For the one in six couples struggling to fall pregnant, several intertwined factors could be to blame.
A weighty issue
Gynaecologist Dr Bronwyn Devine is a Fertility Specialist at Monash IVF. “We take weight seriously,” she said. “In women, obesity is associated with increased risk of almost all pregnancy complications including miscarriage, stillbirth, gestational diabetes, and difficulty with labour and birth. Overweight women can also struggle to ovulate regularly without assistance.
“We need to be careful [advising about] rapid weight loss though...yoyo dieting can be detrimental to long-term reproductive health.” Weight loss should be achieved “sensibly and slowly” so that the weight stays off.
“However being underweight has significant effects on ovulation as well, and, if pregnancy is achieved, can be associated with growth restriction in the baby,” Devine acknowledged.
Men haven’t been let off the hook. “Obesity is associated with hormonal effects, inflammatory changes and oxidative stress, leading to low sperm counts, fragmentation of sperm DNA and other fertility issues,” Devine said.
“The effects of cigarettes, alcohol and recreational drugs on reproductive health are well known,” Devine said. “There is also increasing evidence that exposure to harmful substances in our everyday environment may be having long-reaching effects on our ability to reproduce.”
Plasticisers (substances that keep plastics flexible) have been linked to multiple adverse health effects, “including altered reproductive development and male fertility issues,” Devine said. Bisphenol A in hard plastics for example is an “endocrine (hormone) disrupting chemical that can have trans-generational effects on [egg and sperm development].” Her tip? “Don’t use plastic wrap or plastic containers when heating food in the microwave.”
What about stress?
The relationship between stress and infertility is complex, and the evidence around this is conflicting, Devine acknowledged. “But we do see that approaches such as mindfulness and acupuncture can work with stress reduction, and that pregnancy sometimes follows. [And sometimes,] after years of infertility and eventual success with assistance, couples then conceive another child or two spontaneously.”
An ‘all or nothing’ approach is another stressor. “I see a number of women who work hard, exercise vigorously and eat a restrictive diet,” Devine stated. “Their menstrual cycles are often irregular or they don’t cycle at all. They believe they are doing the right thing and so fertility should come easily.
“The opposite is often true. These women may need to gain a little weight and [address their stress] levels to improve their chances of a healthy pregnancy.”
Then there’s the stress of IVF. “We meet people who have faced years of infertility and watched their friends and family conceive easily, while they have suffered month after month of negative pregnancy tests,” Devine said. “A standard IVF cycle has a success rate of about 30-40 per cent, but factors [like the age of the person whose eggs are being fertilised will impact this.]
“At our fertility peak, natural intercourse has a maximum chance of pregnancy of about 25 per cent per month, so the IVF success rates need to be taken in context. Nevertheless, when a cycle is not successful, couples and singles do become quite despondent.
“We need to be aware of this, and ensure a whole IVF treatment team is there to provide support,” said Devine, who works alongside psychologists and counsellors. “A lot of those facing infertility are struggling and need to be able to voice this.”