Frequency of sexual intercourse
Ovulation usually occurs 14 days prior to onset of menstruation. In a 28 day menstrual cycle, ovulation usually occurs between day 12 and 14. This may vary depending on the length of the menstrual cycle. As sperm can survive for up to 5 days and the egg maintains its ability to be fertilised for about 12 hours after ovulation, alternate day intercourse is recommended from day 8 to day 16 of the average cycle.
Commencing one month before treatment, we recommend you take folic acid 0.5mg daily. In some circumstances you may be advised by your doctor to take 5mg daily. Scientific evidence suggests that taking this vitamin in small doses can reduce the incidence of fetal spine abnormalities or spina bifida. If you do become pregnant the folic acid needs to be taken during the first 12 weeks of pregnancy.
Smoking is harmful to your health. We strongly recommend that both partners give up or at least moderate their intake before planning to conceive. Smoking may jeopardise the outcome of your treatment. There’s increasing evidence that smoking may also damage the genetic material in the sperm resulting in reduced rates of fertilisation and poorer quality embryos.
Again this is important for both partners. It’s advisable to limit your alcohol intake. Excessive alcohol consumption may reduce sperm motility. There’s no known level of alcohol during pregnancy and current advice is not to drink alcohol when pregnant.
Information on caffeine and fertility is confusing at present and we recommend you minimise its use while attempting pregnancy.
Diet and Exercise
A balanced diet with low fat intake and adequate exercise (around 150 minutes per week) are associated with good reproductive outcomes. A body mass index outside the recommended range (19-25) is associated with reduced fertility for women and may also be the case for men.
Adequate vitamin balance, fruit and vegetables and anti-oxidants contribute to good reproductive health.
Extremes of weight compromise your chance of fertility, increase miscarriage rates and increase risks in pregnancy. Male overweight may also compromise fertility.
Approximately 1 in 6 couples have difficulty conceiving, with many achieving pregnancy through treatments such as ovulation induction and IVF. There are a number of reasons why you may not be getting pregnant. These can include:
(where an egg is not produced from the ovary or is not produced at a regular time from the ovary). This may include disorders such as polycystic ovarian syndrome, premature ovarian failure or reduced ovarian reserve.
There may be a blockage or damage to the small cells lining the fallopian tubes which may prevent passage of sperm or eggs. Sometimes this is caused by previous surgery or infection.
Is a common disorder where there is tissue which is similar to tissue lining the uterus (endometrium) which rather than being inside the uterus is external to it, commonly on the ovaries and ligaments which support the uterus. In severe cases it may distort the anatomy and cause problems with fertility. It is likely that there are other mechanisms whereby endometriosis may reduce fertility and this is an area of current research.
Differences in the shape of the uterus in rare cases may contribute to difficulty becoming pregnant.
Male Factor Infertility
Sometimes reduced number of sperm, or abnormality in the movement (motility) or shape (morphology) of sperm may contribute to fertility problems.
In many situations we are still unable to precisely explain the reason for fertility problems without current methods of investigation. This is often referred to as ‘unexplained infertility’. This diagnosis may be particularly frustrating for couples, however treatment is still available and often successful in this situation.
Generally couples where the female partner is less than 36 who have been trying to conceive for more than 12 months or couples where the female partner is more than 36 years of age and have been trying to conceive for more than 6 months may wish to seek advice regarding fertility treatment.
Some couples may require treatment others may require higher levels of reproductive technology.
At Fertility SA we can discuss the options with you and guide you through your decisions at a pace that you are comfortable with.
We have the individualised care and a deep knowledge of our area in both science and clinical medicine that can make the difference to couples and individuals. We do not believe in a “one-size fits all” approach.
Prior to your first visit you and your partner will be required to complete a health questionnaire to help determine possible reasons for fertility problems and factors that may affect your ongoing treatment.
An examination of one or both partners may be requested with your consent. In some situations a transvaginal ultrasound may be required for the female partner.
Your doctor will formulate a plan with you for further investigation and treatment. This often requires a period of 4 to 6 weeks so that the appropriate investigations can be performed at the appropriate time of the female partner’s menstrual cycle.
Your doctor will then organise for you to have a follow up appointment to discuss these results with you as well as options for ongoing treatment.
We aim to move forward at a pace that is comfortable for you. Some people may find the decision process straightforward; others may need further time and appointments to help them through this process.
Our counsellor is available for further discussion at any stage of assessment and management if you or your partner should have any concerns.
At Fertility SA, our usual advice is for transfer of one embryo in the first treatment cycle. Over recent years changes in the laboratory and culture medium have resulted in a higher percentage of embryos available for transfer and freezing.
Particularly in younger women, with blastocyst culture the transfer of two or more embryos has minimal effect on increasing the pregnancy rate. However, by transferring more than one embryo there is a significant increase in the rate of multiple pregnancy.
The risks associated with multiple pregnancy on the couple and community need to be given serious consideration.
At Fertility SA we have stringent protocols in place to ensure there’s no mix up of reproductive material. When you are first seen at out clinic we will collect information which will help us in the identification process. You will often be asked for these identifiers by us. These factors include but are not limited to:
Date of Birth
You will also be assigned a specific patient identification numberAt least 3 of these identifying factors will be used when performing any tests or procedures or when collecting or transferring any reproductive material.
There is a strict process of cross-checking this information with other staff members during procedures and in the laboratory.
At the moment, the maximum time that embryos can be frozen in cryostorage is 10 years.
Flying in pregnancy (and following an ET) is generally considered to be safe.
• There is no evidence that the change in air pressure or decrease in humidity will have any harmful effect on you or your baby.
• There is no evidence that flying causes early labour or your waters to break.
• With any flight there is a slight increase in the amount of radiation you are exposed to but occasional flights are not considered to present a significant risk to you or your baby.
• If you are a member of a flight crew or fly extremely frequently as part of your work then you may wish to discuss this with your occupational health department or Obstetrician.
• Airlines may not allow you to fly after 37 weeks for singleton pregnancies or after 34 weeks for twins
• If you are over 28 weeks of pregnancy your airline may request a medical certificate from your doctor or midwife to confirm you are not at any increased risk of complications.
• Pregnant women are at slightly increased risk for DVT when flying.
Routine dental treatment is safe during pregnancy.
Some procedures and medications should be avoided in the first 3 months of pregnancy so always inform your dentist you are pregnant.
Visiting a dentist early in pregnancy is highly recommended as some women may be at increased risk of gum disease during pregnancy and women experiencing a lot of vomiting in pregnancy may be at increased risk of tooth erosion.
Always inform your treating doctor or the radiographer that you are or may be pregnant.
X-rays that do not involve examination of the abdomen or torso usually do not pose any risk for the pregnancy or unborn child.
If it is deemed medically necessary to perform a diagnostic X-ray of the abdomen or lower torso during pregnancy the actual risk to you and your unborn child is still very small, however always discuss any concerns with your doctor. In some cases the amount of radiation used can be modified.
If you find out later that you were pregnant when you had a abdominal X-ray performed do not be alarmed – the possibility there has been any harm to you or your unborn child is extremely small.
Up to 2% of pregnant women undergo surgery for non-obstetric conditions. The most common indications include appendicitis, cholecystitis and trauma.
Always inform your treating doctor and anaesthetist that you are pregnant or undergoing fertility treatments.
In general, anaesthetics during pregnancy are relatively safe as long as the anaesthetist is aware you are pregnant as some medications should be avoided. There is NO evidence that anaesthesia in pregnancy causes any congenital abnormalitie.
Whenever possible, elective surgery should be deferred until after the first trimester, and preferably deferred until after the pregnancy.
Altruistic surrogacy is now technically legal in SA (when medically indicated).
Fertility SA does NOT currently run a surrogacy programme. Other clinics in SA may be offering surrogacy.
Our counsellor may be able to give you some general information regarding the psycho-social and legal aspects of surrogacy in SA.
Your treating clinician may be able to give you some advice as to whether surrogacy might be an option for you to consider and may also be able to answer some of your clinical questions related to surrogacy.
Women are not able to undergo IVF in Australia past the average age of natural menopause, according to the guidelines that IVF units have to abide by to maintain their accreditation. This is usually interpreted as 52 years of age.
After 45 years of age, less than 1% of women will have a life birth when they use their own eggs. Many women in this age group will consider the use of donor eggs, as the age of the egg donor determines the outcome of IVF, not the age of the women receiving the embryo. Thus with eggs from a young donor (<35 years), women, even over 45 years of age will have more than a 50% chance of conceiving at Fertility SA.
As women age, it is important to understand that medical problems such as high blood pressure, heart problems and diabetes can make pregnancies much more complicated and there is a higher risk of a poor outcome.
Few studies have been done to determine the safety of electrolysis so there is a lot of uncertainty if women should undergo this treatment during IVF treatment or in pregnancy.
Many people recommend waxing, tweezing or hair loss creams instead. Beauticians often recommend thermolysis (heat only) rather than galvanic (electrical) or blend (a mix of the 2) therapies in pregnancy.
There have been no official reports of negative outcomes from electrolysis.
Modern hair dyes are safe in treatment cycles and pregnancy but check with salon.
• Avoid raising the core body temperature. Moderate exercise is encouraged.
• What you are used to should be safe as long as intensity doesn’t reach extended breathlessness.
A talk test is a good measure of keeping to a safe intensity of exercise.
• Avoid water skiing, horse riding, scuba diving, marathons, bungee jumping or any extreme sports.
The decision to continue or cease breast feeding when undergoing fertility treatment is a personal one.
There are many variables to consider and therefore this should be discussed with your fertility specialist prior to commencing treatment.
You may find commentary on our Blog Page relating to the latest scientific developments in IVF useful.
More information can be found on The Teratology Society website which is an American based site managed by Pharmacologists. They have a number of fact sheets available here.
Please remember that this is not an Australian website and therefore any questions or concerns regarding the use of medications during treatment should be directed to your specialist in the first instance.
The Women’s and Children’s Hospital Pharmacy Department have the most current information available regarding medication use during pregnancy and lactation. They are available to speak to during normal business hours via (08) 8161 7222.