Do I still need to worry about the Zika virus?

closeup of a mosquito on the tip of a human finger

You may have noticed that news coverage of the Zika virus has dwindled in recent months, perhaps leaving you confused about whether it is still a concern for women during pregnancy. Unfortunately, the Zika virus is still active in many parts of the world so if you or your partner are planning travel overseas, it’s best to stay informed about the potential risk of infection. In this blog article, I explain why the Zika virus poses a risk during pregnancy, and what you can do to avoid infection.

What is the Zika virus?

Similar to other well-known diseases such as malaria and dengue fever, Zika is a mosquito-borne virus that is spread by the bite of an infected mosquito. So if your travel plans include the Northern Hemisphere, you need to keep in mind that these countries are heading into Summer and the number of mosquitos around will be on the rise.

While the infection is typically not severe in adults, around 20% of those infected will experience flu-like symptoms, such as fever, skin rash, conjunctivitis, muscle and joint pain, headache, and a general lack of energy. These symptoms tend to improve within just a few days.

Why should pregnant women worry about Zika virus?

If a pregnant woman is infected with the virus, she can pass it on to her unborn baby. Unlike in adults, the infection can have severe consequences for a developing fetus, with high chances of miscarriage or birth defects. In particular, Zika virus can cause a condition called microcephaly – where the baby’s head is small due to abnormal brain development. This can lead to seizures and intellectual disability, or in some cases, can be fatal.

Microcephaly vs normal head size

How do I avoid Zika virus infection?

The good news is that Zika virus has not spread to mosquitos in Australia. However, many other countries around the world are still affected by the virus, so the best way to prevent infection is to avoid travelling to countries with known infection risk. The Australian Department of Health categorises countries based on risk of Zika infection. You can use this resource to guide travel plans if you are pregnant or planning pregnancy. In general, it is recommended that you avoid all higher-category countries. For travel involving countries in lower categories, it is recommended that you seek an individual risk assessment from your GP, obstetrician or a doctor who specialises in infectious diseases.

What if I cannot avoid travel to one of these countries?

If you must travel to a Zika-affected country, you should talk to your doctor about how you can reduce your risk of infection. Of course, the most obvious way to do this is to undertake all appropriate steps to avoid being bitten by a mosquito.

Are there other ways to contract Zika virus?

Although mosquito bites are the most common way the Zika virus spreads, it can also be transmitted through sexual activity. Because of this, it is important that you also factor in your partner’s potential exposure to Zika virus. Whether you are already pregnant or planning a pregnancy, it is recommended that you avoid unprotected sex for at least 8 weeks if your partner has been in a Zika-affected country. Alternatively, if you have travelled to a Zika-affected country and are planning a pregnancy, you should avoid unprotected sex and pregnancy for at least 8 weeks following your return. In either scenario, consider testing for Zika exposure prior to having unprotected sex.

Can Zika virus infection be treated?

Currently there are no treatments for Zika virus infection. However, the World Health Organization has declared the development of a Zika vaccine a global health priority, and vaccination trials are showing promise. Until a treatment or vaccine has been proven effective, it is important to keep up to date with the latest precautionary advice.

Are your upcoming travel plans worrying you?

If you are concerned about your travel plans, you can arrange a personal risk assessment by calling my rooms on (03) 9418 8299 or booking online. Alternatively, contact your GP or closest travel clinic.

Should I get the flu shot while pregnant?

a medical practitioner with gloved hand applying a needle shot into a woman's arm

With Autumn upon us, it’s time to prepare ourselves for the upcoming flu season. Soon you’ll see public health messages encouraging you to get the flu shot to protect yourself and those around you from an infection that can knock you around for a several days, with potentially serious consequences for the more vulnerable in our community.

If I’m pregnant, is it safe and recommended to have the flu vaccine?

Yes. In fact, because pregnant women are considered a ‘high-risk’ group when it comes to the flu, health authorities recommend that all pregnant women should have the flu shot. And to make sure the vaccine is accessible, the flu shot is free for all pregnant women under the National Immunisation Program.

The flu can be severe and cause serious complications in pregnant women and their unborn babies, especially when infection occurs in the second and third trimesters. Sadly, if a pregnant woman is infected with the flu, her risk of miscarriage, premature birth or stillbirth is increased, as is her risk of severe illness or death.

When should I get the flu shot?

It is safe for you to have the flu shot at any time during your pregnancy and your doctor will advise you when the best time is for you.

Because the virus that causes the flu mutates rapidly, a new flu vaccine is developed every year. In Australia, the new vaccine is released in April, so people can develop immunity to this year’s strain before the flu season sets in.

How does the flu vaccine work?

If you’ve never had the flu shot before, it is a very quick process where a nurse or doctor administers the vaccine via injection.

The vaccine itself works like all other vaccinations. Put simply, it takes advantage of your body’s natural immune system, using it to build resistance to the virus without you coming into contact with the virus itself. That way, if you are exposed to the flu, your body recognises the virus and knows how to fight it – which we call being immunised.

Because the virus that causes the flu changes rapidly, immunisation for the flu doesn’t cover you from one year to the next, so you need to have a flu shot for each pregnancy.

What other vaccines should I have while I’m pregnant?

Pregnant women should also have the whooping cough (pertussis) vaccine during the third trimester of pregnancy. The ideal timing is between weeks 28 and 32 of pregnancy, but it can be given up until the baby is born.

Immunisation against whooping cough is very important because it can cause pneumonia, seizures, brain disease and, in the worst cases, death of the baby. Newborn babies can’t be vaccinated for whooping cough until they are 6 weeks old, so they are vulnerable to infection during that time. However, if the mum is immunised near the end of pregnancy, it provides some level of immunisation for the baby to protect them during their first few weeks of life.

In Victoria, the whooping cough vaccine is free for:

  • Pregnant women from week 28 of pregnancy onwards
  • Partners of pregnant women if they have not received a whooping cough booster (follow-up shot) in the last 10 years
  • Parents or guardians of babies born on or after 1 June 2015, if the baby is 6 months of age or younger and they have not received a whooping cough booster in the last 10 years.

A booster shot for whooping cough is needed each time you are pregnant.

Are these vaccines safe for my baby?

The flu and whooping cough vaccines will not harm an unborn baby and have been given to millions of pregnant women around the world. A recent study of over 400,000 babies reinforced that the flu and whooping cough vaccines are safe, showing that babies whose mums had the vaccinations while they were pregnant were no more likely to die or be hospitalised than babies whose mums did not.

What about other infectious diseases?

There are other key vaccines that will protect you and your baby against serious infectious diseases, but for safety reasons these are not given to pregnant women. As these are standard vaccinations, you are likely to be immunised for most if not all already.

If you are planning a pregnancy, speak to your doctor before you become pregnant to ensure you are immunised for measles, mumps and rubella, chickenpox, pneumococcal disease and any necessary travel vaccinations you may need during your pregnancy. Find out more about how to prepare for pregnancy here.

I need vaccinations – what next?

My patients are automatically offered flu and whooping cough vaccinations as part of their pregnancy care. These are stocked at my main consulting suite at Epworth Freemasons. The flu vaccine will be given as it becomes available during the flu season and the whooping cough vaccine will be given in the third trimester of pregnancy. Unfortunately, partners will need to visit their GP to receive these immunisations.

Otherwise, if you are already pregnant and require the flu and/or whooping cough vaccines, make an appointment with your GP.

If you are planning a pregnancy, book a consultation with me to make sure your vaccinations are up to date and to get other personalised advice on preconception care. Call (03) 9418 8299 to make an appointment or book online.

And if you have any questions about which vaccinations you need before and during pregnancy, please don’t hesitate to call my rooms on call (03) 9418 8299.

Should I freeze my eggs?

a patterned layout of eggs on a flat surface

This is a huge question that can weigh on the minds of women who are at a point in their life when they are not ready or able to have a baby, but don’t want to lose the possibility of it happening in the future. Social egg freezing – that is, having eggs removed from your ovaries and stored for future use because of personal (not medical) reasons – is a relatively new development in the world of fertility treatment. Until a few years ago, women didn’t have a way to ‘press pause’ on their biological clock, but now they can.

Of course, nothing is that simple. Here I’ll outline the factors to consider when it comes to deciding whether egg freezing is right for you.

But first, what exactly is egg freezing?

A woman’s eggs are what she needs to have a baby. When you are born, you have a reserve of millions of eggs in your ovaries, but this number steadily declines throughout your life until it runs out. Every month during your menstrual cycle, several immature eggs start to develop, but only one reaches maturity and is released from the ovaries (the others die). After ovulation, the mature egg is ready to be fertilised by sperm.

Egg freezing is a way to collect a number of mature eggs and preserve them for fertilisation at a later stage, outside of the body, by in vitro fertilisation (IVF). The steps for egg freezing are the first two steps in the IVF treatment cycle, which I have outlined here. To explain it briefly, you self-administer hormone injections over a few weeks to make your body produce multiple mature eggs ready for ovulation and then undergo a quick surgical procedure to collect these eggs from your ovaries. The eggs are then frozen by a method known as vitrification, which keeps them viable for use in years to come.

You’re not using up your future egg supply by going through this process – egg stimulation simply makes use all of the eggs from a cycle. It won’t lead to premature menopause.

Timing is everything

One of the most common questions I am asked is ‘when is the best time to freeze my eggs?’. Personal circumstances make this slightly different for everyone, but there are some general rules to go by. Younger eggs are better quality, and when you are young more eggs are available for collection. Because the number and quality of eggs rapidly declines after the age of 35, I generally recommend freezing your eggs before then and definitely not after the age of 38. In Victoria, you can legally store your eggs for 10 years (after which you can apply for an extension) so consider whether you’ll actually want to use them in that timeframe. And if you are younger, there’s still a chance you will conceive naturally when the time comes, in which case undergoing this procedure may not be necessary.

Pregnancy is not guaranteed

While freezing your eggs is a reliable procedure that can help put your mind at ease, I always stress to my patients that it does not guarantee a successful pregnancy in the future.

Once your eggs are ready to be used, there are a number of steps involved before a pregnancy is achieved (steps 3–7 of the IVF process outlined here). Unfortunately, at each step there is a chance that the process will not work. Some eggs may not be viable after they are thawed, some may not fertilise, some fertilised eggs may not survive, and those that are fertilised may not successfully implant into the womb. That’s not to say that women don’t have success with the egg freezing process, but it’s important to be aware of these facts when considering freezing your eggs.

As I mentioned earlier, the quality of your eggs is related to your age when they were frozen. Older women have fewer eggs retrieved and reduced quality eggs, so they generally have less success with egg freezing and subsequent pregnancy. On average, a woman who had her eggs retrieved at 30 may need around 10 eggs to have a baby, whereas a woman who was 40 when she had the procedure may need up to 20 eggs (though it may be harder to actually retrieve that many eggs in an older woman).

Some media reports claim egg freezing has a very low success rate, but it’s important to remember that the newer freezing process (vitrification) is expected to yield better survival rates of thawed eggs than the older method. There isn’t a lot of data available for these eggs, as the majority are yet to be used.

It’s an investment in your future

For social egg freezing (i.e. not for a medical condition), there is no Medicare rebate. However, if you get a referral letter to see fertility specialist, you may get a rebate for your consultation and tests. Costs incurred for the whole egg freezing process include the treatment cycle, medications, day surgery and anaesthetist fees, initial freezing and then an ongoing yearly fee for egg storage. On average, you can expect to spend around $10,000 for the whole process.

Some medical conditions attract a Medicare rebate for egg freezing

When egg freezing is recommended due to a medical condition affecting your fertility, your treatment may attract Medicare benefits. This assessment can only be made after thorough consultation with a fertility specialist. Medical egg freezing may be necessary for conditions such as:

  • Breast cancer and other cancers
  • Severe endometriosis
  • Fibroids
  • Polycystic ovary syndrome (PCOS).

Choose a reputable specialist and clinic

Because of the financial and emotional investment in egg freezing, you want to know you’re in the best hands possible. Choose an experienced fertility specialist who practises at a reputable fertility clinic with the latest technology (e.g. vitrification) to increase your chances of a successful pregnancy down the track. I perform the egg freezing process at Newlife IVF, one of Australia’s leading fertility treatment centres with high success rates.

Egg freezing isn’t your only option for having a baby

Freezing your eggs is one way that you can increase your chances of having a baby in the future. But it’s not the only option. Other fertility treatments may be better suited to your situation. I offer a range of treatment options so you can find the solution that works for you.

You can also consider:

  • Freezing embryos – If you have a partner but you’re not quite ready to have a baby for career or other reasons, it may be better to freeze embryos rather than eggs. This is because not all frozen eggs are viable. If they make it to the embryo stage before being frozen, that’s one step closer to a successful pregnancy.
  • Donor sperm – If not having a partner is holding you back from having a baby, but you’re ready to become a mother, donor sperm is an option. There are a number of ways donor sperm can be used to help you achieve a pregnancy, including intra-cytoplasmic sperm injection (ICSI), intrauterine insemination (IUI) and IVF.
  • Donor eggs – Women who are not suitable for egg freezing can consider using donor eggs to become pregnant. The donor egg can be fertilised by sperm and implanted in your womb or a surrogate’s womb.

Is egg freezing for you?

At your first consultation, we will have a comprehensive discussion about egg freezing and undertake some tests to see if your ovarian reserve means that it is a possibility for you. We’ll also have a detailed discussion about your other options, so you can make an informed decision about the best step forward for you. To make an appointment, call (03) 9418 8299 or book online.

Can my diet really affect my fertility?

woman at kitchen counter wearing an apron and chopping fruits

While it’s common for women to avoid certain foods once they find out they are pregnant, making changes prior to conception can be even more beneficial – particularly if you are having trouble conceiving. While most people readily associate age and certain medical conditions with fertility problems, it’s less well understood that day-to-day lifestyle factors such as diet, weight, smoking and alcohol intake, can also impact how fertile we are. In this article, I focus on how diet affects fertility.

Food and drink can play a role in your ability to fall pregnant.

The impact of diet on ovulation

The main way diet affects fertility is through ovulation. Problems with ovulation – the process by which a woman’s egg becomes available for fertilisation each month – represent around a quarter of all infertility cases. Adequate hormonal function is essential for successful ovulation. Unfortunately, a poor diet can play havoc with our hormones, which in turn, can lead to ovulatory issues. This means that eating certain foods and avoiding others can actually improve our fertility. Indeed, when the Harvard School of Public Health asked women with irregular or absent ovulation to change their diet (and exercise) habits, those who changed five or more aspects of their diet (and exercise), reduced their risk of infertility by 80 percent!

Food-led hormonal imbalances

Most women are familiar with hormones like oestrogen, progesterone and testosterone but when it comes to diet and fertility, the hormone we tend to be most interested in is insulin. Excess insulin in your body can interfere with ovulation by stopping eggs from maturing properly and increasing ovarian cyst formation. A woman will often have high insulin levels if she eats a carbohydrate-dominant diet with lots of sugar and starchy foods, e.g. white bread, white flour, white potatoes, white rice. This type of diet forces the pancreas to release a lot more insulin than usual to help the body metabolise the large amount of carbohydrates being consumed.

So what kind of dietary changes will aid ovulation?

The simplest rule is to limit your intake of anything containing sugar (refined carbohydrates), along with foods high in ‘trans fats’ (e.g. commercial baked and snack foods, french fries and some margarines), which can all raise insulin levels and impair ovulation. The best way to avoid these kinds of foods is to just eat ‘real food’, i.e. foodstuffs that have not been processed but have simply been grown or farmed, like vegetables, eggs and animal meat. Increasing your intake of fatty acids like omega-3 (found in flaxseed, fish oil, salmon, sardines and walnuts) is also recommended, as it contains hormone pre-cursors, therefore helping to stimulate ovulation. Patients are sometimes surprised that I don’t recommend intake of fruit at all. Fruit is not essential and is very high in sugar, and therefore intake should be minimised. In terms of what you consume, don’t forget about what you drink. One of the most common causes of insulin excess is the regular intake of sugary soft drinks and sports drinks. Eliminating these drinks from your diet is a great strategy for reducing the amount of sugar in your diet. Water, herbal teas and full-cream milk are a much better choice.

It’s not all about excess

Food is an important source of vitamins and minerals. Unfortunately, some foods have very little nutrient value. If you haven’t been prioritising the ‘good stuff’, you may be lacking in one or more vitamins or minerals. Deficiencies in iron, vitamin D, selenium and iodine are all linked to lower ovulation rates. While a pregnancy-specific daily multivitamin is recommended for all women trying to conceive, it should not be used in place of a wholesome diet. Choose spinach, beans, pumpkin, tomatoes and beetroot to improve your intake of iron and other important nutrients.

What about him?

While men don’t ovulate, they do need to provide their partners with healthy numbers of healthy sperm – a process also ruled by our hormones. A healthy weight and diet can also improve a man’s ‘hormonal milieu’. Therefore, men can also follow the dietary and lifestyle advice provided for women above. This will aid sperm number and quality, further enhancing a couple’s chances of conceiving.

Advice specific to you

For expert advice specific to your personal circumstances, contact my rooms to make an appointment – call (03) 9418 8299 or book online.

Starting a family as a same-sex couple

a female hand holding a rainbow heart over her belly

Thanks to advances in fertility treatment and recent legislative changes, it’s very feasible for same-sex couples to have a family. But with the unique fertility challenges that same-sex couples face, what is an incredibly exciting time can also be a bit daunting. Rest assured that there are fertility specialists out there, like myself, who are experienced at providing fertility treatment for gay or lesbian couples and can give you the special level of guidance and support that you need.

I have been fortunate to help a number of same-sex couples have a baby, and the journey for every couple is different. For a gay or lesbian couple, I draw on the same fertility treatments that I use for heterosexual couples or single women, such as IVF, intrauterine insemination (IUI) and donor sperm. To help you understand the process it could take for you and your partner to have a baby, I’ll describe a few different scenarios that I have used for my patients to achieve their dream of starting a family.

There are various fertility treatments for same-sex couples

A lesbian couple wants to have a baby and they have a friend who has agreed to be their sperm donor. What are their options?

There are a few different fertility treatments that could be used to help this couple become pregnant. Firstly, I’ll make the point that women in same-sex couples face the same fertility issues as all other women – that is, the amount and quality of a woman’s eggs declines with age and women with certain conditions (e.g. PCOS or endometriosis) may have difficulty getting pregnant. I generally recommend doing some initial tests to assess each partner’s chances of becoming pregnant and whether any additional treatments are required.

The couple then needs to decide whose egg will be used and whether the same woman will carry the baby during the pregnancy. This decision dictates the type of procedure we will use. ‘Assisted conception’ can be used when the same woman whose egg is used will also carry the pregnancy. There are a few different assisted conception techniques. Essentially, these all involve a fertility specialist performing a procedure to place the donor sperm inside the woman’s body to facilitate fertilisation.

The other scenario, where both mums play a role in the pregnancy, requires assisted reproductive technology (ART). ART is where fertilisation occurs outside the body in a lab setting – the best-known type of ART is IVF (see below).

Let’s say in this instance the couple has decided to go with assisted conception. Both mums, and the donor, need to go through counselling and provide consent before we can initiate any treatment. This is so that everyone involved in the process understands the implications of the situation. For example, even though the donor is ‘known’, they still need to understand that their information will be accessible to the child from age 18.

The couple can choose to have screening performed to test whether the donor sperm carries medical and/or genetic diseases that could be passed on to the child. Provided the results of screening are negative, we’ll then proceed with treatment.

The most common assisted conception procedure I perform is intrauterine insemination (IUI), which takes about as long and feels similar to a pap smear. This fertility treatment is available to couples where the woman is 40 or younger. During the insemination procedure, a very fine tube (about 1mm in diameter) delivers the prepared sperm through your cervix and directly into your uterus. The procedure will be timed to coincide with ovulation and you may need to take some hormones to increase your chances of becoming pregnant.

As an alternative, the couple could choose to perform ‘home insemination’, rather than coming into the clinic for IUI. This involves you tracking the timing of your ovulation and inserting the fresh donor sperm using a small syringe. Home insemination has the advantage of being economical and convenient but lacks the protection against infectious diseases that IUI can provide.

How can a fertility specialist help a lesbian couple who want to share the pregnancy and require donor sperm?

When both mums are physically involved in conceiving the baby, it’s known as ‘partner IVF’ – one mum will undergo ovary stimulation and egg retrieval (steps 1 and 2 of the IVF process), the egg and donor sperm will then be fertilised in a lab and the embryos are grown (steps 3 and 4) before being transferred into the womb of the other mum (step 5). The woman who is carrying the pregnancy will take hormones in the lead-up to the transfer of the embryo to prepare her body for pregnancy.

When a couple requires donor sperm, I can help them through the process of finding and choosing a donor. All ‘clinic-recruited’ donor sperm (i.e. unknown to the recipient) is rigorously tested and quarantined for several months before use. Upon donating sperm, the donor consents to identifying information being accessible by the child at age 18.

Counselling is also an important part of the process – it ensures that the couple has had a chance to fully understand the implications of using donor sperm and what it means for their future child.

How can a fertility specialist assist a gay couple who want to have a baby?

Helping a gay couple have a baby is more complex because it requires surrogacy, but it is possible. While surrogacy is becoming more accessible in Australia, it is still difficult for a few reasons:

  • The couple must find a surrogate themselves – unfortunately, this is not something a fertility specialist can help with. The Victorian Assisted Reproductive Treatment Authority (VARTA) provides advice on finding a surrogate.
  • By law in Victoria, the same woman cannot donate her eggs and be the surrogate. Therefore, couples must find a separate egg donor and surrogate.
  • In Australia, surrogacy must be altruistic – a person cannot be paid to carry a pregnancy for you.
  • The surrogacy process requires extensive counselling, psychological assessment, a consenting process, independent legal advice and health screenings.
  • In Victoria, surrogacy cases need to be approved by a surrogacy ethics committee and a patient review panel.

As mentioned above, in addition to finding a surrogate, gay couples also need an egg donor. This can be someone you know or – unlike surrogacy – you can seek help from a fertility specialist to find one. For example, I can help my patients source a donor from the world egg bank
Once a couple has both an egg donor and a surrogate, they then need to decide whose sperm will be used to fertilise the egg. I recommend undertaking some fertility tests to check sperm quality before commencing treatment.

The fertility treatment used in this situation is IVF (from step 3 onwards). The dad’s sperm is used to fertilise the donor egg, and then the fertilised embryo is implanted into the surrogate’s womb to start the pregnancy.

Talk to a fertility specialist who understands your unique situation

These are just a few examples of ways that same-sex couples can achieve a pregnancy – the procedure that’s right for you as a couple will depend on your age, health, preferences and whether you have known donors or require assistance finding a donor.

My role as a fertility specialist is to not only perform the procedures that allow you to start your family, but also to help you understand your options and the expected success rates, and answer any questions you may have. I’ll also ensure that you feel adequately counselled before consenting to go through with any fertility treatment to help you have a baby.

Perhaps the most important message is that it’s never to soon to speak to a fertility specialist and find out what your options are. So if you feel ready to make an appointment and take the first step towards starting your family, call my rooms on (03) 9418 8299 or book online.

A guide to your contraception options

a package of contraceptive pills

Finding the contraception that works for you isn’t always easy. Some women experience side-effects from certain types of birth control, while others need a method that is easy to adhere to. Thankfully, there are plenty of different contraception options, so you will be able to find the one that’s right for you. Read this guide to understand the contraceptive methods that are currently available to you.

Combined oral contraceptive pill (The pill)

‘The pill’ is a daily tablet and is a very popular contraceptive choice. It’s over 99% effective at preventing pregnancy if taken properly (i.e. at the same time every day), but it’s common for people to forget to take the pill or take it late, which reduces its effectiveness to around 93%. The contraceptive effects aren’t immediate – it takes 7 days before the pill works, and if you miss a day, you need to take it properly for 7 days before it is effective again.

The pill contains two hormones – oestrogen and a synthetic version of progesterone called progestogen. By changing the hormone balance in your body, the pill stops you from ovulating and also makes the mucus in your cervix thicker, which prevents sperm from entering your uterus.

There are various brands of the pill, each with a different ratio of hormones. You may need to try a few different types to see what one works well with your body, particularly if you experience side-effects such as nausea, breast tenderness, breakthrough bleeding or mood changes or depression.

Many women don’t experience any side-effects and actually find that the pill makes their period more bearable (shorter, regular and lighter) and that it clears up acne. The pill can also help to manage symptoms of PCOS and endometriosis.

Because the pill is associated with an increased risk of some serious health problems, a doctor will determine if you are suited to this method of contraception. Women who are breastfeeding should not use the combined pill.

Progestogen-only pill (The mini pill)

Known as the mini pill, the progestogen-only pill is a daily tablet that prevents pregnancy by changing the hormone levels in your body. Progestogen prevents pregnancy by creating a thicker layer of mucus at the cervix (thus stopping sperm from entering the uterus) and by changing the lining of the uterus so that a fertilised egg cannot implant in it. When taken at the exact same time every day, which can be difficult, the mini pill is over 99% effective, but with typical use it’s more like 93%.

As the name suggests, this pill only includes progestogen and not oestrogen. Women who have difficulty with contraceptive methods that contain oestrogen (e.g. the combined pill) may be better suited to the progestogen-only pill. Compared to the combined pill, the mini pill has fewer side-effects and may be used while breastfeeding. Some women experience spotting between periods or have periods further apart than normal while using the mini pill, and you may also notice skin changes or mood changes initially, but these usually settle with time.

You’ll need to talk to a doctor to see if you can take the mini pill.

Hormonal intrauterine device (IUD) (Mirena)

Often referred to by its brand name ‘Mirena’ in Australia, the hormonal IUD is a small T-shaped device made of plastic. The device sits in the uterus and releases progestogen, which prevents pregnancy by thickening the cervical mucus and changing the uterus lining. It sometimes also stops the ovary from releasing an egg.

The Mirena works in the same way as the mini pill but, because forgetting to take tablets isn’t an issue, it’s the most effective reversible contraception available – being over 99.5% effective at preventing pregnancy. There are minimal side-effects, it may be used while breastfeeding, and there’s the added benefit that it makes bleeding lighter or stops periods completely.

Once in place in the uterus, the hormonal IUD lasts up to 5 years but can be removed at any time. The device has a fine thread attached to it that allows you to check that it is in place and makes taking it out easier. Apart from when you check that it’s in place, you shouldn’t be able to feel the IUD.

You’ll need to talk to a doctor to see if the Mirena is an option for you and if so, it will need to be inserted by a doctor (usually a gynaecologist).

Copper intrauterine device (IUD)

The copper IUD is a very small coil made of copper and plastic that sits in the uterus. The copper prevents pregnancy in two ways –  it makes sperm unable to survive in the womb, and it also causes changes in the uterine lining that prevent a fertilised egg from being able to attach and start a pregnancy.

Being over 99% effective at preventing pregnancy, the copper IUD is one of the most effective methods of contraception and it has the major benefit of lasting for 5–10 years without you needing to do anything. When in place, the IUD usually cannot be felt by you or your partner during sex. However, there is a piece of thread that lets you check that it is in place, which also makes it easy for a doctor to remove when necessary.

There are minimal side-effects associated with the copper IUD and it’s a great choice for women who prefer a non-hormonal contraceptive option. Some women experience heavier bleeding and cramping for the first few months, but in most cases this resolves.

The IUD needs to prescribed by a doctor, and a doctor (usually a gynaecologist) will place the device in the uterus through the vagina. You’ll also need to visit a clinic to have the IUD removed or replaced.

Contraceptive implant (Implanon)

The contraceptive implant is a thin plastic rod roughly 4 cm long that is inserted under the skin of the inside of the upper arm. It works the same way as the mini pill and hormonal IUD to prevent pregnancy – by releasing progestogen, which increases cervical mucus and stops the ovary from releasing an egg. The Implanon is over 99% effective.

The implant is a good option for women wanting a long-lasting contraceptive option where they don’t need to do anything – it lasts for 3 years, but can be removed at any time in a quick procedure. Around 20% of women will have no period with the implant and others may have irregular periods. Most women tolerate it well but some experience weight gain, acne and mood changes and may choose to have it removed.

Tubal ligation (sterilisation)

A laparoscopic (keyhole) surgical procedure known as tubal ligation can stop you from being able to conceive. You may have heard this referred to as ‘having your tubes tied’ – in reality, the surgeon either places permanent clips on the fallopian tubes (so eggs cannot travel down the tube to be fertilised in the uterus) or removes the fallopian tubes completely (so eggs cannot travel between the ovary and uterus). Removal of fallopian tubes has been associated with a reduced risk of developing cancer.

The effects are immediate after surgery and there is nothing you need to do going forward to prevent pregnancy. In addition, there are no long-term side-effects after surgery – however, the usual risks associated with any surgical procedure do apply. It’s important to note that around 1 in 400 times the surgery is performed it is ineffective.

If your fallopian tubes are removed it is permanent and irreversible. When clips are used, a tubal ligation can be reversed and your chance of having a baby will be around 50%. Because of this, tubal ligation is generally reserved for older women who are sure that they do not want to have any (or any more) children.

Vaginal ring (NuvaRing)

The vaginal ring is a small, flexible, plastic ring that you insert high into your vagina, similar to inserting a tampon. You can think of it like the combined pill, but instead of taking a daily tablet, the ring releases oestrogen and progestogen over 3 weeks. For the fourth week of your cycle, you remove the ring to allow a monthly bleed. Most women don’t feel it, but some women do struggle to keep it in place. If used properly, you shouldn’t feel it during sex.

This method has the same benefits, side-effects, potential health problems and effectiveness at preventing pregnancy as the combined pill – it’s 99% effective with perfect use, but with typical use this drops to around 93%.

In Australia, the brand name of the vaginal ring is the NuvaRing. It’s not PBS-listed, so it is a more expensive contraceptive option. However, some women opt for this method if they struggle to take the pill every day but can remember to change the ring after 3 weeks. The NuvaRing needs to be prescribed by a doctor – you pick it up from the pharmacy and insert it at home yourself.

Condoms

Condoms don’t need an explanation – I’ll just state that they are 98% effective at preventing pregnancy when used correctly, but with typical use this reduces to around 85%. Condoms have the added benefit of reducing the risk of STIs.

Fertility awareness

In 2018, it’s probably unsurprising that there are apps that can be used for tracking your fertility. But you may be surprised to learn that an app has been approved by the FDA as an effective birth control. Natural Cycles requires you to measure your temperature at a set time each day and input that into the app to track your ovulatory cycle. The app then lets you know whether you are fertile that day, so you know when to avoid sex or use other protection (in which case the effectiveness at preventing pregnancy will depend on that particular method).

Natural family planning has no side-effects and, if used perfectly (i.e. sex is avoided on ‘fertile’ days), the method has around the same rate of effectiveness as the pill. However, fertility awareness as a form of contraception won’t be ideal for everyone. It’s particularly ineffective for those with irregular periods and if you are unlikely to be able to abstain on the recommended days.

A gynaecologist can assess which of these contraception options is suitable for you

So there you have it – there are many different contraceptive options that you can use if you wish to avoid becoming pregnant. From long-term methods that alter hormones to temporary barrier methods, what works for each woman is different and will likely change over time.

If you want further advice on your contraception options or specific advice about what you should use if you have an existing medical condition, call (03) 9418 8299 or book online to make an appointment.

Understanding miscarriage

woman reclining in hospital bed with a closeup of somebody holding her hand

Miscarriage, or the loss of a pregnancy in the first 20 weeks, is not uncommon. In Australia, it’s estimated that around one in five confirmed pregnancies end in miscarriage, and even more women miscarry without knowing they were pregnant in the first place. The risks are highest in the early stages of pregnancy, especially in the first trimester (up to 12 weeks), which is why many couples choose to wait until passing this stage of pregnancy before sharing their news more broadly.

Going through a miscarriage can be devastating. There is no right or wrong way to feel and it’s normal to experience a range of emotions. Many women and their partners require support through this difficult time – there are support services for people dealing with miscarriage, or you can speak to your doctor for advice. While it can take time to recover from the loss of a pregnancy, it’s important to remember that most women who miscarry will go on to have a healthy pregnancy in the future.

What causes a miscarriage?

There are two broad requirements for a successful pregnancy. Firstly, the embryo (or developing baby) needs to be healthy, which largely depends on the health of the egg and sperm. Secondly, the mother’s body – particularly her uterus and fallopian tubes – must be able to establish and carry a pregnancy.

If something goes wrong with any of the steps that are needed for a healthy pregnancy, it can result in miscarriage. It’s important to note that almost always, the factors that lead to loss of a pregnancy are outside of the mother’s control. So, it might help to think of these as reasons a miscarriage occurred, rather than causes.

For example, one of the most common reasons for a pregnancy ending is that the embryo has an abnormal genetic make-up (e.g. too many or too few chromosomes), which eventually prevents the baby from progressing through the normal stages of development. This can happen by chance at conception – when the sperm fertilises the egg – and there is nothing that can be done to prevent the miscarriage.

In other cases, the pregnancy may not be viable if the embryo fails to implant into the uterus wall, because this means the baby can’t get the nutrients it needs to grow properly. Generally speaking, a single miscarriage is considered relatively normal, and the next pregnancy will most likely be successful.

What factors increase the risk of miscarriage?

We know that as women age, their rate of miscarrying increases (see Figure 1). This is due to a decrease in the quality of a woman’s eggs as she ages, with more eggs having chromosomal abnormalities. Likewise, as men age they start to produce more abnormal sperm, which can have genetic defects. Both of these factors increase the chance of having a baby with a genetic abnormality that leads to miscarriage. So, if either parent is older – e.g. the mother is over 35 or the father is over 45 – and the couple has a miscarriage, it may be worth seeking specialist fertility help as early as possible.

Another scenario where a sole miscarriage may be of concern is when a couple has been trying to get pregnant for a long time, and then they lose the pregnancy. The initial struggle to get pregnant may indicate that there is an underlying issue preventing successful pregnancy, so the sooner expert help is sought, the better.

Maternal age miscarriage rate (%)

Other factors that increase the chance of having a miscarriage include:

  • Smoking
  • Serious infections and high fever
  • Hormonal imbalance
  • Anatomical abnormalities (e.g. of the uterus, fallopian tubes or cervix)
  • Chronic diseases such as diabetes, lupus or PCOS.

It’s also important to limit alcohol consumption and reduce your caffeine intake to one coffee per day if you are trying to become pregnant.

Seek medical help for multiple miscarriages

When a woman has three miscarriages in a row, with no normal pregnancy in between, we call this ‘recurrent miscarriage’. When multiple, continuous miscarriages occur, it is more likely that there is a specific reason the pregnancies are unsuccessful. If this happens to you, it’s important to seek the help of a fertility specialist, who will try to determine the cause, and whether it is treatable. While it is common for women to suffer from miscarriage, recurrent miscarriage only affects around 1% of couples.

Speak to a specialist

When dealing with a miscarriage, the uncertainty around your likelihood of a healthy pregnancy in the future may be distressing. If you have suffered a miscarriage or you’re at heightened risk of miscarrying and need the help of a specialist, please make an appointment by calling (03) 9418 8299 or book online.

Pregnancy weight gain: is there a right amount and why does it matter?

pregnant woman holding belly while standing on a scale

Pregnancy weight gain is normal and healthy. While you’re pregnant you’ll progressively gain weight to support your baby’s growth and development and to prepare your body for breastfeeding. However, a recent global study has found that nearly 75% of women don’t gain a healthy amount of weight during pregnancy, with 23% not gaining enough weight and 50% gaining too much. So what is the right amount of weight to gain and why does it matter?

How much weight should you gain?

While every woman will gain weight differently during pregnancy, your total weight gain for the entire pregnancy should sit somewhere between 11.5–16 kgs. All women can expect to gain 1–2 kg during their first trimester (up to 3 months). From there, your ‘healthy’ rate of weight gain depends on how much you weighed before you became pregnant. If you were carrying some extra weight before pregnancy, you are advised to gain less weight than someone starting off in a lower weight range:

Pregnancy weight gain chart

Pre-pregnancy weight Total weight gain recommended Recommended weight gain per week in second and third trimesters
(3–9 months)
Underweight (BMI <18.5) 12.5–18 kg 500 grams
Normal weight (BMI 18.5–24.9) 11.5–16 kg 400 grams
Overweight (BMI 25–29.9) 7–11.5 kg Less than 300 grams per week
Obese (BMI ≥30) 5–9 kg Less than 300 grams per week

Source: US Institute of Health

If you are carrying twins or triplets, you will need to gain more weight in order to provide enough nutrients for all of your babies. In this case, your total weight gain for the pregnancy should sit higher at around 11–24 kg (depending on your BMI before becoming pregnant).

Why is gaining too much weight a problem?

Excess weight gain during pregnancy can increase your risk of medical complications. The most serious of these is pre-eclampsia, a condition where the blood flow to the placenta is restricted, meaning your baby may not get the oxygen and nutrients it requires. Pre-eclampsia is characterised by high blood pressure, severe fluid retention and protein in the urine, all of which are signs we monitor for during your routine antenatal visits. Gaining too much weight also puts you at increased risk of gestational diabetes, a type of diabetes that occurs during pregnancy due to hormonal changes that make it harder for your body to keep blood sugar levels in check. Unfortunately, if you are overweight when entering pregnancy, your risk of these particular complications is even higher (you can read more about that here).

In the longer term, the extra weight you put on during pregnancy (over and above what you and your baby really need) does tend to be harder to lose. And this sustained increase in weight can elevate your risk of suffering from a range of health conditions such as type 2 diabetes and high blood pressure – making it hard for you to keep up with your growing/busy child.

Gaining too much weight during pregnancy can also impact the health of your baby. If you are overweight while pregnant, your baby is more likely to be born overweight, to be large for gestational age (i.e. be larger than expected given the stage of your pregnancy) and to require a caesarean delivery. Because excessive weight gain can adversely affect placental function, having a baby that is too small (growth restriction) is more likely too. Your child is also more likely to suffer from childhood obesity and to develop metabolic syndrome (heart disease, stroke and diabetes) in later life.

Why is gaining too little weight a problem?

While it’s important for your own health and the health of your baby to keep weight gain in check during pregnancy, it’s also important that you do not try to lose weight during your pregnancy. If you diet, skip meals or restrict your intake of certain food groups, your baby may not get the nutrients it needs for its development. This can lead to premature birth and/or increase the likelihood that your baby will be underweight and small for gestational age.

How can I safely manage my weight during pregnancy?

Not ‘eating for two’ and making sure that what you are eating is, for the most part, healthy and nutritious, is one of the best ways to achieve a healthy pregnancy weight. I recommend women follow a low sugar and carbohydrate diet such as this one from the CSIRO. Many established guidelines on healthy eating during pregnancy are old fashioned, and may promote weight gain by encouraging intake of fruits (high in sugar) and carbohydrate-rich foods containing refined flours such as pasta and bread, which should really be avoided. For SAFE EATING practices during pregnancy, see this handy guide.

It’s also important to remain active during pregnancy – exercising is both safe and healthy, and has benefits for you and your baby. The recommended level of activity changes during the course of your pregnancy (see this helpful guide) and also depends on how much exercise you were doing before you became pregnant. In general, you should do at least 30 minutes of moderate-intensity physical activity on most days of the week. You can find more information on the benefits of exercise during pregnancy and suggested exercises here. Of course, you should always check with your doctor before embarking on any new exercise routine.

Need help establishing a healthy pregnancy lifestyle?

If you would like more information or feel like you are struggling with pregnancy weight gain, diet or physical activity, don’t hesitate to raise these topics with me during your next antenatal appointment. For advice in-between appointments, call my rooms on (03) 9418 8299.

Food safety during pregnancy

woman sitting with a plate of artistically arranged fruit

A safe and healthy diet during pregnancy is vital to ensure normal development of your baby. You’ve probably heard that you shouldn’t eat raw fish and soft cheeses, but there’s more to making safe choices than simply steering clear of one or two foods.

As a general rule, it’s recommended that you avoid raw, unpasteurised or pre-prepared foods while you’re pregnant. These types of foods can carry potentially harmful bacteria, such as listeria and salmonella, which can cause premature labour, stillbirth or miscarriage.

If this sounds daunting or you need some help with your diet, please feel free to make an appointment with me by calling (03) 9418 8299 or booking online.

Additionally, you can use my quick and convenient guide to Food safety during pregnancy, which you can print out and refer to at home and on the go.

Morning sickness during pregnancy

woman standing in sunny room grimacing in pain with hand over her mouth

Feeling a little queasy and needing to steer clear of certain foods you normally love? Perhaps you’ve lost your appetite and are suffering from repeated spells of nausea? Or maybe you’ve found yourself completely overcome by persistent nausea and vomiting? While there are many joys to bringing life into the world, morning sickness isn’t one of them.

Unfortunately, it’s a very common side-effect of pregnancy. In fact, it’s estimated that up to 80% of pregnant women will experience some degree of morning sickness.

Unlike the name suggests, morning sickness isn’t restricted to a bout of nausea when you first wake up. The symptoms typically peak in the morning, hence the name, but in reality, morning sickness can strike at any time of the day. Some pregnant women even feel sick at all hours of the day.

How soon does morning sickness kick in and when will it go away?

Most women who experience morning sickness find that it starts sometime in the first few weeks of their pregnancy and ends after the first trimester. For around one in five women, morning sickness continues on into the second trimester. And in rare cases, the symptoms can persist through the whole nine months.

What causes morning sickness and can I prevent it?

We don’t know exactly what causes morning sickness, so we can’t prevent it from happening. However, your body is undergoing significant physical and chemical changes during pregnancy – including changes to your hormones, blood pressure and blood sugar – and it’s likely that it’s this combination of factors that causes morning sickness.

However, there are some ways you can manage your symptoms to help you get on with your day.

Tips to manage morning sickness

  • Before you get out of bed in the morning, try to eat a few dry crackers or plain sweet biscuits with a glass of water. It may help to keep these beside your bed so they’re in easy reach.
  • You’ll quickly learn what foods and smells trigger your nausea (e.g. perfumes or fried foods) so avoid these, where possible.
  • Though the last thing you may feel like doing is eating, an empty stomach is likely to make you feel worse. To combat this, try to eat small meals regularly throughout the day (e.g. every 1–2 hours).
  • Avoid food and drinks that may upset your stomach such as fatty or spicy foods and coffee.
  • Ginger can relieve nausea and vomiting. Try eating ginger chews or lozenges and drinking ginger tea or dry ginger ale.
  • If cooking or preparing meals makes you feel ill and someone else can help you out, take them up on the offer.
  • Keep your fluids up. Drink water and anything else that is well-tolerated while nauseous (e.g. flat lemonade, diluted fruit juice, weak tea, ginger tea etc.). If you can’t stomach fluids, try sucking on ice cubes.
  • Wear loose clothes so you don’t feel constrained across your abdomen.
  • If movement aggravates your symptoms, rest whenever possible.
  • Try acupuncture wristbands. These are usually used to prevent travel sickness and can be found in most pharmacies.
  • Consider taking a vitamin B6 supplement. I recommend taking either Blackmore’s Morning Sickness (a vitamin B6 and ginger combo) or vitamin B6 (50 mg tablets), 4 times a day. Ongoing use is much more effective at suppressing nausea than sporadic use. But be aware that taking too much vitamin B6 can be harmful, so ask your doctor or pharmacist for advice if you are taking a different supplement to those mentioned here.
  • If vitamin B6 alone isn’t working, you can also take an over-the-counter antihistamine called Doxylamine (Restavit). This is a safe medication to take while you are pregnant, but it can make you feel a bit drowsy. Take 1 tablet at night and ½–1 tablet in the morning and afternoon (depending on how drowsy it makes you feel).
  • Prescription medications that can help control your nausea during pregnancy are available. I encourage my patients to contact my rooms anytime if you feel you might benefit from them. It’s important that you only take drugs that have been prescribed to you by a doctor who knows that you are pregnant.

What if my morning sickness is debilitating?

Some women suffer from severe morning sickness, which can cause them to lose weight and become dehydrated, and in turn can sometimes deprive their baby of proper nutrition. The condition is known as hyperemesis gravidarum and has been in the spotlight in recent years after Kate Middleton (aka Catherine, Duchess of Cambridge) shared that she suffered from it.

Severe morning sickness affects around 1 in 1000 pregnant women. Because the consequences of repeated vomiting, weight loss and dehydration can be serious for your baby, women are usually hospitalised to get their fluids back up (via an IV drip) and to make sure they get adequate nutrition.

You should always seek medical help if your morning sickness is causing repeated vomiting and you can’t keep any food or liquids down.

Talk to your doctor if you’re suffering from morning sickness

Moderate morning sickness will not harm your baby but you should tell your doctor if you are suffering from it. I recommend first trying the tips described above, but if these don’t work on their own, there are safe medications that can be prescribed to help you manage your symptoms.

My patients can raise their concerns with me at their next antenatal appointment or, as always, feel free to call my rooms on (03) 9418 8299 for advice between appointments or to request a script for additional medications that require a prescription.

For some women, morning sickness may trigger depression or anxiety. Speak to your GP or obstetrician if you are experiencing feelings of anxiety or depression, or find out more about support services available for pregnant women at Pregnancy Help Australia.