So here you are, your heart and mind so ready to have a baby, but your body...not so much.

In Australia, 15% of us have had no luck conceiving after 12 months of trying.
That's one in every six couples.
And one in ten couples have difficulty conceiving their second child.

Those are big numbers.

Conceiving isn't easy to begin with - a young healthy couple actually have only a 20% chance of conceiving each cycle. This number decreases with any additional reproductive issue, like age, sperm abnormalities or endometriosis for example.

So, why are so many of us struggling with our fertility?

Female and male factors affecting fertility

Both female and male factors contribute to fertility issues, and these are usually accounted for in the following way:

40% of issues are female factor
40% of issues are male factor
20% of issues are 'unexplained' or a combination.

Female factor issues

These might be ovulation disorders, luteal phase defect, blocked fallopian tubes, endometriosis, PCOS, uterine sub-mucosal or intra-mural fibroids, uterine polyps, pelvic inflammatory disease, STI's, bacterial vaginosis, uterine scarring, Asherman's syndrome, adhesions, structural uterine issue, cervical issues, obesity, premature ovarian failure, autoimmune disease.

Male factor issues

Low sperm count, low sperm motility, low sperm morphology, poor sperm DNA fragmentation, hormonal disorders, varicocele, STI's, structural issues affecting transport of sperm, ejaculation issues, diabetes, erectile dysfunction, obesity, vasectomy reversal issues, anti-sperm antibodies.

In practice it's so very rarely one big thing contributing to the sub-fertility picture. Usually it's a combination of factors from both sides.

Some of these issues will respond fantastically to a naturopathic approach, or a change in diet and lifestyle. Others will need surgery or medication. Either way, having a practitioner assist in identifying any issues and treating them, will get you on your way to baby sooner!

Age is a factor...in women and men

Most individuals and couples coming to see me are over the age of 35, and fertility rates start to decline at this age.

Maternal age

Anyone out there been labeled of 'Advanced Maternal Age'? At 35? Yup!...and Ouch!

Most of us start trying to conceive when we're ready! - when we've met someone we'd like to make babies with, when we're feeling financially secure, and when we're in the right place in our career.

Sometimes the stars are all aligned after we turn 35.

Egg quality starts to decline from this age, and our ability to conceive and maintain our pregnancies (in part) depends on the quality of this cell. If you have ovaries, and you know you'd like children some day, you do need to be aware of this, and thinking about it.

There are a few issues for women over the age of 35 that impact on their fertility:

the number of eggs we have available is in decline
the quality of those egg cells drops off
those available eggs have higher rates of chromosomal abnormalities

These issues affect conception itself, and the maintenance of our pregnancies, with women over 35 experiencing a higher rate of miscarriage and recurrent miscarriage.

Egg freezing (or 'fertility preservation') is a ‘back-up plan’ growing in popularity. Some workplaces are even offering it for their female employees. But there are questions about how many eggs are required for a successful pregnancy down the track, and many specialists would counsel against this as an 'insurance policy'.

Based on the evidence, it looks like freezing your eggs at <38years has the highest probability of live birth, with most specialists suggesting freezing at <35years.

A woman over 35 years with 8 frozen eggs has a 20% chance of proceeding to live birth. So this isn't exactly the 'insurance policy' any of us might think.
Another study showed if a 35 year old woman has 20 frozen eggs she'd have a 60% chance of proceeding to live birth...so that represents quite a few stimulated cycles to go through!

Egg freezing might not be a perfect plan (hey, what in this crazy world of fertility is a perfect plan?), but it does give a woman a greater chance of conceiving using her own eggs than if she'd started the process at 40+ years.

Paternal age

Older men tend to have poorer semen parameters, a higher rate of sperm DNA damage and lower reproductive outcomes.

The issues that affect male fertility when over the age of 40 are:

lower semen volume
poorer sperm morphology
poorer sperm DNA integrity

In men over the age of 35 years, sperm DNA integrity starts to drop off, and this becomes more pronounced after the age of 40. Unfortunately poorer DNA integrity is associated with reduced fertility rates and a higher miscarriage rate.

Paternal age 46+ years was associated with poorer outcomes in an IVF setting.

In addition, it looks like advanced maternal age + advanced paternal age amplify each other, where a women 35+ years, with a partner 40+ years have a 10% lower IVF success rate than younger partnerships.

And this is all so grim it feels a bit overwhelming!

But there are ways to optimise fertility outcomes in older women and men, and reduce the risk of age-related deficits.

Preconception care can rule out any other underlying factors that might impact fertility. Addressing diet and lifestyle goes a long way to supporting overall and reproductive health.

And antioxidants, antioxidants, antioxidants.

Our endocrine disrupting environment

Our fertility isn't just about egg + sperm. Unfortunately it's well acknowledged there are plenty of chemicals we're exposed to on a daily basis that affect our fertility. These are endocrine disrupting substances, and they affect how our hormones are made, function, bind, are transported and excreted.

Chemicals like parabens, PUFA's, dioxins, pesticides, Bisphenol-A, phthalates, heavy metals, triclosan, atrazine, insecticides, glyphosate...

We eat them in and on our food, we inhale them in the air we breathe, we drink them in our water, we absorb them through our skin.

They are pervasive and persistent.

Endocrine disruptors affect our fertility by:

affecting hormone function including ovarian and thyroid hormones
impacting sperm cell generation and function
impacting embryonic development
increasing the incidence of testicular cancer
acting as 'obesogens', affecting metabolic function and contributing to weight gain

The Endocrine Society of America recognises critical windows of vulnerability to the effects of endocrine disruptors, such as prenatal, in-utero and adolescence exposures. They declared the evidence for adverse reproductive events is strong and recommend greater regulatory oversight.

The good news is we can take action in our day-to-day lives to reduce our exposure to these substances.

There's more to come from me about this, but you'll find some fantastic resources at the Environmental Working Group.

So...what you're saying is...?

Conceiving a baby is not just about women. And I can't emphasize this enough. In the effort to be thorough, a full investigation of both partners is important. A good semen analysis looking at all sperm parameters, including DNA fragmentation, is essential. And there are lots of ways to improve sperm health if a problem is found.
That woman or man, if you know you want children, your age needs to be on the radar. And I know life happens at a unique pace for us all…and we all have different perceptions of the best time to start trying…and who-the-hell-am-I anyway to tell you what to do...but keep your age in the back of your mind, consider 'back-up' plans, and if you’re 35yrs+ get some great practitioners on your baby-making team! x
That little things add up and amplify each other. 1 + 1 becomes 3. Low dose chronic exposures to chemicals, coupled with an irregular cycle. alongside slightly slow swimming sperm, and that bottle of wine between two on Friday night...these things add up.

Nourishing your fertility is about reducing risk wherever you can.

What next?…Preconception care

Another reason infertility rates are where they are, is that people wait too long before seeking help. This is an area where good and thorough preconception care comes into its own - comprehensive exploration of any underlying contributing factors can be done from the outset.

Make sure your story is investigated with due care and diligence.

have you been investigated for nutritional deficiencies?
is your thyroid working optimally?
what about your menstrual cycle?
your insulin levels and weight?
any underlying auto-immune disease?

Any of these problems can reduce your fertility.

Because if 1 in 6 of us is having trouble conceiving, it's usually due to a combination of issues, such as ovulation disorders, sperm quality issues, age, endometriosis, PCOS, obesity, autoimmune disease or folate metabolism issues.

A naturopath views your fertility as a symptom of your overall health, and the aims of preconception care would be:

to identify, remove and detox environmental chemical exposures
commence couple-focused investigation and treatment where possible
to nourish and restore hormonal and overall balance.

Treatment will involve dietary and lifestyle changes, as well as nutritional and herbal medicine where indicated.

The next step might be orthodox medicine. Maybe some further diagnostics like a specialised ultrasound, or sometimes even surgery to remove fibroids or endometriosis. Or potentially the next step for you might be IVF. Your naturopath can work collaboratively with GP's or IVF specialists to support you through any assisted cycles, to optimise your chances.

So if you're out there struggling with your fertility, and feeling like everyone around you is having babies...they're not. You're absolutely not alone. Some of those babies around you were conceived with IVF or donor sperm, or donor eggs. Some were conceived after two miscarriages and three years of trying. And that doesn't diminish your own story, and what you're feeling, but you're not alone. And there's lots that can be done to support your fertility, including preconception care.

If you have any questions about preconception care or your fertility please book an appointment with Jacintha to discuss.

While you’re here, you. might also be interested in:

my 90-day first. fertile. program to support your fertility
my article Why you should consider detoxing before pregnancy
my article Miscarriage & pregnancy loss and working with a naturopath

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Why are so many of us struggling with our fertility?