Many Kiwi couples trying to conceive are ignorant of the risks to their fertility through delayed childbearing, smoking, alcohol and being overweight, research shows.
Both men and women should "be fertility fit", according to a new campaign starting today for New Zealand's inaugural Fertility Week.
Fertility Associates group operations manager Dr John Peek said many couples lacked basic common knowledge about fertility, including knowing when a woman's fertile window was each month.
A woman's fertility declines sharply after 30 while women over 35 are almost twice as likely to have unexplained infertility. Paternal age also poses fertility problems.
A University of Auckland study (by Lucas and Shelling) of New Zealand university students showed some had unrealistic beliefs about fertility.
Most of those surveyed, 81 per cent, indicated they wished to have children in the future but planned to do this "late" or "very late".
The students predicted fertility decline to occur later than it does in reality and believed treatment was more successful than it actually is.
Age is one theme highlighted in the Fertility New Zealand campaign with weight, alcohol, smoking and timing of sex all targeted as factors couples can control.
Dr Peek, who helped write a fertility guide for the campaign, said though many people were aware that fertility declined with age, they didn't know from what age or how quickly.
"And a lot think things like IVF [in vitro fertilisation] treatment can overcome the effect of age, which it can't."
Women's fertility declines sharply after 30. Photo / Thinkstock
Delayed childbearing became a serious problem when couples found they had trouble conceiving.
"If you do have problems you run out of time to see if nature's going to take its course. By the time they wait for two years to see if they can get pregnant their chances, if they have to use something like IVF, are going to be much lower."
The average cost of one cycle of IVF is about $12,500 and those eligible for public funding get up to two cycles free.
Evidence also shows both men and women's fertility is lower if they are over or underweight and both conditions can affect the health of the baby.
Women with a body mass index of more than 32 must lose weight in order to become eligible for publicly funded fertility treatment. A body mass index between 20 and 25 is considered healthy. Women older than 40 or those who smoked were not eligible for public funding.
Underweight women can also have trouble conceiving and excessive exercise in men and women is known to negatively affect fertility, alongside poor diet.
Alcohol is reported to decrease fertility and increase miscarriage risk, with as little as one drink a week associated with reduced conception rates.
Dr Peek said quitting smoking was a "no-brainer". Smoking halved a woman's chance of conception each month and damaged sperm DNA.
Dr Peek said fertility was not such an issue in the past because couples didn't delay parenthood, there was no fertility treatment and adoption was an alternative.
"We haven't had to think about these things until the last few decades because if you look at the average age women had children, most had their first child in their mid-20s. But now the average age is 30 or a bit more and then it starts to matter.
"There's a whole segment of moderately young women who have a career and actually are planning to have children in their mid to late 30s, and that's where I think they just don't realise what they're up against."
His advice was for couples to factor in childbearing when considering their life plan.
Alcohol decreases fertility. Photo / Thinkstock
Although historically viewed as "a woman's problem", only 30 per cent of infertile couples are a direct result of the female partner.
Another 30 per cent are attributable to men, 30 per cent are because of both partners, and 10 per cent are unexplained.
Fertility New Zealand president Nigel McKerras said the Fertility Week campaign was about maximising the chances of a healthy pregnancy and healthy baby - either through natural conception or assisted reproductive technology.
"We also encourage younger couples and singles who wish to become parents in the future to become aware of these factors, enabling them to preserve their fertility and plan for children," Mr McKerras said.
He said having an understanding of the female partner's fertile window, up to five days before ovulation, was crucial.
And the man's role in conception was often overlooked also.
"Many people are unaware, for instance, that men's fertility declines from around age 45."
Parts of the Fertility Week campaign are based on an Australian campaign and include a fertility fitness guide for GPs.
Activities across the week include a national roadshow, webinars from fertility specialists and free fertility fitness check-ups at selected locations throughout the country.
Fitness, health and seeking help the key
Aroha and Rawiri Daniels come from big families and expected having a baby would be easy but when nothing happened for a year after their October 2010 wedding, they sought help.
Mrs Daniels, then 28, was diagnosed with polycystic ovary syndrome and prescribed Clomiphene but nine months later doctors discovered she was still not ovulating.
In 2012 she underwent painful surgery to have holes drilled in her ovaries allowing her eggs to fall out but again the treatment failed. The Wellington couple, who had kept their infertility secret, endured endless jokes from unsuspecting relatives until Mrs Daniels told her father.
"It was really difficult. My husband and I were the only two who didn't have children. The questions and jokes were endless. They all broke my heart but we smiled and carried on like we were living the dream."
Every time there was another baby announcement in the family Mrs Daniels choked back the tears and put on a brave face, until in 2012 the couple were referred to Fertility Associates.
She gave herself injections but still did not ovulate and in early 2013 Fertility Associates specialist Dr Andrew Murray recommended in vitro fertilisation (IVF).
"I couldn't believe it. I just fell into the IVF basket that you only read about in the magazines."
Mrs Daniels decided to "prime" her body for IVF, signing up for Oxfam, walking up to 50km each weekend, playing indoor and outdoor soccer, and hiring a personal trainer.
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She dropped 10kg and underwent the invasive treatment in July last year, just as she turned 30.
"I had half a glass of wine at my 30th and I'm a party girl but I just didn't want to risk putting toxins in my body."
Mrs Daniels is now 36 weeks pregnant, due on May 3 with a baby boy. Her advice was not to wait, but see a specialist as soon as possible, get fit and healthy, and consider telling some family or friends instead of suffering in silence.
Getting fertility fit
Preconception care can not only increase chances of conception but it can also have an impact on the health and development of a child during its life. Being fertility fit four months before conception aims to ensure adequate supply of the nutrition essential to the health of sperm, eggs and foetus. Some of the factors affecting fertility are:
In women fertility is highest until age 30 before it declines. Women over 35 are almost twice as likely to have unexplained infertility and the incidence of genetic abnormalities and spontaneous abortion increases with maternal age. In 2011 the average age of women undergoing assisted reproductive technology treatment in New Zealand and Australia was 36 and for men, 38. Twenty-six per cent of women aged between 25 and 29 undergoing fresh non-donor treatment gave birth. In contrast only six per cent of women aged between 40 and 44 had a baby.
*Timing of sex
The timing of sex relative to ovulation is the factor which couples trying to conceive have the greatest control over. The "fertile window" is determined by the lifespan of the sperm and the egg once it has been released at ovulation. Sperm live up to 3-5 days and the egg survives for 12-24 hours. Studies show the maximum fertile window is the day of ovulation (when an egg is released from the ovaries) and the five days before, with the most likely days to achieve pregnancy to be one or two days before ovulation.
It's not just overweight couples who can have trouble conceiving - being underweight is also a problem. Obesity in men is associated with infertility and can cause ovulation to stop in women. During pregnancy overweight and obesity are associated with increased risk of miscarriage, gestational diabetes, pre-eclampsia, premature and stillbirths. Likewise low maternal weight before pregnancy and poor weight gain during pregnancy are known to result in an increased chance of pre-term delivery and low birth weight infants. Low body weight also causes anovulation (ovulation to stop).
Alcohol is known to decrease fertility and increase the risk of miscarriage. It can cause ovulation to stop. It is also harmful to a foetus and can impair brain development in an unborn child. In men, alcohol has been linked to decreased libido and decreased sperm count.
Associated with lower fertility rates and a higher risk of IVF failure. Exposure to cigarette smoke, active or passive, impairs every stage of the reproductive process in women, including hormone production, embryonic development and implantation and placental formation.
Ensure adequate protein including fish, chicken, lean red meat, eggs, dairy, and legumes. Reduce saturated fats and trans fats and ensure sources of healthy fats such as olive oil, coconut oil, nuts, seeds and avocados. Reduce sugars and refined carbohydrates, but eat adequate amounts of whole grains. Avoid processed foods. Source: Fertility New Zealand
By the numbers
1 in 6 couples are infertile
1 in 5 women experiences a miscarriage
1 in 5 women has a Caesarean
1 in 6 women suffers post-natal depression
1 in 8 women gets gestational diabetes
1 in 10 women experiences toxaemia
1 in 30 babies has a congenital defect
1 in 10 children is affected by learning or behaviour problems
1 in 4 children suffers from asthma
Source: Ministry of Health
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