When it comes to infertility, myths and misperceptions abound, and one of these is that any failure or delay to conceive is most likely because of a health issue with the woman.
That simply isn’t the case, says Dr Bart Kuzcera of Beacon Care Fertility. It takes two to make a baby and in cases where there is a problem with conceiving, roughly 40 per cent will be as a result of female infertility, 40 per cent will be due to a male infertility issue, and about 20 per cent will go unexplained.
Fertility in humans can be quite hard to explain says Kuczera. “Women don’t present with obvious signs of ovulation and we don’t have mating season like animals do. The only way to know if you can get pregnant is to begin trying to conceive.”
According to Dr Marta Moschetta, fertility specialist at Sims IVF, there has always been a misconception that fertility issues are women’s issues. “But I think this is diminishing now,” she said.
“For example, we now know that sperm ages, and that is why a DNA fragmentation test is recommended in men over 40 with a history of infertility or miscarriage. DNA fragmentation is damage to the DNA of sperm and its risk increases with age. Other lifestyle factors can influence DNA fragmentation such as smoking and obesity.”
What is different is that male infertility can be more straightforward in terms of investigation, Kuczera explains. “Male fertility is not as affected by age as much as the women, but generally speaking we do believe that female infertility is driven by age. Males will most likely have some inborn problems, such as undescended testicles or perhaps cystic fibrosis. It may also result from an acquired infection.”
When it comes to sperm, the issue is not just quantity but quality. Kuczera echoes Moschetta when he says that an abnormal semen analysis may be unexplained, but it can also be due to obvious lifestyle factors. A recent research paper was able to highlight stark differences between men who enjoy Western lifestyles (obesity, alcohol intake and smoking) and those living elsewhere, Kuczera explains.
“Overall, men in the Western world had much poorer sperm quality than those living in other parts of the world and we know that men nowadays have poorer sperm quality than three generations ago. We advise men to lose weight and quit smoking and reduce alcohol. Extreme exercise can also hamper sperm quality. That is the impact of environment and lifestyle on male fertility, but we know that this hasn’t had the same impact on women.”
‘Noticeable difference’
Changes in lifestyle can make a "noticeable difference" to male sperm quality, says Dr Tim Dineen, laboratory manager at Waterstone Clinic. Dineen says he and his colleagues in the fertility sector have noted an increasingly common trend of men who are avid gym-goers, who are taking testosterone and anabolic steroids to pursue the perfect look.
“These men attend the clinic and discover there is no viable sperm in their samples. This lifestyle choice has a completely detrimental effect on fertility, on virility,” he explains.
The good news is that it is reversible; “if they stop taking all supplements and chemicals and allow their body six months or so to recover, they generally return to producing sperm,” Dineen says.
But when it comes to women, investigating any potential fertility issues can be far more complex. Younger women struggling to conceive may be suffering from ovulatory disorders such as polycystic ovary syndrome or tubal disease, whereas for women in their late 30s and beyond, it is most likely due to diminishing egg quality or number. Women are now having babies later than ever, and first-time mothers in Ireland are among the oldest in the European Union. “There is a progressive decline in fertility which also can overlap with modern lifestyle issues,” Kuczera says.
Even for women with endometriosis – a condition where the tissue that typically lines the womb (endometrium) grows outside it instead – this can be progressive in nature and thus any subsequent impact on fertility can be compounded by advancing age and decreasing egg quality, he adds.
“The longer it lasts, the more damage it can do to the tubes and the ovaries, so as time goes by those women are less fertile.”
According to Moschetta, female age is a “huge contributor” to fertility and success rates with advanced reproduction techniques. She says that women’s fertility typically peaks at around at the age of 30. “At age 34 it will start to decrease. It does not mean women can’t get pregnant at 38, there are plenty that do. However, chances are lower, and it might take time to conceive,” she explains.
Kuczera agrees. “By the age of 35, one in 10 formerly fertile women are no longer fertile and by age 40 it is one in three. Women aren’t always aware of these statistics when they are planning their families.”
While it is important to maintain a healthy lifestyle while trying to conceive, its relevance is the same regardless of the woman’s age, Moschetta adds.
“If you are trying to conceive, the female should be taking folic acid 400mcg as a minimum. A good preconception supplement can be of value. Both partners should maintain a healthy lifestyle, e.g., keeping alcohol and caffeine to a minimum, no smoking, good diet and exercise. Couples should have sexual intercourse every two to four days to ensure that they capture ovulation,” she advises.
Making the decision to try to conceive can bring some apprehension, Moschetta adds and she advises couples not to let the pressure get to them. “Some key things should be remembered but above all, we would tell couples to enjoy the trying and not to be too caught up in time of cycle, etc. Do your best to maintain a positive mind set. If you are still struggling to get pregnant after six to 12 months, then it would be a good idea to get some tests done.”
Five trends in fertility treatment
It’s over 40 years since the first “test-tube baby” was born. Since then, fertility treatment has advanced dramatically, with new technologies, medications, and testing strategies ensuring the highest possible chance of success.
1. Embryo freezing: IVF treatment has been transformed by advances in embryo freezing, meaning patients can feasibly complete their entire family from just one round of IVF. While a decade ago just 5 per cent of the babies born each year were from frozen embryo transfers, nowadays that’s more like 40 per cent, with success rates for fresh and frozen embryos on a par.
2. Time-lapse technology: Many clinics now offer time-lapse technology, which facilitates continuous monitoring of your embryos while they are in the incubator. This allows embryologists observe key features of embryo development and means they can select the embryos that they believe are more likely to result in pregnancy. Fertility experts say it may also aid in identifying why treatment may not be succeeding.
3. Genetic screening: Pre-implantation genetic diagnosis (PIGD) and pre-implantation genetic screening (PGS) has been available for a number of years but techniques are increasingly sophisticated. Originally introduced to allow screening for genetic disorders such as cystic fibrosis, genetic analysis is performed on embryos at day five of development to ensure there is a normal number of chromosomes. Recent studies suggest PIGD can improve clinical pregnancy rates and decease miscarriage rates although more trials are needed, say experts.
4. Egg freezing: Egg freezing is becoming increasingly popular as women defer pregnancy until they are older. Originally developed to assist cancer patients in preserving their fertility, which could be impacted by chemotherapy, it involved freezing their eggs prior to treatment with the hope of conceiving a baby at a later stage. However, clinics say there is an increasing trend among women to defer having a baby for financial, career and relationship reasons and thus egg freezing is viewed as an “insurance policy”.
5. No more multiple births: While twins and even triplets were once a hallmark of IVF-assisted births as several embryos were transferred in the hope of success, multiple pregnancies are now regarded as one of the main avoidable risks of IVF. Experts have learned that implanting more than one embryo has no significant impact on the chance of live birth and multiple pregnancies now account for less than 10 per cent of all births from assisted reproduction.