Dr Preeya Alexander: 7 helpful things to know about fertility

ARTICLE

1 April 2024

5 mins read

From when the ‘biological clock’ kicks in to whether a test can predict the chances of getting pregnant, Dr Preeya Alexander, a practising GP, sets us straight answering seven common fertility questions she hears from patients.

As a GP, I see many patients who come in to talk about fertility, be it preconception care, pregnancy-related issues, fertility preservation options, or difficulty conceiving. While tackling fertility issues can be difficult and emotionally taxing, I approach healthcare with the belief that there’s no place for stigma when it comes to our wellbeing. The more we know, the more informed our decisions can be.

Whether you’re ready to try to get pregnant or curious about your options for five years down the track, understanding the basics of fertility can help you make healthy, balanced choices for your future.

What is fertility?

The basic definition of ‘fertility’ is the ability to conceive. To conceive, a sperm needs to meet an egg and fertilise the egg (becoming an embryo), and then the embryo needs to attach itself to the uterus’s lining.

What is infertility?

Infertility is the inability to conceive after a prolonged period (usually 12 months) of having regular unprotected sex. It’s not uncommon: according to a recent report from the World Health Organization, infertility affects 1 in 6 people around the world¹.

We health professionals tend to talk about ‘primary’ and ‘secondary’ infertility. Primary infertility refers to when a pregnancy has never been achieved, while secondary infertility refers to when a pregnancy has previously occurred.

What is the ‘fertile window’?

Basically, the fertile window is the time in the menstrual cycle when conception is most likely to occur. It captures the five days before the egg is released from the ovary (ovulation) and the 24 hours after the egg is released². Lots of people don’t realise that an egg only survives for 24 hours, while sperm can survive for up to five days. So, having sex every second day in the fertile window can improve the chances of pregnancy.

Tracking your menstrual cycle is a great way to find out when your fertile window is – whether you’re trying to become pregnant or avoid pregnancy (some of my patients use fertility awareness methods as a form of contraception). I think it’s wonderful that people are so interested in understanding how mood, vaginal discharge, libido, and lots of other things can shift according to where you are in your cycle.

Is the ‘biological clock’ the biggest thing that affects fertility?

I like to talk with my patients about the modifiable factors (lifestyle habits you can change) and non-modifiable factors that can affect fertility, for both men and women.

Two big modifiable factors that can affect fertility are alcohol consumption and smoking. When it comes to both smoking and drinking alcohol, either quitting entirely or reducing can not only improve fertility but also the health and wellbeing for mother and baby during pregnancy. Diet also plays a big part in fertility (a dietitian can guide you, and also help you make sure you’re eating well during pregnancy). Research shows that stress may impact fertility too³.

Now let’s talk about that ‘biological clock’. Age is the biggest non-modifiable factor – we turn a year older every year and that’s just the way it is! A woman reaches the peak of her fertility in her early to mid-20s, when each month she has a 25–30% chance of getting pregnant⁴. Her fertility starts to decline after the age of 30, speeding up around age 35 before dropping to a 5% chance of getting pregnant each month by age 40.

Male fertility declines from age 40, when sperm quality decreases⁵.

Is there a test that can predict fertility?

The short answer is yes (but there are some caveats!) – and it’s a hot topic. The ‘AMH’ (anti-müllerian hormone) blood test gives an indication of ovarian reserve. I explain it to my patients like this: the AMH gives you the ‘vibe’ of your egg reserve, but the test will not tell us exactly[MF1] how many eggs are left in the ovaries (females are born with all their eggs), nor the quality of the eggs. It tells us some key information but doesn’t give us the whole picture.

While this test can help guide family-planning decisions, it can also be costly (it’s a privately billed blood test, not covered by Medicare) and anxiety-generating if it’s done without a clear intention.

My advice is to speak to your GP. I’ve had plenty of patients ask about the test after the topic came up at a dinner party and then leave my room confident that they don’t need it because it won’t change their existing family planning, or they decide it may cause them unnecessary worry. For others, the test can help make family planning decisions – if the ovarian reserve is lower than expected, for example, patients might consider trying to conceive sooner than they had planned or chatting to a fertility specialist to consider fertility preservation options like egg freezing.

Is it common to need help to get pregnant?

Sometimes getting pregnant is difficult. Research tells us that 92% of heterosexual couples who have regular unprotected sex will conceive within 12 months, and 98% will conceive within two years⁶. But it can take time for many people to conceive, and many people with fertility issues go on to get pregnant – either with intervention (such as medication to trigger ovulation, or IVF) or without.

As a GP, I have a low threshold to refer a patient to a fertility specialist – sometimes it will be because there are diagnoses such as polycystic ovarian syndrome (PCOS), endometriosis, or recurrent miscarriage, and other times I refer simply so a patient (+/- partner) can make an informed decision.

I’ve often had patients feel inferior when everyone around them is conceiving without intervention. The stigma around infertility can make people feel isolated and reluctant to seek help – and research shows it can cause stress and be a factor in mood disorders like anxiety and depression⁷. That’s why I try to talk about ‘conceiving with or without intervention’ as opposed to using terms like ‘natural conception’, which can imply that fertility intervention is not common or normal.

When is a good time to consider fertility preservation, like egg freezing?

Generally, for women, looking into fertility preservation in your early 20s is not necessary (unless there are underlying medical issues – patients with cancer, for example, may want to preserve their fertility before undergoing radiation treatments).

If you’re in your late 20s or early 30s and considering pregnancy in the next five or so years, but not immediately, then it may be the time to start talking to your GP about your family planning decisions and options.

With any fertility preservation option, you want a balance of risk and benefit. Egg collection can be expensive, as can the freezing of eggs or embryos, and it’s not risk-free – it can come with complications and symptoms such as mood changes and cramping. Ultimately, you want to get bang for your buck while also ensuring doors are not closing on you.

My top three fertility tips

Before you start trying to conceive, see your GP – ideally 6–12 months beforehand. Preconception care is all about optimising health before conception to improve the outcomes for mother and baby in pregnancy. This is also the time you and your GP can address any fertility concerns.
Learn more about fertility preservation. Speak to your GP or seek out resources (like Pregnancy, Birth and Baby and the Victorian Assisted Reproductive Treatment Authority) to help you make an informed decision.
Check in on your lifestyle. Lots of factors within your control can impact fertility, like how much you drink or smoke, what you eat, or how sedentary your lifestyle is. Changing your daily habits can improve your chances of getting pregnant.

Footnotes

¹https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility

²https://www.yourfertility.org.au/everyone/timing

³https://pubmed.ncbi.nlm.nih.gov/38036244/

⁴https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility

⁵https://www.healthymale.org.au/news/age-and-male-fertility-when-right-time-have-child

⁶https://academic.oup.com/humrep/article/18/9/1959/708200

⁷https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9233676/

Dr Preeya Alexander

Dr Preeya Alexander is a general practitioner based in Melbourne and our resident AIA Vitality Expert. She’s passionate about improving health and wellbeing literacy for all Australians. A prominent expert health educator, Preeya has featured across a range of TV, news and digital media, as well as running her own successful blog, The Wholesome Doctor.

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