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What is female infertility? Fertility specialist Mark Trolice explains

Here Dr Mark Trolice, a fertility specialist at Fertility Care in Florida, gives invaluable advice to any woman experiencing fertility issues

Female infertility is defined as a woman of reproductive age who is unable to conceive within a year of having unprotected intercourse.

When should a woman consult a fertility specialist?

It’s generally recommended that women under the age of 35 should be investigated for potential fertility issues after 12 months of actively trying to conceive.

Women between the ages of 35 and 39 should consult a specialist after trying for six months without success, and if over the age of 39 should be evaluated after three months.

What causes female infertility?

Almost 15% of all couples will struggle to become pregnant. Of these couples, 35% will both have fertility problems, and 8% will be male only factors. The rest will struggle due to female factors, mainly equally down to ovulation dysfunction and tubal blockage.

Other factors that can affect female fertility include health conditions such as PCOS, fibroids, endometriosis and pelvic adhesions. Female fertility can also be affected by lifestyle choices such as smoking and high BMI.

How can a woman be tested for infertility?

80% of female infertility is due to ovulation problems and tubal blockages. A woman experiencing infertility can check for ovulation problems by using a urine based ovulation detection kit, that can be bought in pharmacies.

Alternatively, a woman can have a series of blood tests that will test for the presence of progesterone that can indicate ovulation.

Some woman know when they’re ovulating as they experience cramping and bloating.

Testing for blocked tubes is more complex and involves a procedure called HSG, or hysterosalpingogram

During this procedure, a specialist doctor slowly injects a liquid dye into the uterus via the cervix, which shows any blockages up on x-ray fluoroscopy.

The ovarian egg reserve, or ‘ovarian age testing’, can also be investigated by a blood test

This blood test is called an AMH, or Anti-Mullerian Hormone’ blood test. This is often used alongside an ultrasound test to scan for the small antral follicles that will produce eggs. Together, these tests will give a better indication of a female’s fertility.

How can a woman increase her fertility?

A woman can reduce her chances of conceiving by practicing poor lifestyle choices, so not smoking, taking recreational drugs or drinking too much and being at a healthy weight (not overweight or underweight) can help increase her fertility.

Practicing safe sex to avoid STIs that can block the tubes and attempting to conceive under the age of 35 can also help. Taking medical advice to treat recurrent urine infections caused by mycoplasma can also be beneficial for fertility.

Reducing stress levels can also help increase a woman’s fertility, as stress can cause a rise in the hormone cortisol which can affect a woman’s ability to become pregnant.

Can women experiencing infertility still have periods?

Some women who experience infertility still have regular periods. But one of the main causes of female infertility is PCOS, which can cause infrequent, or no periods.

An early menopause, or primary ovarian insufficiency can also lead to irregular or absent periods and infertility.

What’s the best age to try to get pregnant?

Dr Trolice says that female fertility naturally begins to decline once a woman reaches 30 years old. Before a woman is 30, she has around a 20% monthly chance of conception.

Pregnancy rates continue to decline for the remainder of a woman’s reproductive lifespan, with chances reducing to 10% at age 35 and 5% at age 40.

A man’s age can also impair fertility

In men around 40-45 years old, studies have shown higher rates of infertility, miscarriage, and preterm labour in their partner as well as higher rates of autism and birth defects in their offspring.

These findings were further supported by a recent study conducted at the Stanford University School of Medicine. The study found that men aged 45 years or older are 12% more likely to father children with adverse pregnancy outcomes and 14% more likely to have premature and low-birth-weight offspring, as opposed to fathers in their 20s and 30s.

Also, the older the father, the more likely he is to have babies who need breathing assistance and neonatal intensive care.

Can a woman’s diet influence her fertility?

Having a healthy BMI, in both men and women, will optimise fertility. In women, a high BMI can impact on ovulation and in men, it can reduce sperm production and quality.

There is no ‘ideal fertility diet’ but it’s thought that the Mediterranean diet may have fertility advantages.

Do folic acid supplements increase fertility?

Folic acid supplements are recommended to help prevent neural tube defects in unborn babies. But there is evidence that they can also help a woman become pregnant, and your doctor can give you more advice on the dosage.

Is female infertility increasing?

As the average age for women having children increases due to career reasons and finding the right partner, infertility rates have increased as older woman will naturally find it more difficult to become pregnant.

Women delaying having a family until their mid or late 30s can significantly decrease their chances of becoming pregnant.

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