When it comes to falling pregnant, the common and overriding narrative women are fed is that age is the biggest barrier to fertility. We’re hit with many gags about the body clock and the tick-ticking of its hands, but how accurate is the assumption one of the only things stopping us falling pregnant is the speed at which we decide to do so?
According to Dr Anne Poliness of City Fertility Centre in Melbourne, infertility is by no means an uncommon issue facing women today.
“We generally find one in six women don’t conceive within the first six-12 months of trying. In our human population, the majority should have conceived within a year, assuming they’re having regular intercourse without contraception,” she says.
Dr. Poliness tells Mamamia there are six key reasons women aren’t able to immediately fall pregnant. And although age is the most common, it’s certainly not the only one be wary of.
Polycystic Ovary Syndrome
Dr. Poliness says one key cause of infertility is PCOS, where the ovaries secrete relatively high amounts of testosterone that often cause problems with ovulation. Women with PCOS have enlarged ovaries that contain multiple small cysts.
She says women with PCOS don’t “necessarily” have to be on some form of hormone suppressants (for example, the Pill) and that a decision to go on hormone suppressants can come when considering how regular – or irregular- periods are.
“For women with PCOS the main issue is how frequent the periods are. If someone has a cycle every four or five weeks, it’s not always necessary to be on hormone suppressants. However, if the cycles are every three or six weeks it might be necessary,” she says.
Doing so has the intention of keeping the period, and period of ovulation, more regular.
She adds that ovulation may also be induced with a medication called clomiphene. Up to 80 per cent of women using clomiphene will have success in ovulating, resulting in pregnancy rates comparable to that of the general population. Otherwise, in vitro fertilisation (IVF) is another option for women who cannot conceive after other options haven’t worked.
Finally, she says, obesity is often a common factor in women with PCOS. As such, there’s the possibility that you can increase the rate of ovulation if you monitor diet and exercise for weight loss (if required).
Dr. Poliness says Endometriosis may be another cause of infertility. However, she says, your likelihood of conceiving isn’t directly linked to how severe your endometriosis is.
“It doesn’t have to be severe endo to change the body parts that make it hard to conceive,” she says.
For example, if the endometriosis is on the ovaries, tubes or even behind the uterus, it may be difficult to conceive naturally. A laparoscopy to remove endometriosis can improve the chances of natural conception.
Deb Knight did 14 rounds of IVF and then had a baby naturally. Post continues after audio.
“Endo should be the considered a condition you want to dampen down from returning so hormone suppression should be continued, even after surgery,” she says.
However, if a laparoscopy has not resulted in a pregnancy, Dr. Poliness says fertility treatments such as Intra-Uterine Insemination (IUI) or IVF can be considered because IVF treatment can “bypass damaged or blocked tubes”.
Blocked fallopian tubes
When fallopian tubes are blocked, the egg can be prevented from meeting the sperm. According to Dr. Poliness, it is often caused by either endometriosis or previous pelvic infections.
Therefore, surgery to remove external scarring might be necessary to unblock the tubes. If this is not possible, IVF treatment that can bypass damaged or blocked tubes could be a good option.
Dr. Poliness believes many of the health issues that cause infertility, endometriosis, have genetic components, saying it’s a “mixture of environment and your pre-disposition”.
Irregular menstrual cycles may lead to a problem with ovulation, although not always dangerous. However, it might be important to uncover the cause of the irregularity.
For those who are looking for treatment of irregular cycles are making you struggle to regularly ovulate, Dr. Poliness suggests the use of medication like that of Clomid or follicle stimulating hormone.
As many of us are well aware, our chances of conceiving decline the older we get. Dr. Poliness believes conception rates for normal healthy couples are, at best, 20-25 per cent per menstrual cycle. By age 40, it is estimated a woman's natural conception rate is in the range of 5-8 per cent per month for the first 6 months.
And by the age of 43, the pregnancy rate is thought to be as low as 1-3 per cent per month.
So what can you do? And how do you know when you might need help?
It's recommended that those under 35 who have been trying to fall pregnant to no avail for 12 months should seek help from a fertility specialist, while those over 35 who have been trying to fall pregnant for six months should also seek help.
Fibroids are non-cancerous masses found in the uterus or cervix. Fibroids’ impact on fertility depends upon their size and location and most fibroids do not need surgery. Dr. Poliness says it's important to note that not all gynecologists would agree whether fibroids conclusively cause infertility, but that it's useful understanding what they are the damage they cause.
After all, if it is cause for concern, there is a small risk that the uterus may have to be removed. Surgery is not always necessary, but if it is, the pros and cons of surgery on the uterus should always be carefully considered.