Infertility: know the facts

Infertility is not an issue for people until they hit their late thirties: MYTH.
"Infertility isn't an older person's disease. What I think it gets mixed up in is the fact that, as you get older, your chances of conceiving are decreased.

"At Ninewells Hospital in Dundee the average age is about 33 or 34, which is younger than people would think. A woman's fertility dips significantly after 31 or 35, depending on which statistics you use, but it's a continuum and you have to look at in that way. In the UK, the average age for patients having IVF has changed from 35 to 37. People are coming later for treatment, possibly because of more high-profile older mums, but that's a mistake. Patients who are over 40 have about a 5% chance of getting a baby from IVF.

"The age factor affects men and women. It's more pronounced for women, but for men it's a more continual decline. A man who is 50 has half the chances of being a father than when he was 25. So men need to get on with it, too."

Women have a limited number of eggs. When they run out, the menopause occurs: FACT.
"Women do have a limited number of eggs, and the quality of those eggs declines dramatically with age. Quality is one of the most important factors."

I've already had one baby, so I'll have no problems conceiving again: MYTH.
"This is a mistake for several reasons. One is that you are often a lot older; also, perhaps you could have taken quite a long time to conceive in the first place.

"Just because you've conceived doesn't mean that you won't take long, if not longer, the second time. In general, however, if you take patients at an infertility clinic, the people who have conceived before are statistically more likely to get pregnant. There's a grain of truth, but a beach of possible error."

Freezing your eggs stops your biological clock: FACT.
"Freezing eggs is not a very simple procedure. On average, of every 100 eggs that are frozen, only five are likely to make it into an embryo that can be put back into the patient. So freezing isn't that successful if you consider that for each patient you will have only three or four eggs.

"However, the statement is true in that it's the age of the biological egg which is important, not the patient."

If a woman is coming off oral contraception, it will take at least six months for her cycle to go back to normal: MYTH.
"That's not such a big issue now. Generally it is recommended to leave it just a couple of months."

Taking two aspirin a day can help fertility: MYTH.
"That just helps your general wellbeing - which is obviously related to your fertility - but, again, it's something I'd take with a pinch of salt."

Being overweight lowers your chance of conceiving: FACT.
"Yes, it does, there is no question about it. That is true for men and for women. But it refers to both ends of the weight spectrum: a very thin woman has difficulties ovulating because you need a certain amount of fat to metabolise and make the hormones.

"We have to encourage some women to put on a few pounds - but most people we see are overweight, which again changes the hormonal profile and therefore the profile of the eggs and the menstrual cycle, and makes it much harder to get pregnant. It's quite easy to lose weight but most patients don't, even when you tell them that if they don't lose 10kg then their chances of getting pregnant are very reduced. Most patients, while they are desperate for children, will not lose 10kg. It's amazing to me."

Infertility issues affect mostly women: MYTH.
"Most fertility problems arise in men - for example they have low sperm numbers, or don't have any sperm, or the sperm don't swim very well or don't fertilise the egg when they reach it. If you break down 100 patients, the single most common cause, at 28%, is that the sperm don't work very well. Ovulation disorders account for about 18%. "What surprises many patients is that we can't do anything for them. There is no real pill you can take as a man to improve your sperm numbers. If a woman doesn't ovulate, we can give her drugs to ovulate - but if a man is producing very few sperm or no sperm, we can't give him drugs to stimulate it.

"What we'll do first is try to make sure he isn't taking something that is counterproductive - for example steroids, which affect the sperm, if he's a bodybuilder. In general, it's stopping smoking and stopping drinking that will make a difference to some patients.

"If they're not doing any of that and they've still got very poor quality of sperm, we treat them either with IVF - we put the sperm around the egg - or inject the sperm into the egg."

Cycling can make men infertile: MYTH.
"If a man has been a semi-professional cyclist for a long time, it's true that the rubbing and the heat on the testes can have an effect on fertility. Sometimes, however, these cyclists are also taking performance-enhancing drugs, which also have an effect on fertility, so it's not such a straightforward case. Just cycling to work isn't going to make a difference, though."

Diabetes causes genetic damage to a man's sperm that might affect his fertility: FACT.
"There is some evidence for that. Diabetics generally have problems with erectile dysfunction anyway, so that is one cause of infertility, but the process and changes in the metabolism of the body can affect the genetic basis of the sperm. It can be tested whether that has happened. It's not a very frequent occurrence, but it can occur."

Not taking a hot bath may be one way to improve a man's fertility: MYTH.
"That comes from studies that have been done in rats. If you took a rat and put him in your bath at home, it would make him infertile. So the idea was that, if you put your own testes in the bath, it would make you infertile - which is clearly not true.

"What it does relate to is that the testes are kept at a lower body temperature than the body. There are cases of patients who are particularly susceptible to heat, so in those cases we would say: spend less time sitting down and more time walking around. For men who sit down for greater than five hours a day, compared to men who don't, there is a statistical difference between the chances of getting their partner pregnant."

Single embryo transfer lowers the success rate of pregnancy: MYTH.
"There is a significant problem in IVF with the number of multiple births that occur, and the only realistic way to deal with that is to put back fewer embryos. Historically, the more embryos you put back, the better the success rate - but that's changed in the past five or six years because the success rates in IVF have increased, so the embryo quality is better. As long as we can select those embryos - so if there were five under the microscope, we pick the good guy or girl - we can put only that one back and therefore give the patient a reasonable chance of success, compared to putting two back where one wasn't really good. That's where single embryo transfer comes in. Statistically, there is a difference between putting back two embryos and putting back one - but if you select the patients correctly there isn't."

IVM technique is safer, faster and cheaper than IVF: FACT.
In Vitro Maturation involves extracting still-dormant eggs from the ovaries and maturing them in a laboratory Petri dish. "The idea behind it is that you would mature your eggs in vitro, rather than stimulate the patient full of drugs. That can work in some cases - but a relatively limited number, where patients have got a very good chance of getting pregnant in the first place. For a patient who produces very few eggs, IVM is not a good first line of treatment.

"The technique is that you give the patients minimal stimulation, maturing the eggs in vitro and fertilising them. There are fewer drugs and therefore fewer side effects, costs, etc."

Infertility can be caused by stress. Just relax and stop trying: FACT.
"There is a lot of anecdotal evidence for that. There is biological evidence for stress affecting fertility: having to have intercourse at a certain time and constantly failing to conceive can be very stressful, and that will affect ovulation and sperm production. There is evidence to suggest you should really try to relax - but, of course, it's very difficult to do that."

When we started trying, I was very naive'

Seeta and Tahir Rashid are proud parents to a daughter, Hema, 30 months, and nine-week-old Gibran. Hema was born through IUI - where sperm are artificially placed in the uterus - and Seeta discovered she was pregnant with Gibran just before the couple started IVF treatment.

They started trying for a baby when Seeta, now 35, was 28. A year later, she visited her GP; blood tests suggested polycystic ovarian syndrome (PCOS), which ran in her family. A scan one year later revealed this was not the case, and the diagnosis was "unexplained infertility".

"At least when I had a diagnosis there was something to treat," says Seeta, who lives with her family in Kilbarchan, Renfrewshire. "When you don't have a diagnosis, it's very difficult to come to terms with - there are all sorts of things going through your head.

"The thing everybody says is: Just relax and it will happen.' People say you're just too stressed or need to stop thinking about it. But after five years it's the only thing on your mind. You want to say: we weren't stressed when we started trying.

"You think that if you start early enough there's going to be no reason for any problems. One of the myths is that problems happen to people who are older because they leave it too late or they've put their career first. You don't know whether people in their late thirties would have had the same problems earlier on.

"When we first started trying for a baby I was very naive about getting pregnant and fertility issues. The amount I've learned about how to help yourself is huge. While I was going through treatment I did change my diet: I didn't eat meat anyway but I cut out wheat, sugar and refined products, and ate fresh food and lentils.

"If you ask medical professionals about alternative or complementary therapies, they say it's up to you. It could be the placebo effect - whatever you feel is helping you. As long as what you're doing doesn't have any negative implication that is going to affect treatment, I would say go ahead with it.

I took Chinese herbs and I also did yoga.

"There's a lot of information that you're given, and some people can't take it all in. At the time, you just don't know the right questions to ask. But if you join a support group such as Cradle you can ask the questions that you're afraid to ask the doctors. You're getting first-hand experience from women who have gone through it themselves."