Understand Your Fertility

Many different things can affect fertility

Age, weight, general health and past medical conditions can all impact fertility. However many couples will experience unexplained infertility, which though difficult to understand, can have good outcomes with fertility treatments.

The sooner you understand your own chances, the sooner you can have a healthy baby.

Being informed

Seeking information is one of the best things you can do – and if you need more clarity or are feeling worried for any reason, having an appointment with one of our fertility doctors is the best option.

We recommend the following areas as a good place to start when trying to understand your own fertility.

Age

Age is the most important factor when having a baby. Young women without fertility problems have a about a 25% chance per month of having a baby naturally if they try at the right time of the month. This falls to about 12% at age 37 and 5% at 42. Today, we are seeing more women over 40 wanting to have their first child. It is possible, but you are also more likely to need help. To work out your chances visit our biological clock – link to bio clock below.

Timing is everything in fertility

Waiting and continuing to try naturally for a bit longer may be an option for some people where the woman is younger, infertility is unexplained or only mild factors are found, and also when the length of infertility is quite short. Importantly trying naturally means continuing to have regular intercourse around 12-15 days prior to the next period, which is when ovulation occurs giving you the best opportunity.

Our advice is to continue to have regular intercourse. However if this hasn’t worked after a year then please see a fertility specialist to understand what is going on.

Get to know your cycle so you can get the timing right: If you have a 28 day cycle, the best days to conceive are days 11, 12 and 13 or you could just time sex when you notice slippery clear mucus.

Other health conditions

If you have other conditions such as polycystic ovaries or endometriosis it is also recommended you seek advice early to understand their potential impact on your chances.

FAQs & Fertility Language

Ovulation Induction
is a treatment to induce ovulation in women with irregular or absent cycles.

Intra-Uterine-Insemination
is when sperm is placed directly into the uterus

In Vitro Fertilisation
It strictly means adding sperm and egg together outside the body, but it is usually used to describe the entire process covering medications, egg collection, fertilisation, and embryo transfer.

Embryo Transfer
when the embryo(s) is transferred back into the uterus. SET Single Embryo Transfer – when only one embryo is transferred into the uterus at a time.

Frozen Embryo Transfer
Essentially the defrosting and replacement of an embryo that has been frozen and stored with us after a cycle of ivf . Also known as Thawed Embryo Replacement (TER).

Blastocyst
The name given to an embryo 5-6 days after fertilisation when it consists of an outer layer of cells that will become the placenta and an inner mass of cells that will become the baby.

Surgical Sperm Retrieval
when sperm are taken directly from the testes using a fine needle.

Insemination
Placing sperm into the cervix or uterus, or in IVF placing sperm with the eggs in culture conditions the laboratory

Ovulation
Release of the egg from the ovary. This usually occurs about 14 days before the next menstrual period

Infertility Explained

Infertility is usually defined as not becoming pregnant after a year of trying, but some couples know or suspect they are infertile well before a year is up.

For instance, the woman might have irregular periods or not ovulate at all. Studies from various European countries show 15 -20% of couples experience infertility some time in their reproductive life, so it is a very common problem. For many people infertility is not absolute. The chance of conception may be lower than normal, say only 1-5% a month, so it takes longer to get pregnant.

For some people infertility is absolute – there may be no sperm, or the woman’s fallopian tubes may be blocked. This used to be called sterility, but this is a misleading term because modern treatment gives most couples with absolute infertility a good chance of having a child.

Very broadly about half of infertility is male based and about half female based. Whatever the cause of the infertility is it is a couple’s problem and requires the couple to work together towards a solution.

Common causes of infertility

Women

Tubal problems
Endometriosis
Ovulation disorders
Polycystic ovaries
Recurrent miscarriage
Hormonal problems
Autoimmune (antibody) disorders

Men

The cause of most male infertility remains unknown. Known causes can include the following:

Failed vasectomy removal
Retrograde ejaculation
Blocked ducts
Absence of vas deferens
Undescended testes in childhood
Autoimmune (antibody) disorders

There are some simple tests that check ovulation and sperm quality that can provide reassurance to couples so that to either try a little longer before more intensive investigation or to quickly identify a problem.

A woman’s chance of conceiving each month falls with age, especially in the late 30s and early 40s, so age is an important factor to consider. In some cases you may be encouraged to wait a while before any invasive tests are performed, for example, if you have been trying for only a few months, the woman is under 35, and there is nothing to suggest an anatomical problem.

On the other hand, couples that may need longer to conceive because the woman is older, require earlier investigations because there is less time left for conception.

There are circumstances when earlier advice should be sought, such as:

lack of regular periods
known low sperm count
a previous operation to bring down a testis into the scrotum as a child
previous treatments for cancer in either partner.

Get to know your chance of having a baby

A typical fertile couple in their mid-to-late 20s having regular sex have about a 20-25% chance of conceiving each month. After 6 months at least three-quarters of such couples will be pregnant, and after a year at least 90%. Click here to work out your chances of having a child given the length of time you and your partner have been trying for and your age.

How hormones work

How age effects fertility

For women

The chance of pregnancy falls as a woman gets older, and the risk of miscarriage and abnormalities increases, even for people with no fertility problems. If you are having trouble becoming pregnant, the sooner you seek help, the better your chance of having a baby.

For men

While there’s no male equivalent to menopause, and the age of the mother is more important where fertility is concerned, the number of sperm made each day and their quality do fall with a man’s age.

Pregnancies from older men show higher incidences of some types of abnormalities among children – such as schizophrenia and autism. The total risk of a child having a serious birth defect (from the biological father, the mother, or newly arising in the child), increases from an average of 20 per 1000 children for men aged 20; to 26 per 1000 children for men aged 50.

A man’s age does not seem to affect the chance of success in fertility treatments such as IVF – at least up to the age of 50.

Nutrition and Lifestyle

Mediterranean-style diet

There is increasing evidence that a Mediterranean-style diet reduces the risk of having difficulty becoming pregnant and may improve the chance of pregnancy using treatment.

What is a Mediterranean-style diet? Lots of vegetables, fruit and vegetable oils, fish, poultry and lower fat dairy products are typical. While the relationship between diet and fertitily is still being studied, this sort of diet is healthy.

Eat breakfast, lunch and dinner every day

Don’t panic about your meals needing to be perfectly balanced – a piece of fruit, some yoghurt or a couple of bits of toast are all better than stopping at a cafe or getting takeaways.

Choose lots of wholegrain and high-fibre carbohydrate foods – these give us most of our daily energy requirements. Unless you have Coeliac disease, you do not need gluten-free foods (which are often expensive, low in fibre, and higher in unhealthy fats and sugars).

Eat plenty of fruit and vegetables

Most of our antioxidants and fibre come from fruit and vegetables, so start upping your intake. We recommend at least two handfuls of fruit and three handfuls of coloured vegetables per day.

Organically grown fruit and vegetables are not nutritionally superior to regular ones – just ensure you always wash them thoroughly.
Frozen vegetables are an excellent choice, and often much cheaper than buying fresh.
Choose plenty of colourful vegetables with main meals, as the vitamin C in these will help increase your iron absorption.
Despite what most people think, fruit juice is not a great drink choice, and should be limited to one glass a day or less. It contains the same high level of sugar as regular soft drink, cordial, and fruit-flavoured drinks, and none of the fibre of actual fruit.

Keep your calcium intake up

Dairy products are our main source of calcium, with low-fat milk varieties such as calci-trim/trim/reduced fat (lite blue) milk higher in calcium and protein than standard (blue) milk.

If you are lactose intolerant or avoiding cow’s milk for any reason, the best substitute is fortified soy milk. Rice and oat milks are less nutritionally balanced.

Greek and plain yoghurt can be quite high in saturated (unhealthy) fat; choose reduced fat yoghurt instead.

Lower your saturated (unhealthy) fat intake

Most of the saturated fat in our diets comes from meat fat, chicken skin, takeaways, pastry-based items, butter, high-fat dairy products and processed snack foods (e.g. baking, chips and chocolate). To lower your saturated fat intake, try reducing your consumption of these types of foods.

Unsaturated fats such as those found in nuts, seeds, avocado and oil are very good for us. Be warned though, they are very high in fat and will easily cause weight gain if portions aren’t kept small.

Avoid caffeine and alcohol

Coffee and alcohol are a big part of life in Malaysia, and making changes to your intake can be difficult.

Despite this, avoiding alcohol and limiting caffeine is important as these drinks have been shown to decrease fertility in both sexes in some studies. Many people wait until treatment before cutting back, but it is beneficial to start well in advance.

Common sources of caffeine are coffee, tea, green tea, cola and energy drinks.

Try using decaffeinated varieties of coffee, caffeine-free coffee substitutes, and herbal teas.

Water and low fat milk are the healthiest drinks.

Fertility Associates Dietician:

For a tailored nutritional programme to meet your fertility needs you can access our dietician Rachel.

You’re welcome to email Rachel and ask her a question regarding your lifestyle and current dietary habits. She can be contacted on xxx

Rachel also offers phone or Skype consultations for people who cannot make it to the clinic.

Take folic acid supplements

There’s no need to take nutritional supplements during or prior to treatment – you will get adequate amounts of vitamins and minerals from a varied diet, and these are more easily absorbed from food than pills.

The exception is folic acid; women need to be taking 800mcg/day of folic acid for at least a month prior to fertility treatment and for the first three months of pregnancy. Some women need higher levels of folic acid – your doctor will advise you if you need more.