Thursday 23 May 2019

10 things affecting your chances of conception

With nearly one-in-six couples in Ireland now experiencing infertility, our reporter talks to four experts on the conditions that can impact on your ability to start a family

There are a number of things you can look at to help boost your chances of conceiving.
There are a number of things you can look at to help boost your chances of conceiving.

Áilín Quinlan

Becoming pregnant might seem easy for a lot of women, but for others it's not so simple. Everything from diet to niggling little health problems could be causing problems. But there are a number of things you can look at to help boost your chances.


Almost one-in-six couples experience problems with fertility - and age is one of the biggest factors. Here's how it works: Women are born with all the eggs they will ever have, explains Dr Spyridon Chouliaras, consultant in reproductive medicine at the Create Fertility Clinic in London. On the other hand, he says, men constantly produce sperm.

"We sometimes say that women are 'warehouses' of eggs whereas men are 'factories' of sperm," he explains, adding that as women age both the number and quality of their eggs decrease.

Senior clinical embryologist Declan Keane, founder of the ReproMed Fertility Clinics puts it like this: "As the woman ages, her ovarian reserve, or the number of her primordial egg follicles, is reducing significantly year on year."

In fact, he says a woman's egg numbers reduce all the time, even prior to her first period.

"Every menstrual cycle, many hundreds of egg follicles are recruited from the woman's ovaries, but only a few mature eggs are to be ovulated.

"This large wastage means that, year on year, the egg numbers available from the ovaries are reducing." So, actually, explains Keane, it's not so much a woman's age but her egg numbers and their quality that directly reduce her chances of conceiving by decreasing fertilisation capacity and increasing the miscarriage rate and foetal abnormality rates.

"Even younger woman can be affected by reduced fertility due to their ovarian reserve," he says, adding that a simple blood test of your anti-mullerian hormone AMH can be a guide to your contemporary fertility profile. It is estimated that after the age of 37.5 years women lose two eggs per ovary per day, says Chouliaras, who points that the drop in fertility increases significantly after the age of 35 and more so after 40.

"A couple trying to get pregnant has approximately 20pc chance per month when the woman is 30 but only 5pc chance per month when she is 40. After 44 the chance of conception is very slim."

Assisted reproduction technology such as IVF can help older women to get pregnant, he says, but as the reserve of the eggs and their quality deteriorates, the success of IVF diminishes.

Oocyte cryopreservation (egg freezing) is a technique which is now increasingly used by women who wish to preserve their fertility.

Scientists believe that men's sperm deteriorate with age says Chouliaras, adding that fertility is affected for men once they are over the age of 40 - more so over 45, he explains.

Declan Keane explains: "We know from sperm DNA fragmentation research that as men age, the genetic quality of their sperm decreases.

"DNA in cells is tightly bound into the double helix structure," says Keane, adding that the quality of the genetic message which the sperm delivers to the egg is negatively affected by the breakdown or fragmentation of this structure.

"Diet, general health and lifestyle factors can influence sperm DNA packaging," he says, adding that as men age the DNA quality of cells is decreasing in quality.

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Overall, autoimmune issues such as thyroid problems, Addison's Disease or pernicious anaemia, which target the endocrine system, affect the quality of the egg, the sperm and the hormonal environment in which the fertilisation process is taking place, resulting in problems with fertilisation, implantation and maintenance of pregnancy, says Dr David Walsh, medical director of the Sims Clinic.

It is standard practice to investigate thyroid function in women experiencing difficulty in conceiving, because it is recognised that thyroid malfunction can affect female fertility.

"The thyroid produces a hormone called thyroxine, so the fertility of women who are deficient in thyroxine can be affected adversely," explains Dr Spyridon Chouliaras of the Create Fertility Clinic in London.

"This can be the situation even if they have no symptoms. It is standard practise for clinicians to investigate thyroid function and supplement women with thyroxine where appropriate."

Equally, he says, an overactive thyroid could affect fertility by possibly affecting implantation.

There is also an increasing belief that a malfunctioning of the thyroid gland can affect male fertility by altering the sperm parameters, says Chouliaras.


PCOS: Is diet the answer? - Dietician Orla Walsh gives the facts

Polycystic Ovary Syndrome is a common endocrine system disorder amongst women of child-bearing age. Women diagnosed with the condition may have enlarged ovaries which contain follicles, or small collections of fluid, located in each ovary. The exact cause of the condition is not known.

As a result of PCOS, explains Declan Keane, ovulation can be delayed or simply does not happen. "There can be a metabolic effect that can cause a woman to be overweight or underweight, which can affect her ovarian function and thus her menstrual cycle," he says, adding that when fertility experts discover that a woman has PCOS, the priority is to regulate the cycle in order to ensure good quality eggs.

"PCOS is a potential factor in infertility but it is not always the cause," he says, adding however, that the condition can lead to diminished ovarian reserve, which in turn means egg numbers can be low and this will further affect fertility. However, PCOS doesn't have to be the end of the world, reassures Dr John Waterstone, medical director of the Cork Fertility Centre.

"PCOS is a common condition where women can have too many eggs in their ovaries," he says, adding that a scan may show that although a woman has more eggs than normal, she is not releasing them every month as normal.

"However, PCOS is not the worst thing in the world to have - we would prefer a woman to have too many eggs than too few," he says, adding that women can become very concerned on hearing that they have PCOS: "It is very common and often simpler treatments will work," he says.


Fibroids are growths in the muscle wall of the uterus which can affect the implantation of the embryo. They are more prevalent in certain ethnic populations, such as in women of African origin, explains Dr Spyridon Chouliaras.

However, he says that a woman may often experience no symptoms, although their presence may also be signalled by heavy periods.

Very big fibroids may cause bladder problems.

"It's very important to get fibroids checked through an ultra sound scan as their effect on a woman's fertility depends on their size and their location in the uterus.

"They may need to be surgically removed," he adds. In the majority of cases, explains Dr John Waterstone, fibroids are "innocent bystanders."

However, he says, if they are large and are distorting the uterine cavity they may be the reason why the woman is not getting pregnant.

"If it's felt they could be causing a problem they need to be surgically removed via a myomectomy."


Pelvic Inflammatory Disease is not a large cause of fertility problems in Ireland, says Dr John Waterstone, who explains that sexually transmitted diseases such as chlamydia and gonorrhoea are a cause of PID, as they can give rise to inflammation and infection in the fallopian tubes.

In turn the tubes may become blocked or damaged and lead to problems with fertility. However, he warns, the incidence of PID in Ireland is increasing in line with "more relaxed sexual behaviour amongst young people."


Sometimes men who have had testicular cancer and received treatment in the form of chemotherapy or radiotherapy find that their fertility has been affected, explains Dr Waterstone. Some men will have frozen their sperm before receiving treatment as these therapies can destroy a man's ability to produce sperm.

"Chemotherapy can result in premature menopause at a much younger age, so while the woman survives the cancer, she cannot ovulate," explains Dr Waterstone.

In this case, he says, women may go down the route of using donor eggs because their own egg supply has been destroyed by the therapy.


Endometriosis: can your diet help? 

Endometriosis, explains Dr David Walsh, medical director of the Sims clinic in Dublin, is a disease of non-pregnant females. The condition can result, he explains, in a "backlog of fluid into the pelvis," which in turn can result in scarring and distortion, ultimately affecting the quality of the eggs.

"It is retrograde menstruation and in an extreme form can actually impact on the ovary, affecting both the quality and the number of the eggs.

"This in turn makes it more difficult to become pregnant because endometriosis is progressive - any woman who has this condition will find that it tends to get worse and it hinders pregnancy, affecting the fallopian tubes, egg quality and the fertilisation of the egg."


What he does for a living can potentially impact on a man's fertility, say the experts. It's all to do with the temperature of the sperm and testicles, so if you spend much of your day in a sedentary position in a warm environment, it may have an impact on your fertility.

"Taxi drivers or lorry drivers, for example are seated in a warm vehicle all day. This increases the scrotal temperature and can in turn affect the quality of the sperm," says Chouliaras.

He explains that men seeking to start a family are also advised to avoid hot baths, saunas or steam baths for the same reason and should not sit with their laptops on their laps because of the heat generated by these devices.

"We advise men to wear loose underwear to facilitate cooler temperatures around the scrotal area."

According to Declan Keane: "The biochemistry of the sperm produced in the testicles is temperature sensitive. Therefore if you are in a sedentary position for a long period of time, the testes are pushed toward the core body temperature, which is higher than the temperature the testes should be."

However, he points out, there are many men in sedentary employment who have children, so this is just one possible causal agent and will be investigated as part of the package of investigation.

"Evidence shows there are many men in office jobs whose fertility is not affected by sedentary occupations - however, if you are having difficulty in relation to fertility, this is one of a possible number of causes which must be investigated."

And it can be remedied, he points out, adding that a sedentary life is also linked to being overweight, poor eating habits and lack of exercise.


The nicotine in cigarettes induces increased secretory activity within the cells of the fallopian tubes, explains Declan Keane. "As a consequence, the fertilised egg cannot properly detach from the tube to the uterine lining after fertilisation. Smoking has been shown to decrease the blood flow to the uterus, which can cause restriction of the growth of the foetus."

Smoking affects the genetic integrity of the sperm, with the many different chemicals having a negative effect when burned.

"Sperm simply bumps into the egg, opens and releases its cargo of DNA but when you are a smoker or have a poor diet or lifestyle it can have a negative effect on the structure of your DNA," Keane explains.


Caffeine is associated with an increased risk of miscarriage, explains Dr Chouliaras. "It is recommended that women who are trying to conceive cut back their intake of coffee and tea to a total of about three cups a day, or less than 200 milligrams of caffeine per day," he adds.

He points out that, as epidemiological studies in infertility patients can be difficult to conduct and have many limitations - especially when trying to measure lifestyle factors - any interpretation of the results should be very careful. His advice, generally, to patients is moderation.

"There is a well-known association of increased caffeine intake during pregnancy with adverse outcomes such as slowing of the baby's growth and miscarriage," he explains.

"Caffeine can pass from the maternal bloodstream to the baby but the foetus doesn't actually have the ability to metabolise caffeine. This effect appears to be dose-related and only heavy caffeine consumption appears to be significant.

"Caffeine use by women when trying to get pregnant also seems to be associated with an increased risk of miscarriage."

Dr Chouliaras points to recent US research, the LIFE Study, which followed couples trying to get pregnant.

It showed that consumption by both partners of more than two cups of coffee a day may increase the chances of pregnancy loss.

Remember, he warns - caffeine is not only found in tea and coffee but also in energy drinks, chocolate, cola drinks as well as cough syrups and many supplements that can be bought over the counter.

Caffeine can also affect male fertility - a US study in 2014 reported that two shots of espresso (more than 265 mg of caffeine) can reduce a man's fertility.

The study found that men who drank two more cups of strong coffee a day had a one-in-five chance of becoming fathers through IVF - whereas the chances for those who drank less than one cup a day was nearly 52pc.

Researchers at Massachusetts General Hospital in Boston believe caffeine may harm sperm at a molecular level.

"This study will not come as a shock to those working in the field of fertility who every day witness the negative effects of caffeine, excessive alcohol consumption and other dietary factors on male fertility," said Declan Keane of ReproMed, adding that as the effects of these and other lifestyle choices are not however always evident in a basic semen analysis. ReproMed clinics in Dublin, Kilkenny and Limerick offer a DNA fragmentation analysis in addition to semen analysis.

This he said, could help shed some light on why a couple or individual may be experiencing problems getting pregnant.

"We aim insofar as possible to help couples to improve their own natural fertility potential, and if we can encourage this by recommending a few simple dietary and lifestyle changes we favour this approach rather than proceeding immediately to more invasive assisted reproduction techniques such as IVF.

"We try not to encourage couples to go to drastic measures to improve their lifestyles and having a cup of coffee in the morning or a glass of wine at night can indeed reduce stress levels and thus aid conception, but we do encourage a moderate approach!"

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