HealthAgenda

Pregnancy & Birth

Infertility and its challenges

When to check in with your doctor if your baby-making isn't going to plan and what to expect in the months ahead.

Karen Burge 
July 2018

Tracey Porter had a gut-feeling something wasn’t quite right. After trying for a baby on and off for more than 2 years, she knew it was time to see her GP.

After a further 9 months of concerted effort, and a second medical opinion, Tracey and her husband Matthew were referred to a fertility clinic.

“In our case it was found that I had an extremely low ovarian reserve and, at aged 35, was only around 3 years from menopause,” she explains. “Because my levels were so dire, we started the IVF process less than a week after I got the results from my fertility specialist.”

One in 6 couples experience infertility, which is an inability to conceive after a year of unprotected sex, or the inability to carry pregnancies through to a healthy delivery. There are many reasons why a couple can’t fall pregnant, and in most cases a physical problem can be diagnosed.

When to seek help

The Royal Australian College of General Practitioners (RACGP) recommends a visit to your GP at any stage for tailored advice. But as a rule of thumb, women in their early 30s or younger can wait 12–18 months and women in their mid 30s or older should be seen at the 6–9 month-mark.

Dr Wendy Burton, Chair of the RACGP Antenatal and Postnatal Care Network, says you can expect your GP to take a good history (sometimes couples just don’t get their timing right) and examine you. They may also organise tests including:

  • pelvic ultrasound
  • ovulation confirmation
  • sperm count. 

If necessary, they may refer you to a specialist.

Seeing a specialist

In vitro fertilisation (IVF) expert and author, Dr Raphael Kuhn, says there can be a number of reasons why couples aren’t conceiving.

To get a clearer picture, your specialist will take a thorough medical, surgical and sexual history, do a physical examination and perhaps more targeted screening.

Identifying the problem

In 25% of cases the cause relates to male factors, such as very poor-quality sperm or, uncommonly, no sperm at all.

Another 25% of cases are down to female factors, such as age, anovulation (not ovulating, which can be associated with polycystic ovarian syndrome), pelvic Inflammatory disease and endometriosis, explains Dr Kuhn.

“Age is a very important factor because there’s an ever-increasing proportion of chromosomally abnormal eggs after the age of 30. These eggs will either not fertilise, not fertilise normally, or if they do fertilise, the embryos will not fully develop,” he adds.

In a further 30% of cases, it’s a combination of male and female factors, and in the final 20%, the cause is unexplained (idiopathic), Dr Kuhn says.

Treatment

There are various treatment options your specialist might consider, if appropriate:

  • Lifestyle and weight improvement: such as healthy eating, quitting smoking and alcohol, losing any excess weight and moderate physical activity.
  • Ovulation induction: using tablets or hormone injections if you’re not ovulating naturally.
  • Intra-Uterine Insemination (IUI): sperm is deposited into the uterus around the time of ovulation.
  • Surgery: in cases of endometriosis or pelvic adhesions (scarring).
  • IVF: sperm and unfertilised eggs are placed together (in a laboratory), a fertilised egg (embryo) is then transferred into the uterus.

Assisted reproductive technologies (ARTs) are interventions that involve medical technology, such as IVF and IUI. A report in the Medical Journal of Australia (MJA) showed almost 70,000 ART cycles are performed each year in Australia and New Zealand. In 2014 they resulted in the births of 12,875 babies – 1 in 25 children born in Australia.

Success data

Success can be viewed in different ways and can often be hard to compare. Dr Kuhn says the average live birth rate per cycle, from fresh or frozen embryo transfer, is on average just above 20%. However, this figure is very age dependent.

“If a woman is between 30 and 34 years of age, the likelihood of her taking a baby home as a result of her first cycle is 40%, but only 10% if she is between 40 and 44 years of age.”

To get a better understanding of how successful couples and individuals were over time following repeated cycles of ART, researchers have examined ‘cumulative live birth rates’ (CLBRs).

In the MJA report, it found that for women who started ART treatment before they were 30, the CLBR for the first complete cycle was 43.7%, rising to 92.8% for the seventh cycle. For women aged 40–44 when starting treatment, the CLBR was 10.7% for the first complete cycle, rising to 37.9% for the eighth cycle.

The authors noted that women discontinue ART treatment for a number of reasons, but mainly because of the psychological and physical demands of treatment, and its costs.

Emotional wellbeing

Tracey, who lives on the NSW Central Coast, says the impact of her IVF treatment was greater than she first imagined.

“There’s no such thing as an easy IVF ride. I never got immune to it – each failure cuts a little deeper until you realise you barely have any hope left. And yet, you have to have faith. IVF is a huge physical, emotional and financial commitment and there’s no point in even riding the roller coaster if you don’t believe (on some level at least) it’ll have a successful outcome,” she recalls.

The Victorian Assisted Reproductive Treatment Authority explains that women can often experience depression and anxiety during IVF, particularly when waiting for results and if treatment fails. Deciding whether to continue or cease treatment can also be difficult.

If you’re going through an emotionally difficult time, reach out to the support services around you, including IVF clinic counsellors, online support services (such as Access Australia or beyondblue) your team of medical professionals or local psychology/counselling services.

For Tracey and Matthew, there was light at the end of the tunnel. After 4 rounds of IVF the final 2 embryos they had available took hold and Tracey gave birth to a healthy set of twins, now aged 6.

If you need to talk to someone, contact beyondblue on 1300 22 4636. Alternatively, contact The National Perinatal Anxiety & Depression Helpline from 9am-7.30pm AEST/AEDT on 1300 726 306.

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