Fertility Concerns

“When a patient comes in to see me for their first ultrasound after getting a positive pregnancy test, and we are all waiting together as I move the ultrasound probe… then all of a sudden we see this tiny flicker of a heartbeat… that still brings tears to my eyes.”

– Dr Monique Atkinson

Learn about fertilty testing

Factors affecting female fertility

How age affects female fertility

As we get older the chances of falling pregnant declines. Also with ageing, there is an increased risk of having a pregnancy with chromosomal abnormalities (aneuploidy) and for suffering miscarriage. The chance of falling pregnant for women who are 40 years old is about half of that, compared to women in their 20’s and 30’s.

Weight as a factor

Being under or overweight can impact your chances of falling pregnant due to its potential to disrupt hormonal balances and ovulation. It is also a significant contributor to the safety of your pregnancy and the health of your child. I will endeavour to work with you to optimise your weight, such that you improve your chances of falling pregnant, and having a happy, more comfortable, pregnancy, and a healthy child.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) affects a significant portion of the population. It can be the underlying cause for having irregular menstrual cycles, pregnancy complications and infertility. Importantly however it can also be associated with psychological problems (anxiety, depression and body image) and metabolic disorders (insulin resistance, type 2 diabetes and cardiovascular disease). If you have PCOS, my care of you will be based on international evidence based guidelines and aims to wholistically manage you throughout each stage of your life.

The implications of endometriosis

Women with infertility commonly have endometriosis. It may also be a cause of period pain or pain during sexual intercourse. A number of mechanisms have been proposed for how endometriosis reduces fertility. Adhesions may distort pelvic anatomy or inflammation may alter the ovarian, fallopian tube or endometrial function. Hence the health of eggs (oocytes)and sperm, and the ability of an embryo to implant into your uterine lining (endometrium), may be reduced.

And to help us, we have a range of fertility testing available:

Around 80% of couples will conceive within the first 6 months of attempting pregnancy. Hence, if you have been unable to conceive within 6-12 months (depending on your age), it is worthwhile consulting me, as a CREI Fertility Specialist. Following our discussions regarding your medical history I will be able to arrange investigations. We will aim to identify any underlying problems that could explain why it is taking longer than expected to fall pregnant. Together, we can then explore if there are targeted strategies we could employ to optimise falling pregnant naturally, or with the assistance of fertility treatments. Some of the tests I may order are listed below:

Fertility testing for women

Anti-Müllerian Hormone (AMH):

This is a blood test measuring a hormone released by the cells surrounding your eggs (oocytes) which have the potential to develop and be released (ovulated). Hence, AMH is an indicator of the ‘functional’ ovarian reserve. Your AMH level does not necessarily indicate your chances of having a successful pregnancy. We will be able to use the result of this test to guide decisions regarding fertility treatment and how you may respond to the hormonal stimulation in an IVF cycle.

Follicle-Stimulating Hormone (FSH):

FSH can be thought of as the hormone released from your pituitary gland in your brain, which is ‘talking’ to your ovaries to tell them to develop an egg each month. Hence, if you have diminished egg numbers, the pituitary gland has to ‘yell’ at your ovaries and so releases a large amount of FSH. So, if you have an elevated level of FSH, it may suggest you have a low ovarian reserve. In comparison, a lower level of FSH, may indicate that you still have sufficient oocytes to either fall pregnant naturally, or through IVF.

Luteinizing Hormone (LH):

LH is a hormone that contributes to the normal development of an egg. Each month, there is a surge in the level LH, which triggers ovulation. Ovulation describes the release of an egg into your fallopian tube, which gives it a chance to be fertilised. We can monitor your LH levels to predict when you may release an egg. LH is the hormone most commonly measured in urine ovulation kits and you should get a ‘positive’ result, when the surge in hormone levels occurs. However, different medical conditions can also effect your LH levels so urine ovulation kits may not be accurate for all women. Tracking your hormone levels, including LH, via blood tests, can be used to assist with timing of intercourse to optimise chances of conception.

Oestradiol:

Oestradiol is released by the eggs (oocytes) developing in your ovaries and acts on the lining of your uterus (endometrium) to help it prepare for embryo implantation. Your oestradiol levels fluctuate during your menstrual cycle, reflecting follicular development and endometrial receptivity. Monitoring your oestradiol levels helps us assess your ovarian function.

Progesterone:

Progesterone is released by the ovary following ovulation. A good progesterone level is important to support the development and maintenance of the uterine lining (endometrium), facilitating embryo implantation. Testing your progesterone levels can add to our assessment of your ovulatory function.

Prolactin:

Prolactin is naturally high in women who are breastfeeding. Abnormally elevated prolactin levels (hyperprolactinaemia) however may interfere with ovulation and menstrual regularity. If hyperprolactinaemia is diagnosed through this blood test, we can often treat this using medications, which may then allow you to fall pregnant naturally.

TSH/Thyroid Antibody:

The thyroid is a gland in your neck which produces thyroxine hormone, under the influence of TSH (thyroid stimulating hormone). Thyroxine regulates your metabolism. Thyroid hormones also act on ovarian, uterine and placental tissues so normal levels are also critical to ovulatory function, and the development of your baby during pregnancy.

Ultrasound Scan:

Ultrasound imaging enables us to visualise your uterine and ovarian morphology, so we can detect abnormalities. Transvaginal ultrasound scans offer detailed assessment of ovarian follicles, uterine lining, and structural abnormalities, providing essential information for fertility evaluation and treatment planning.

Sonohysterogram or HyCoSy (hysterosalingo-contrast-sonography):

These are ultrasound based tests used to assess the shape of your uterine cavity and if your fallopian tubes are patent (open). Patency of your fallopian tubes is vital to allow for sperm to reach your egg, leading to fertilisation. During these tests, aerated saline is passed through your cervix into the uterine cavity and its passage along the fallopian tubes is tracked with ultrasound. The test is performed during days 5 – 12 of your menstrual cycle.

Factors affecting male fertility

The male in the relationship may be the sole cause for infertility in around 20% of couples, and contributes to another 30 to 40% of couples presenting with infertility. While there are some uncommon conditions that can directly cause a man to have a low sperm count, in many situations a man’s sperm quality is a reflection of his general health. If this is the case, dedication to healthy lifestyle habits can result in significant improvements to sperm health in just three months.

Weight and male fertility

Being overweight can significantly impact on the number and quality of your sperm. Excess adipose tissue (fat) can be a source of extra oestrogen. This can lower testosterone levels, and hence impede sperm production and be associated with erectile dysfunction. Furthermore, factors released by excess adipose tissue can increase inflammation, potentially causing sperm DNA fragmentation. Also, a higher testicular temperature associated with obesity can impair sperm development. The good news is that engagement in healthy lifestyle changes and weight loss may improve sperm parameters. Importantly maintaining a healthy body weight and general physical fitness also sets you up for being able to manage being a father of active children!

Fertility testing for men

Semen Analysis:

Analysis of an ejaculated semen sample is performed routinely for men presenting with sub-fertility. The andrology scientist will analyse various semen parameters, including sperm count, motility, and morphology.

Scrotal ultrasound:

An ultrasound may be used to examine for obstruction in the tract along which sperm must travel to be ejaculated. It can also identify varicoceles, or testicular masses which may be impacting sperm quantity and quality.

Hormonal analysis:

A blood test can be performed to assess your testosterone, FSH (follicle stimulating hormone) and LH (luteinizing hormone) levels. This is particularly useful information if any abnormalities are identified in your semen analysis, as it contributes to diagnosing the underlying cause.

Our Services

We offer a full spectrum of reproductive health care services for all our patients.

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I am open to see patients face to face at Bella Vista, or via Telehealth