GP's Information
At IVF Sunshine Coast and IVF Caboolture, we believe that the GP has a very important role in assisting couples to become pregnant. Recent evidence suggests that simple advice regarding lifestyle, smoking and weight can be much more significant than at first appreciated. The GP is an important support person for couples who have problems becoming pregnant.
IVF Sunshine Coast and IVF Caboolture - Liaison Officer
A dedicated Liaison Officer is employed to help GP's with any enquiries they may have. For further information contact Kellie Campbell on 0409 630 031 or email kelliec@ivfq.com.au.
Advice and information.
Put problems into perspective.
- in six months, 50% of couples conceive
- in 12 months 85% of couples conceive
- Of the remaining 15%, a number will continue to fall pregnant, with normal intercourse over the next two or three years.
General advice for couples.
- Both partners should be advised to give up smoking.
- Women should be advised to limit alcohol to a minimum (less than four units per week).
- A weight loss and exercise program is strongly recommended for women who are overweight.
- There is no evidence that the use of temperature charts and urine ovulation tests improve the chance of pregnancy. Regular intercourse daily or every second day, at the time of ovulation, is all that is recommended.
- A woman's fertility starts to fall significantly when she reaches her late thirties. The risk of miscarriage and genetic abnormalities in the baby also increase significantly after this age.
- Women should have their Rubella status checked. Folic acid should be taken before conception, in a dose of 300 to 500mcg daily to reduce the incidence of spina bifida. Pregnancy formula multi-vitamins may also reduce the risk of congenital malformations.
Lifestyle
Advice on lifestyle may be critical. Problems which we know will affect fertility include excess weight, smoking, alcohol and caffeine. With regards obesity, the ability to fall pregnant is reduced, miscarriages are more common, pregnancy complications are more common and in women with PCOS, ovulation may be infrequent. In women undergoing exercise and weight reduction programs, there is a high rate of return of ovulation, sometimes before there is any obvious weight reduction (provided they have started exercising regularly). A modest reduction in weight of 5 to 10kg may be all that is required. Even if ovulation does not return, the sensitivity of the ovaries to fertility hormones, including Clomiphene and FSH, is increased.
With regards smoking, most of the risks are well known. It takes about twice as long for smokers to fall pregnant as it does non-smokers. As for caffeine and alcohol, it has been found that drinking more than one cup of coffee per day or small amounts of alcohol, may contribute to sub-fertility. In one study, it was found that women who drank more than one cup of coffee per day and who had any alcohol at all in the month had about half the fertility rate of women who drank little or no coffee and no alcohol.
Information Resources
For a clinical guideline on fertility assessment and treatment for people with fertility problems visit the National Institute of Clinical Excellence website:
http://guidance.nice.org.uk/CG11.
Initial Assessment
A history and examination should be performed for both partners. A pap smear may be performed if required. Initial assessment should take into account the three main features regarding the ability to fall pregnant.
- Firstly, the regularity of the woman's cycle, which will give good circumstantial evidence for ovulation.
- Secondly, tubal patency may need to be assessed. This is usually the domain of the specialist gynaecologist, if women are having difficulties falling pregnant.
- Thirdly, a sperm analysis can be done readily at one of the local laboratories.
If there are any obvious concerns with the regularity of ovulation or the sperm analysis, then early referral may be necessary. For women with irregular cycles, some further information may be useful. 85% of women who have a long or erratic cycle will have PCOS. These women do not always fit into the classical picture of sub-fertility, obesity and hirsutism. The diagnosis is usually based on the clinical features, the appearance of the ovaries on ultrasound scan and the biochemical and hormone results. A baseline screen for such women would include LH, FSH, oestradiol, progesterone, prolactin, thyroid function tests (TSH and thyroxine for women with severe oligomenorrhoea or amenorrhoea) and 17OHP. Other less common causes for irregular cycles includes hyperprolactinaemia (arising from either a micro or macro adenoma of the pituitary) and late onset congenital adrenal hyperplasia.
Referral of appropriate couples
Couples should be referred for specialist review after regular unprotected intercourse over 12 months. Early referral should be considered for the following reasons:
For women,
- Over the age of 35 years
- Oligomenorrhoea or amenorrhoea
- Significant endometriosis or other pelvic disease
- Abnormal pelvic examination
- Recurrent miscarriage or ectopic pregnancy
- Early menopause
For men,
- Reduced sperm numbers (oligospermia less than 20 million)
- Abnormal examination, varicocele
- Previous genital surgery or pathology
- Men about to undergo vasectomy in whom sperm storage can be offered
Oncology patients
For either partner, chemotherapy or radiation treatment may result in sub-fertility. Freezing of sperm or embryos may be possible before treatment begins.
Fertility management after vasectomy or tubal ligation
For men, sterilisation reversal may offer the best chance of conception, especially if the vasectomy is recent (within 5 years). However, surgical aspiration and microinjection of sperm offer an alternative to vasectomy reversal. For women, standard IVF treatment offers an alternative to reversal of tubal ligation.
