Facts on fertility and points on pregnancy

"More and more Australian women are delaying pregnancy to stay ahead in their career or sometimes they just don't meet their man until later in life. One of the most significant reasons women have trouble conceiving is declining fertility with age so when they do decide that the time is right to have a baby they unexpectedly have difficulty falling pregnant. Regardless of your stage of life, if you are considering having a baby, it is important to talk your GP." Dr Christine Bennett, MBF's Chief Medical Officer.

What are some of the factors that may make it hard to fall pregnant?

The odds of a young fertile couple conceiving by having sexual intercourse around the time of ovulation are approximately one in five every month. A couple isn't thought to have fertility problems until they have tried, and failed, to conceive for one year. Approximately 20 per cent of couples experience difficulties. In most cases, the couple can be helped with assisted reproductive technologies. Around 40 per cent of fertility problems originate in the woman. Female fertility problems include failure to ovulate, and abnormalities of the fallopian tubes or uterus.¹

What were the new developments from the World Congress on Endometriosis?

The 10th World Congress on Endometriosis 2008 was held in Melbourne from 11 to 14 March 2008. The Congress highlighted trends in the management of endometriosis and offered practical solutions to its two main symptoms - pain and infertility. The Congress aimed to improve the coordination of efforts to diagnose the disease earlier and showcased improved diagnostic tools and drugs as well as the highest level of science in reproductive medicine and women's health.

Some of the findings released during the Congress included:

Green tea may help control the symptoms or progression of endometriosis. A Hong Kong study showed that catechins, or potent antioxidant compounds in green tea, restrict the formation of new blood vessels, which assist in the spread of endometriosis.
Women with moles, freckles and skin sensitivity to sun may have a higher risk of endometriosis. Earlier research has suggested that endometriosis and malignant melanoma may share some common genetic traits.
A new Australian study showed that girls that are underweight at 16 have a higher risk of endometriosis.

For more information, please visit the Congress website: www.wce2008.com

Why does endometriosis make it hard to fall pregnant?

Endometriosis can significantly affect a woman's fertility. Because the lower abdominal or pelvic pain of endometriosis may often be taken to be an unwelcome but 'normal' part of a woman's menstrual cycle, women frequently do not seek help for their symptoms for many years. Delay in the diagnosis of endometriosis can result in some difficulties conceiving a pregnancy.

If scarring occurs on the ovaries, it can burrow in to form cysts (endometriomas).

It's believed that chemicals may be released from the endometriosis cells that interfere with the ability to conceive. In moderate to severe cases, scarring may cause interference with the release of the egg (ovulation) and passage of the egg along the tube between the ovary and the uterus because of damage or blockage.

What can you be tested for while you are pregnant?

Infectious diseases : blood test at 10 weeks for HIV/ syphilis/ rubella/ hepatitis B and C/ varicella (chicken pox) with urine test for chlamydia
Urinary tract infection (UTI)
Downs syndrome : a blood test is interpreted with a nuchal scan ultrasound at 13 weeks to measure the thickness of the baby's neck
Genetic or chromosomal abnormalities :
- CVS (chorionic villus sampling): biopsy of placental tissue to test for genetic abnormalities eg cystic fibrosis
- Amniocentesis: amniotic fluid is extracted from the amniotic sac that surrounds the bab
- If you have a family history of a genetic disorder (other than downs syndrome) eg cystic fibrosis
- Women with a family history or genetic carriers (both male and female) of chromosomal abnormalities
- Women who have already had children with chromosomal abnormalities.
Organ abnormalities : morphology scan at 18 weeks looks for abnormalities in major organs for example heart/ brain/ spina bifida
Diabetes : glucose tolerance test is used to test for gestational diabetes at 28 weeks
Vaginal infection : swab at 36 weeks to look for possible infection in the birth canal
Other tests : full blood count for anaemia, iron studies and vitamin D, B12, folate, thyroid function tests including urinary iodine to detect an under active thyroid.

(As recommended by the RANZCOG.)

How accurate are these tests?

The nuchal scan and blood test are non-invasive tests, which are approximately 98-99% predictive for downs syndrome in women aged over 35, which means the need for an amniocentesis is reduced. ²
Amniocentesis is 100% diagnostic in women over 35 at 15 weeks or over.

Are there any risks to the baby when you have these tests done?

There is no risk to mother or baby with a nuchal scan. There is a risk of haemorrhage, infection, injury or death of the baby when doing an amniocentesis. The procedure is safer when it is performed after 16 weeks gestation. The results are available in 2 weeks.

Chorionic Villus Sampling may be risky for the baby causing bleeding or miscarriage.

Is it dangerous to exercise while you are pregnant?

Regular exercise during pregnancy can prepare a woman's body for labour and the demands of a new baby. Caring for a newborn can be stressful and physically demanding, so it helps to be fit and strong. ¹

Women may need to modify their existing exercise program or choose a suitable new exercise program if they were sedentary before conceiving. Suggestions for exercise during pregnancy include walking, swimming and supervised classes such as yoga or tai chi. Pelvic floor exercises are important before, during and after pregnancy.

Always consult your GP before starting an exercise program but especially if intend to start exercising and/ or have high blood pressure, multiple foetuses, increased risk of premature labour, vaginal bleeding, pre-eclampsia or heart disease. They may advise limited physical activity or to avoid it altogether. ¹

Pregnancy affects the way your body responds to exercise, including:

Hormones soften ligaments, which increases the risk of joint injuries.
Balance is affected because of a larger belly.
The ideal average weight gain during pregnancy is 10 kg to 15 kg, which puts extra strain on joints.
Your blood pressure drops in the second trimester, so it is important to avoid activities that involve fast changes of position.
Your growing baby needs oxygen, so never exercise to the point of breathlessness.

30 per cent of women in Australia are having a caesarean birth and this rate is increasing. Why is the rate so high?

The 'too posh to push' phenomena is far less common than suggested and is said to be more of an issue in higher socio-economic areas. One of the reasons why women may choose to have an elective caesarean is more choice or control of when to have their baby. But there are plenty of genuine medical reasons why the number of caesareans is increasing. These include:

If the pregnancy has gone more than 1 week past the due date it is safer to have an elective caesarean rather than risk a difficult labour or emergency caesarean.
Babies are getting larger because of the higher prevalence of obesity – a woman's pelvis may be too small to deliver a large baby.
There is a higher incidence of gestational diabetes, which also produces bigger babies.
Better monitoring to measure foetal wellbeing or distress is common. This may result in a caesarean to reduce foetal morbidity.
Fertility rates are declining because more women are delaying pregnancy so there are more IVF babies. Parents tend to be more cautious when it comes to giving birth. At the first sign of a problem they don't want to risk something going wrong.

What are the advantages and disadvantages of caesareans versus vaginal deliveries?

Advantages of caesarean

May be safer for women who have pre-eclampsia, prolapsed umbilical cord, breech baby, bigger babies, multiple pregnancy, foetal abnormality or distress, previous caesarean, previous neonatal death or when women are older.
It can be quicker than a vaginal delivery if the baby is in distress or at risk.
Don't have to go through labour pain.
May suit some women who have been sexually assaulted (or have gone through IVF).

Possible complications of caesarean
A caesarean section is generally a very safe procedure but, since it is an invasive type of surgery, there are risks for both the mother and her baby. Some of these risks and possible complications include:

Infection of the mother's wounds
Damage to the mother's bladder and other internal organs
Damage to the mother's blood vessels
Damage to the baby inflicted by surgical instruments
Increased risk of the baby experiencing respiratory distress
Increased time in hospital
Increased abdominal (tummy) pain
Increased risk of having a caesarean section in the future.
It takes longer to heal than a vaginal delivery ¹

Advantages of vaginal delivery

The stress of being born activates the lungs in preparation for breathing, increases blood sugar for energy and stimulates virtually all body systems for the radical change in environment.
Mother experiences an immense release of the hormone oxytocin during labour (the hormone of love) which physically helps her give birth and activates the "maternal circuit" priming her for motherhood and reducing stress before meeting her baby.
Decreased risk of blood loss, infection and deep vein thrombosis to the mother
There is no need for anaesthetic
The recovery time for the mother is less than caesarean.

Possible complications of vaginal delivery

Tearing/ episiotomy
Prolapse of the uterus
Some women complain of reduced sensitivity or even pain during sexual intercourse.
Severe pain.
Obstructed labour; later prolapse; haemorrhoids

General statistics

Caesareans account for 28.5% of births in Australia in 2004 (compared to 19% in 1994)³ and 58% of these were without labour
MBF data shows that 43% of deliveries were via caesarean in 2007

Sources:

Better Health Channel, Victorian Government (www.betterhealth.vic.gov.au)
Westmead Foetal Welfare Clinic
Australian Institute of Health and Welfare (www.aihw.org.au)