Fertility

Planning to start a family can be approached many different ways. Sometimes you need the expertise of a fertility specialist or fertility clinic to assist with your decisions.

Planning Pregnancy?

If you are planning to start a family, here are some tips that may help you:

  • It is very important to be as healthy as you can be before pregnancy. This will help you to conceive and will ensure baby has the best start possible. Cutting out cigarettes and alcohol, taking folate supplements and being in a healthy weight range are an excellent start.
  • Ovulation occurs 14 days before the first day of your period. Therefore the window for fertilisation should be between day 10 and 18, and intercourse every other day around this period should give you the best chance at conceiving.
  • Chlamydia can affect the fertility by blocking the tubes. So it is important to have safe sex practices.
  • Also another factor that could affect fertility is Endometriosis. Timely diagnosis and treatment can improve the outcome. If you have painful period or painful intercourse it’s advisable to have referral to the gynaecologist through your GP.
  • If there is sudden gain in weight, then it is important to see your GP to exclude hormonal problems. PCOS is another common cause of infertility. Also, if you have irregular cycles or unwanted hair growth, it is advisable to organise referral to gynaecologist through your GP.
  • If you are 30 year old and have not conceived within 6-12 months of trying, it is time to see your GP to look into any possible fertility problems you or your partner may have. By 35 it is a good idea to see your doctor after 6 months of trying, as if you need IVF or other fertility treatments it is best to start as soon as possible to optimise the chance of pregnancy

As always, if you feel you need more advice then do not hesitate to talk to your GP.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (or PCOS) is a common hormonal disorder among women of reproductive age. It can affect you from adolescence into older age and can express itself in different ways.

What are the symptoms of Polycystic Ovarian Syndrome?

In adolescence, absence or infrequent menstruation may be a single sign associated with increase in weight and excessive hair growth. In women beyond adolescence, it can express itself as an irregular periods, leading to pregnancy delays, unexplained weight gain or loss.

Causes

  • Large ovaries containing numerous small cysts – This can be detected by ultrasound.
  • Excessive insulin causes insulin resistance, so the pancreas has to produce more insulin, increasing the production of androgen, therefore leading to acne, excessive hair growth and weight gain.
  • Excessive androgen can cause male pattern hair growth and acne; it also causes irregular periods that can lead to infertility.

What are the health risks for women with PCOS?

PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences. For example, insulin resistance increases the risk of type 2 diabetes mellitus and cardiovascular disease.

Women with PCOS may have endometrial hyperplasia – when the lining of the uterus becomes too thick. This condition increases the risk of endometrial cancer.

Other complications are:

  • A higher risk of obesity
  • A higher blood pressure
  • High cholesterol and lipids
  • Obstructive sleep apnoea
  • Heart attack and stroke
  • Abnormal uterine bleeding
  • Gestational diabetes and diabetes mellitus
  • Sub-fertility

Tests and diagnosis

To test for PCOS, a thorough medical history check is the first step. A physical examination including pelvic examination, blood tests for androgen/insulin levels, blood sugar levels, lipid profile and a pelvic ultrasound looking for pearl necklace appearance of the ovaries, are primarily used in diagnosis for PCOS.

Polycystic ovarian syndrome treatments

  • Life style changes – a 5% reduction in body mass may help a woman to ovulate. Consider dietary changes and increase exercise, which can lower your blood sugar levels.
  • Medication – Oral contraceptive pills are used to regulate the periods and to prevent increase in the thickness of endometrial lining.
    • Clomid and Metformin can induce ovulation if the problem is infertility.
    • Spironolactone or oral contraceptive pills can decrease androgen production, therefore reduces excessive hair growth and acne.
  • Surgery – Laparoscopic ovarian drilling can reduce androgen formation.

Reproductive Strategies

There are reproductive strategies that couples try in order to increase their chances of becoming pregnant. The strategies include:

  • Adopt a healthy lifestyle – If you do not already eat healthy and exercise, start doing so. Replace junk foods, alcohol, caffeine and recreational drugs with foods that have high nutrients and are baby friendly. The best exercise is walking for 30 minutes, 5 times a week. Cease any smoking habits as it decreases fertility as well as oestrogen levels and ovulation.
  • Have regular sexual intercourse – Having sex on a regular basis increases chances of conceiving a baby.
  • Become familiar with your menstrual cycle – Women with regular 28-day cycles are able to predict their ovulation date by counting 14 days from the day their period should begin. Women with irregular cycles require ovulation kits to predict their most fertile period.
  • Have sexual intercourse before you ovulate – According to Clarice Weinberg, Ph.D., pregnancy rates peak a few days before a woman ovulates. Therefore it is suggested to have sexual intercourse on the day that you feel a hormonal surge as well as the following two days.
  • It is advised that women have dental exams before, during and after pregnancy due to fluctuating hormone levels turning small dental issues into major dental concerns. Oral infections have been associated with low-birthweight or premature babies. Prenatal check-ups are important for preventing potential health problems you and your baby may face while going through pregnancy. These include:
    • Collection of medical history
    • Blood pressure measurement
    • Pelvic examination
    • Blood and urine tests
    • Height and weight measurement
    • Doppler foetal heart rate monitoring
    • Discussion with caregiver
    • Ultrasounds (more common in the second trimester onwards
  • Your partner – Their lifestyle effects their fertility and chances of providing sufficient sperm that can fertilise your egg(s). Your partner should adopt a healthy lifestyle in order to have better quality sperm.
  • For women with irregular, unpredictable cycles, there are medications for correcting your cycle in order for you to predict when you may ovulate. After 10 days of taking this medication a blood test is taken and after 12 days, an ultrasound is conducted to see how many follicles have developed. If you develop a follicle or follicles, there is a high chance that you will fall pregnant.
  • Anti-Muellarian Hormone (AMH) blood test – This test can give insight into your egg reserve, to see how many eggs are left and how many fertile years you have left, however the test cannot give an indication on the quality of the eggs. This test can you help you decide whether you are eligible for artificial reproductive technology (ART).

Ectopic Pregnancy

Ectopic pregnancies occur outside of the uterus. They commonly implant in the fallopian tubes which is potentially life threatening. Less than 2% of all pregnancies are ectopic. Normal growth and development of the foetus cannot proceed in an ectopic pregnancy.

Signs and symptoms to take note of include:

  • Vaginal bleeding, most commonly light or spotty, accompanied by cramping, abdominal or pelvic pain.
  • Any pain that accompanies nausea and vomiting, as well as dizziness or fatigue. If the fallopian tube ruptures, it can cause sudden and severe pain in the abdomen and the internal bleeding.
  • Light internal bleeding can cause nerve irritation which can lead to pain in other parts of the body, most commonly in the right shoulder.
  • Extensive bleeding in the abdomen can cause an increased heart rate, lightheadedness, fainting and shock.

Causes

Most of the time no cause is found. Normally conception happens in the fallopian tube and later the pregnancy travels down to and implants in the uterine cavity. Anything which delays this process can lead to an ectopic pregnancy.

Diagnosis of ectopic pregnancy is made with an ultrasound.

Risk Factors

Women are at an increased risk of ectopic pregnancy if they have:

  • previously had ectopic pregnancies are more likely to have another as their chance of having another ectopic pregnancy is increased by ten-fold.
  • inflamed or damaged uterine tubes or an infected uterus, uterine tube or ovary, usually due to diseases such as gonorrhea or chlamydia, or history of pelvic inflammatory diseases.
  • fertility issues
  • had invitro fertilisation (IVF)
  • fell pregnant with an intrauterine device or have previously had tubal device
  • become pregnant after using an emergency contraception (morning after pill)

Treatments

Laparoscopic surgery is usually required for an ectopic pregnancy. Many women need a salpingectomy (removal of a fallopian tube). In some cases, a ‘wait and watch’ management plan can be utilised as some ectopic pregnancies can resolve spontaneously. Occasionally an injection of methotrexate is used in treatment of ectopic pregnancy.