General Advice for Fertility

General Advice for conception

Alcohol- For women trying to conceive, they should drink no more than 1 or 2 units of alcohol (10-20 ml alcohol) once or twice per week and avoiding episodes of intoxication. This reduces the risk of harming a developing foetus.
For men, alcohol consumption less than 3 units per day is unlikely to affect their semen quality. However, excessive alcohol intake is detrimental to semen quality.

Smoking - Both active and passive smoking are likely to affect chance of conceiving. Both should be avoided once the woman plans to conceive.
There is an association between smoking and reduced semen quality. Men should stop smoking, which will improve their general health.

Caffeinated beverages - There is no consistent evidence of an association between consumption of caffeinated beverages (tea, coffee and colas) and fertility problems.

Obesity - Women who have a BMI of 30 or over and who are not ovulating should lose weight, which is likely to increase their chance of conception.
Men who have a BMI of 30 or over are likely to have reduced fertility.

Low body weight - Women who have a BMI of less than 19 and who have irregular menstruation or are not menstruating should increase body weight, which is likely to improve their chance of conception.

Tight underwear - Men should be informed that there is an association between elevated scrotal temperature and reduced semen quality. However, it is uncertain whether wearing loose-fitting underwear improves fertility.

Prescribed, over-the counter and recreational drug use - A number of prescription, over-the-counter and recreational drugs interfere with male and female fertility, and therefore a specific enquiry about these should be made with regards to fertility and appropriate advice taken.

Complementary therapy - The effectiveness of complementary therapies for fertility problems has not been properly evaluated and that further research is needed before such interventions can be recommended.

Folic acid supplementation - Dietary supplementation with folic acid before conception and up to 12 weeks’ gestation reduces the risk of having a baby with neural tube defects. The recommended dose is 0.4 mg per day.

The above has been adapted from NICE Guidelines (Feb 2013).

DHEA supplement and anti-oxidant supplements Some studies have shown that DHEA supplement, CoQ10, vitamin C, vitamin A and other anti-oxidants may improve ovarian reserve but there is still no randomised control trials showing that these supplements improves pregnancy rates.

Q&A

Q: How do I know whether I ovulate?

If your menstrual cycle is between 28-35days, most often ovulation do occur.
You can have ovulation assessed in 3 ways

Blood LH surge tests at around ovulation time
Follicle tracking by ultrasound at around ovulation time
Blood progesterone test 7 days after ovulation

Q: If I have regular menstrual cycles, will oral ovulation induction medicine improve
my pregnancy rate?

Probably not. Regular monthly cycles indicate that you most probably ovulate regularly. Oral ovulation induction medicine like clomid may decrease the thickness of the inside lining of the uterus, making implantation of the embryo difficult.

Q: Is there medicine that can improve semen parameters?

Poor semen parameters is usually genetic in origin. Taking medicine like clomid, testosterone or steroid will not improve semen parameters. Male infertility usually necessitates in vitro fertilization treatment, with or without intracytoplasmic sperm injection (ICSI).

Q: If a couple has been diagnosed as being suffered from infertility, is the chance of
getting pregnant very slim?

No, on the contrary, if you get appropriate management of your infertility problem early, the chance of pregnancy is still pretty high. Although simple advice and measures can help for the initial stage, aggressive treatment may have to be employed at a later stage. According to Nice guideline (Feb2013), in vitro fertilization (IVF) will be offered to women with unexplained infertility, mild endometriosis and mild male infertility who have not conceived after 2 years.

Q: Will I have premature menopause after a few cycles of IVF, since many eggs have been
used up during each treatment cycle?

No. Each woman have 400,000 eggs at puberty and one egg will reach maturity to ovulate every menstrual cycle. There is a total of 400-500 menstrual cycles for the whole reproductive life span. The rest of the eggs will become atretic. Infertility treatment recruits some of the eggs that will regress anyway. Menopause is a stage when all the eggs have naturally regressed and therefore you do not have to worry about premature menopause.

Q: I have tried intrauterine insemination (IUI) for 3 times, why am I still not pregnant?

Usually, IUI is considered a milder form of treatment for infertility if the fallopian tubes are normal. The success rate is around 10 percent per cycle even if gonadotropins injection is employed. You do not have to be discouraged even if you have failed to get pregnant after 3 cycles of IUI. We can employ in vitro fertilization for treatment as the success rate is 3-4times higher than IUI. Some cases do require IVF for success.

Q: Will ovarian stimulation medicine cause ovarian cancer?

Up to date, literature has shown that ovarian stimulation will not increase the chance of ovarian cancer.

Q: What is considered completion of one cycle of in vitro fertilization?

One cycle of ovarian stimulation for in vitro fertilization may result in producing many embryos. For every subsequent cycle, we put back 1-2 embryos into the uterus, if pregnancy has not been achieved. It is not until we have put back all the frozen embryos that it is considered we have completed one full cycle of IVF.

Q: Is the pregnancy rate employing frozen thaw embryos less than fresh embryos?

No. Nowadays, we employ ultra rapid method (vitrification) for freezing embryos, which will not lead to crystal formation that is damaging to the embryos. Moreover, we usually employ natural non stimulated cycle which involves a lower estradiol levels, when we put back frozen thaw embryos and this result in a better pregnancy rate.

Q: Usually how many IVF cycles should I undergo?IVF

Usually we will advise at least 3 cycles of IVF before giving up as the cumulative pregnancy rate increases. Of course, it depends on assessment after each cycle.