’t always the answer

For a fertility specialist like Dr Sgroi, it’s about looking for clearly identifiable and reversible obstacles and treating them individually, with not all cases requiring the assistance of IVF technologies. “A lot of people come to a fertility or IVF doctor thinking that they’re going to do IVF,” explains Dr Sgroi. “But for a woman not ovulating it could be as simple as giving her a tablet to take as oral medication.”

Less-invasive assisted interventions like cycle tracking, better timed-sex, oral medications, ovulation scans and ovulation inductions may be offered before any attempt at an IVF cycle. “And for same sex-couples and single women, the only thing we may be doing is artificial insemination,” Sgroi adds. 

The most important thing to note? Every fertility journey is different. And remember - your Instagram feed isn’t real life. 

 

References

https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20reproductive%20technology%20in%20Australia%20and%20New%20Zealand%202014_0.pdf http://theconversation.com/women-now-have-clearer-statistics-on-whether-ivf-is-likely-to-work-81256)

https://www.fertilitysociety.com.au/

https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/infertility-in-women

https://yourfertility.org.au/for-women/not-getting-pregnant/

https://www.ivf.com.au/fertility-treatment 

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