What not to say when talking about infertility

Written by Dr Anne Coffey
03 Dec

 

As the Christmas and New Year period approaches, many people are planning gatherings of family and friends. The months ahead are some of the most carefree times in the year. For couples experiencing infertility however, these events can be more difficult.

 

Women and couples who are trying to conceive have to navigate a series of predictable questions. “So when are you going to have babies?” “When do I get some grandchildren?” and “Why aren’t you drinking, are you pregnant?”. The couple may have been trying for years and maybe desperately want children but not want to speak about it. There are also predictable scenarios. The “super fertile” sister with a large tribe of kids who is full of advice “you should try eating kale”. The pregnant cousin who loudly complains about how hard pregnancy is. Spending time around babies and pregnant women can be confronting and can be even more difficult after experiences such as miscarriage. In addition, they will usually be subjected to well-meaning advice such as “just relax it will happen”.

 

In my job as a fertility specialist, I frequently speak with people about the advice they receive about their fertility:

  • “Just relax and it will happen”
  • “Just get really drunk”
  • “You are too stressed”
  • “Stop thinking about it”
  • “Take a holiday and you will get pregnant”

 

Many people who are treated for infertility have complex problems with the production of eggs or sperm. A number of these people were born with these issues. A good way to understand this is to think about someone born with kidney or lung that does not function normally. These complex issues are not going to be cured by relaxing or taking a holiday. I tell my patients that if relaxing was the solution, then I would be managing a day spa. A fertility clinic such as the one I work with requires a highly advanced embryology laboratory to overcome the challenges of some forms of medical infertility. Keep in mind that there are many causes of medical infertility and there is no single simple solution to all of these problems.

 

The relationship between stress and fertility has been studied in many scientific studies. There is insufficient evidence to demonstrate that stress independently causes infertility. When someone says “just relax”, it can create feelings of guilt, that the woman is to blame for the fertility issue. This common and well-meaning piece of advice can be a source of distress and added pressure.

 

Couples dealing with infertility should not lose hope. Even after long periods of trying to conceive, many couples are able to conceive naturally. There are ways to support and assist natural fertility. Medical infertility can make it harder to conceive but not impossible.

 

So next time you are spending time with someone who is experiencing infertility, avoid the temptation to offer advice. The truth is, they have probably read and tried everything already. Let them know that you care, offer a hug – sometimes it helps just to listen.

 

Have a great summer.

 

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There’s a sperm donor shortage in Australia – but only 20% of men know about it

The leading fertility clinics in the Virtus Health group, including IVF Australia, Melbourne IVF and Queensland Fertility Group, have joined forces to research sperm donation in Australia

What did we find out about Sperm Donation?

Only 20% of men are aware that there is a shortage of sperm donors in this country.
 
While the majority of Australians are aware of the need for blood and organ donation, the requirement for sperm donors is largely unknown.
 
Used by patients as either part of an In-Vitro Fertilisation (IVF) cycle, or via Intrauterine Insemination (IUI), donor sperm can help overcome male factor infertility (15%), or help same-sex couples (35%) and single women (50%) have a child.

What are the common motivations for donation?

The same research also discovered that the common reasons for wanting to donate sperm included:

  • Helping others to have a family (38%)
  • Knowing other people going through fertility treatment (24%)
  • Knowing my sperm count and quality could be assessed at donation (20%)
  • Everyone deserves to be a parent if they want to be (18%)

Sperm donors in Australia can be known to the recipient or recruited via the clinic. Many couples and individuals choose their sperm donor through a clinic, as knowing the demographic profile of the donor but not their identity is a preferred option. In these cases, children of sperm donors are able to access their biological father’s details when they are 18 years old.
 
While Australians cannot be paid for their sperm (like blood or organ donation) most clinics reimburse donors for legitimate expenses. Sperm donors in Australia are typically aged 25-50, with or without their own families, and of any sexual orientation.

Would you or someone you know now consider sperm donation?

After seeing the results of this research, we want to raise awareness of the need for more sperm donors in Australia. If it is something that you would consider talk to your local clinic for more information.

Sperm Donation in Australia Infographic

Click to Enlarge:

Sperm Donation in Australia infographic thumbnail

 

* Research conducted by Woolcott Research in March 2012. 
Dr Anne Coffey
03 Dec

Mediterranean diet – can it influence IVF results?

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?

Dr Anne Coffey
03 Dec

Current study: Can acupuncture support IVF treatment?

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)

Dr Anne Coffey
03 Dec

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