How to prepare for pregnancy

woman sitting cross-legged with closeup of her hands, legs a tray of cereal and fruit, vitamin bottle and books

Making the decision to try for a baby is incredibly exciting. But it’s also normal to feel a little overwhelmed by the volume of information about what you should do to increase your chances of becoming pregnant. Before you delve into the details of how to prepare your body for pregnancy, remember that every woman has a different pregnancy experience and there is no step-by-step guide that guarantees conception or a healthy pregnancy.

Preconception care is important

That being said, there are benefits to being proactive about preconception measures. Making health and lifestyle changes before pregnancy not only improves your chances of becoming pregnant, it also prepares your body for a healthy pregnancy, and reduces the likelihood of developmental or health problems for your baby.

What should you do to prepare your body for pregnancy?

  • Increase your folate intake: this vitamin is critical for neural tube formation during a baby’s development. The neural tube develops in the early stages of pregnancy, and later becomes the brain, spinal cord and surrounding bones. Increasing your folate intake before you become pregnant reduces your risk of having a baby with a neural tube defect such as spina bifida. Although folate is found in food (e.g. fruits, vegetables, legumes and nuts), and some foods are even fortified with folate (e.g. most breads and some cereals and juices), most pregnant women don’t get enough folate from their diet alone. You should take folic acid – a folate supplement – to ensure you meet the daily intake requirements when preparing for pregnancy. For most women, the correct dose of folate is 0.5 mg/day. Novel folic acid preparations (such as folinic acid) are becoming popular; however, these alternative formulations have never been proven to reduce neural tube defects, and therefore cannot be recommended. If you take folic acid alternatives, I recommend you take normal folic acid as well.
  • Maintain a healthy weight: it’s important to be in a healthy weight range when trying for a baby. Women who are overweight or underweight can have reduced fertility for many reasons. Being a healthy weight when you become pregnant also makes it easier to manage weight gain during pregnancy, which has health benefits for you and your baby, including reducing the risk of pregnancy complications like high blood pressure, diabetes and growth restriction in your baby. The best way to do this is by keeping active and eating well.
  • Eat a healthy diet: a well-balanced, nutritious diet not only helps you manage your weight – certain foods can actually affect your fertility. Those who know me well know that I love a very low sugar and low carbohydrate diet.
  • Exercise regularly: keeping fit through moderate-intensity exercise and weight training has a positive effect on fertility. It’s also good to build up your fitness before becoming pregnant, because keeping active during pregnancy has massive benefits for you and your baby.
  • Limit your alcohol intake: heavy drinking is bad for fertility. Excess alcohol consumption can increase the time it takes to get pregnant and reduce the chances of having a healthy baby. It’s advisable to limit how much you drink if you are planning to become pregnant. Even small amounts of alcohol intake in either men or women reduces fertility as a couple.
  • Stop smoking: cigarette smoke, including second-hand smoke, reduces fertility. The negative impact of smoking on fertility can last up to a year after you stop, so if you are planning to become pregnant it’s important to quit as soon as possible. Smoking is also detrimental to the health of your baby.
  • Limit your caffeine intake: while the impact of caffeine on fertility is not fully understood, existing evidence suggests that limiting caffeine intake is beneficial. Women who are trying to get pregnant should limit their caffeine intake to 1 cup of coffee per day.
  • Have a general health check: visit your GP and tell them you are planning to become pregnant. This gives you a chance to discuss any existing medical conditions and/or medication you take, and how to manage those during pregnancy. At this appointment, you’ll usually have some routine tests as well, such as a breast check, blood pressure test and a pap smear if it’s due.
  • Make sure your vaccinations are up to date: infectious diseases can cause serious harm to a developing baby. If you are planning to become pregnant, make sure that you have been immunised for diseases such as rubella, chickenpox and measles.
  • Visit the dentist: hormonal changes during pregnancy can lead to dental problems, such as gum disease and tooth decay. Researchers have demonstrated an association between gum disease in pregnant women and premature birth with low birth weight, so it’s important that you look after your oral health while you are pregnant. Have a dental check if you are planning a pregnancy and always maintain good oral hygiene.
  • See a fertility specialist: if you have a reproductive health condition such as PCOS, irregular periods, fibroids or endometriosis, or if you suffer from recurrent miscarriage, you may need extra medical help to get pregnant. A gynaecologist that specialises in fertility will be able to help you manage your condition to improve your chances of getting pregnant.

Preparing your body for pregnancy

If you want personalised advice on preconception care – from lifestyle changes to health concerns – please don’t hesitate to make an appointment with me by calling (03) 9418 8299 or booking online.

When to see a fertility specialist?

closeup of a seated couple at waist level holding hands

It may be nerve-racking to book a fertility assessment, but it is best to get an opinion sooner rather than later – waiting too long to see a fertility specialist could reduce your chances of a successful pregnancy.

If you are concerned about your fertility, don’t wait – see a fertility specialist as soon as possible.

If you see a fertility specialist it does not mean you automatically need IVF. I specialise in a number of different fertility treatments, including IVF, non-IVF treatments and fertility optimisation surgery. At your consultation, I’ll assess your chances of becoming pregnant and discuss with you how your fertility could be optimised to ensure you become pregnant in a timely manner.

Who should see a fertility specialist?

People may need to see a fertility specialist for a wide variety of reasons. This depends on your age, existing health conditions and how long you’ve been trying to get pregnant. If any of the following apply to you and/or your partner, you should definitely see me for assessment:

  • Female partner younger than 35 and no pregnancy in 12 months
  • Female partner older than 35 and no pregnancy in 6 months
  • Infrequent or irregular menstrual periods
  • Recurrent miscarriage
  • Very painful periods
  • Gynaecological problems such as endometriosis, fibroids, pelvic inflammatory disease or polyps
  • Inability to have sex due to pain or erectile difficulties
  • Abnormal sperm count
  • Same sex couples who need donor sperm
  • Same sex couples who have a sperm donor, but want donor screening or intrauterine insemination
  • Single women who need donor sperm or want egg freezing
  • Women who need urgent fertility preservation (ovarian tissue freezing or egg freezing) prior to chemotherapy for cancer
  • Men who need urgent fertility preservation by freezing sperm prior to chemotherapy for cancer
  • Family history of a genetic disease that you don’t want passed on to your children
  • Women who want donor egg treatment overseas
  • Multiple miscarriages.

To make an appointment, call (03) 9418 8299 or book online.

Endometriosis

a bare female waist with one hand on hip and other over a red hotspot on belly

Endometriosis is a condition that affects women. It can cause pain in the lower part of the belly and trouble getting pregnant. Endometriosis occurs when tissue normally found in a woman’s uterus, called the endometrium, grows outside of the uterus. This tissue, which does not belong outside the uterus, can then break down, bleed, and cause symptoms.

Symptoms of endometriosis

Some women have no symptoms, but most experience:

  • Pain before or during monthly periods
  • Pain between monthly periods
  • Pain during or after sex
  • Pain when urinating or having a bowel movement (often during monthly periods).

Other symptoms can include:

  • Difficulty getting pregnant
  • Ovarian cysts (sometimes called chocolate cysts or endometriomas) found on ultrasound.

All of these symptoms can also be caused by conditions that are not endometriosis. But if you have any of these symptoms, you may need to be investigated for endometriosis. The only way to know for sure if you have the condition is for a doctor to do a laparoscopy to look for endometrial tissue outside the uterus. Sometimes a specialised ultrasound can be useful, too.

Treatment of endometriosis

There are many treatments for endometriosis. The right treatment for you will depend on your symptoms and whether you want to be able to get pregnant now or in the future.

First-line treatments are medications, such as:

  • Pain medication – such as panadol and/or nurofen on the days the pain is present
  • Contraceptive pill – this can reduce the number of periods (by skipping periods) and the amount of pain. It is not suitable if you are trying for a pregnancy immediately
  • Mirena IUD – this is a device that sits inside the uterus for up to 5 years (it can be removed easily at any time). It has progesterone hormone within it that acts to suppress the growth of endometrial tissue. It is also not suitable if you are trying for a pregnancy immediately.

Some women choose to have surgery as their treatment. The most common surgery is a laparoscopy; this allows the surgeon to see and remove endometriosis tissue. It is usual to follow surgical removal with some attempt at preventing it growing back – either the contraceptive pill, Mirena IUD or pregnancy.

In more extreme cases, or in women who have definitely completed their family, a hysterectomy can help. A hysterectomy is a surgery to remove a woman’s uterus.

Pregnancy considerations

Endometriosis can affect your chances of becoming pregnant, although it should be noted that many women with the condition have no trouble at all becoming pregnant. Endometrial tissue can cause hormonal imbalances that change how your ovaries function and can block your fallopian tubes. Surgically resecting mild to moderate endometriosis probably improves your pregnancy chances. If you have endometriosis and have not become pregnant in 6 to 12 months (depending on your age), you should arrange a timely assessment with a fertility specialist to see if fertility treatment such as IVF might improve your chance of pregnancy. Once you have fallen pregnant, endometriosis is not associated with pregnancy complications.

To make an appointment with me, call (03) 9418 8299 or book online.

10 lifestyle changes to increase your chances of getting pregnant

woman doing yoga stretches on floor

Whether you’re having trouble conceiving or simply want to get pregnant as quickly as possible, I have good news – making changes to your lifestyle can considerably improve your chances of having a baby. Here are 10 ways you can improve your fertility.

  1. Quit smoking and avoid second-hand smoke.

    There’s no doubt that smoking has a negative effect on fertility. Exposure to smoke makes it more difficult to get pregnant because it harms your eggs, alters hormone production, and disrupts embryo transport and the environment in the womb. Smoking also increases the chance of having a miscarriage or an ectopic pregnancy, or of giving birth prematurely. And the negative effects of smoking aren’t limited to women – men’s fertility is also reduced if they smoke. Fortunately, within a year of quitting, these negative effects can be reversed. So if you and/or your partner smoke, now is the time to quit.

  2. Cut out alcohol.

    It’s common knowledge that alcohol can harm a developing baby, so most women stop drinking once they become pregnant. But did you know that heavy drinking is also bad for your fertility? Studies show that women who are heavy drinkers take longer to get pregnant and couples who do not drink alcohol during IVF treatment have higher rates of pregnancy compared to couples where either the man or women has any alcohol intake. If you are planning a pregnancy, not drinking is the safest and recommended option.

  3. Reach a healthy weight.

    In a normal reproductive cycle, you have a chance to get pregnant once a month when an ovary releases an egg. Ovulation is tightly controlled by hormones. However, these hormones can become imbalanced in women who are over or underweight, which in turn leads to irregular or absent ovulation. Combining regular exercise with a healthy diet will help you reach and maintain a healthy weight, bringing your hormones (and ovulation frequency) back in check, which will improve your chances of conceiving. For added motivation, keep in mind that being within a healthy weight range during your pregnancy has benefits for you and your baby and this is easier to manage if you are a healthy weight when you become pregnant. Find out more about pregnancy weight gain here.

  4. Make exercise part of your routine.

    Regular exercise is great for your overall health and wellbeing, so it’s not surprising that it has a positive effect on your fertility. I recommend patients planning a pregnancy exercise for 45 minutes, 3–4 times per week. Weight training and high impact interval training (HIIT) are best (like the training offered by F45 gyms). The added benefit of building this habit is that being active during pregnancy is great for the health of you and your baby. Be wary of overdoing it though. Too much exercise can cause your periods to stop or become irregular, which makes it hard to get pregnant. Find out more about the effects of exercise on the menstrual cycle here.

  5. Eat a diet low in sugars, carbohydrates and trans fats.

    What you eat can have a direct effect on your fertility by interfering with hormones and ovulation, so making simple changes to your diet can help improve your chances of becoming pregnant. I’ve explained how diet affects fertility in a previous post, which you can read here. Cutting down foods that are bad for fertility will also help you maintain a healthy weight.

  6. Limit the lattes.

    The evidence isn’t conclusive, but it is thought that having too much caffeine is bad for fertility. To be safe, I recommend limiting how much caffeine you have (e.g. drinking no more than one cup of coffee per day) while you are trying to become pregnant.

  7. Be wary of harmful chemicals.

    Certain chemicals that block hormones (known as endocrine disrupting chemicals) can reduce fertility. These include BPA (Bisphenol A), phthalates and parabens. It’s virtually impossible to completely avoid these chemicals, but making simple changes can reduce your exposure and therefore limit their effect on your fertility. Avoid eating or drinking from plastic containers, check what chemicals are in your cosmetics and household products, and wash all fruit and vegetables before you eat them. Find out more about how to reduce your exposure to potentially harmful chemicals here.

  8. Get 7–8 hours of sleep every night.

    We don’t fully understand the relationship between sleep and fertility, but recent studies suggest that getting no more or less than 7–8 hours of sleep a night (and making this a routine) is helpful for achieving pregnancy. It’s also known that shift-workers are more likely to struggle with fertility issues, so if you work night-shifts and it is at all possible to make changes to your schedule, it may be worthwhile.

  9. Keep a calm mind.

    Persistent high stress may hinder your chances of becoming pregnant through its influence on your hormones. We don’t know the extent to which stress affects fertility, and it differs per person, but making an effort to reduce stress may help you conceive. Try to incorporate some activities into your routine that help you reduce your level of stress. Examples include mindfulness, yoga or counselling, but it really depends on your personal circumstances and preferences. Other lifestyle changes we have already addressed such as exercise, healthy eating and a good night’s sleep also do wonders for reducing stress.

  10. Review your medications.

    Some over-the-counter and prescription medications can make it harder to become pregnant. Talk to your doctor about the medications you take to see if it is recommended that you stop or change medications to help with your fertility, but never do this without seeking medical advice.

These changes really come down to making your lifestyle as healthy as possible, which will also set you up for a healthy pregnancy and give your baby the best start to their life. It’s unlikely that a single lifestyle factor will determine whether you become pregnant or not, but making a range of lifestyle changes may help you achieve pregnancy sooner. For further tips on how to prepare yourself for pregnancy, click here.

Still have concerns about your fertility?

If you are worried about your fertility or have further questions about how you can improve your chances of becoming pregnant, I recommend coming in for a consultation so that we can determine the best steps forward for you. To make an appointment, call (03) 9418 8299 or book online.

Polycystic ovary syndrome (PCOS) and fertility

woman in colourful sleeveless dress folding her arms and smiling

Polycystic ovary syndrome (or PCOS, as it’s typically called) is a common condition that affects women in their reproductive years. Because the condition influences hormone levels and can prevent ovulation, it can be difficult for women with PCOS to conceive.

Women with PCOS may need medical help to become pregnant

Regular menstruation cycle
PCOS is a complex hormonal condition that leads to changes in the body’s ovulation cycle. You’re probably familiar with a ‘regular’ menstrual cycle happening around once a month. Well, ovulation is the fertile phase of the menstrual cycle – when an egg is released from one of the ovaries – and should also occur monthly.

However, most women with PCOS don’t get regular periods, and that means that their ovaries are not releasing an egg regularly – in other words, they have irregular ovulation. The medical term for this is ‘anovulation’.

Every time an egg is released from the ovaries, it is a potential opportunity for a pregnancy to begin. So, if this doesn’t happen regularly, it reduces the chances of getting pregnant. Rare (or absent) ovulation is the reason women with PCOS often take longer than normal to conceive.

Most women with PCOS can become pregnant

The good news is that around 60% of women with PCOS become pregnant without medical help. And the even better news is that for women with PCOS who are struggling to conceive, there are ways that fertility specialists can help. Fertility treatments for PCOS work to increase ovulation and can range from lifestyle changes or medications to more invasive procedures.

Losing weight can improve fertility

Maintaining a healthy weight can be difficult for women with PCOS. They may find it easy to gain weight, and really hard to lose it. While this can be challenging, it’s really important for women with PCOS to maintain a healthy weight to improve their chances of getting pregnant. In fact, even losing 5% of body weight can improve the chances of conceiving.

Losing weight should be the first port of call if you have PCOS and are struggling to conceive. The improvements in fertility won’t happen overnight – you should give yourself up to 6 months to see if weight loss alone is enough to help you get pregnant. If it isn’t, rest assured that your efforts to maintain a healthy weight will improve your chances of getting pregnant if you go through fertility treatments. Having a healthy weight will also reduce the chance of many pregnancy complications.

Medication can stimulate or regulate ovulation

To help women with PCOS get pregnant, there is a treatment called ‘ovulation induction therapy’. You can think of this as a way to encourage your body to produce and release eggs. Medication (or a combination of medications) is used to give your body the signals it needs to go through an ovulatory cycle to release an egg.

Generally, a tablet called clomiphene citrate (Clomid) is the first treatment choice. Studies have shown that Clomid can achieve pregnancy rates between 30% and 50% after 6 treatment cycles. One of the limitations of Clomid is that after 4 to 6 months it can lead to thinning of the endometrial lining and subsequently reduce the chance of pregnancy.

If Clomid is unsuccessful, the next treatment step tends to be ovulation induction therapy with hormones known as ‘gonadotropins’. These hormones, such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and human chorionic gonadotropin (HCG), are normally produced by your body during a healthy reproductive cycle. So, to mimic the normal hormonal cycle, one or more of these hormones are injected at specific times during your cycle to stimulate the growth and release of eggs.

Surgery is an option for inducing ovulation

If other treatment options have not been effective, there is a surgical procedure that can help to increase ovulation, which is referred to as ‘ovarian drilling’ or ‘laparoscopy with ovarian surgery’. If you have PCOS, the surface tissue on your ovaries produces excessive amounts of androgens (‘male’ hormones), which reduces your fertility. The aim of ovarian drilling is to remove some of that tissue, by drilling small holes in it, so that you can ovulate more regularly for around 6 to 12 months. Because the surgeon only needs to make a small incision below your belly button, the surgery itself is minimally invasive and the recovery is quick.

IVF is another option for women with PCOS

Some women with PCOS may not be able to conceive naturally, even after using treatments to increase ovulation. In that case, it may be necessary to undergo in vitro fertilisation (IVF) to get pregnant. During IVF, the fertilisation step of pregnancy (joining the egg and sperm together) is facilitated in a specialised laboratory. The embryo is then implanted into the uterus to continue the pregnancy. Women with PCOS are given specific hormonal treatments to increase their chances of achieving a pregnancy through IVF. Interestingly, women with PCOS perform very well with IVF therapy. The high number of eggs in their ovaries usually means that many eggs can be collected and fertilised during IVF.

Do you have PCOS and fertility concerns?

PCOS is a complex condition that can be difficult to manage, particularly when it comes to getting pregnant. If you suffer from PCOS and would like a personal assessment and advice about ways to optimise your chances of conceiving, please call my rooms on (03) 9418 8299 or book online to make an appointment.

Laparoscopy

laparoscopy

A laparoscopy is a procedure to examine the appearance of the outside surfaces of the uterus, tubes, ovaries and lining of the pelvis. It is performed by placing a long skinny telescope (called a laparoscope) through a 5mm incision in the belly button. Air is then pumped in to create space around the internal organs, and the telescope sends pictures to a television screen. Another 5mm incision is placed discreetly within the bikini line to allow instruments through.

Laparoscopy diagram

When do you need a laparoscopy?

Reasons for doing a laparoscopy include:

  • Pelvic pain
  • Sub-fertility
  • Ovarian cysts
  • Fibroids
  • Sterilisation (tying your tubes to prevent pregnancy)
  • Ectopic pregnancy
  • Hysterectomy.

What happens during the procedure?

A laparoscopy must be done in hospital, and the vast majority are day cases, meaning you won’t need to stay in hospital overnight. It requires a general anaesthetic – you will be fully asleep with a breathing tube in your throat.

Once you are asleep, the operation takes about 20 minutes for a diagnostic laparoscopy and longer for an operative laparoscopy. A diagnostic laparoscopy is one where no operating is done. An operative laparoscopy is one where something is fixed – for example, endometriosis or removal of an ovarian cyst – and this can take a variable amount of time depending on the complexity of the operation. Some operative laparoscopies take 90 minutes and some take longer.

How long does it take to recover?

After the operation, most patients feel a bit groggy from the anaesthetic, and this generally lasts the whole day, and occasionally into the next day. It is usual to have some abdominal pain after the operation. Initially it can require relatively strong pain relief, like paracetamol, ibuprofen and oxycodone together, but this will become less necessary after a day or two.

The pain should get better every day – if it doesnʼt, this could indicate a complication. In that case contact me for advice. Most people need 4–5 days off work to fully recover, and occasionally up to a week.

To make an appointment, call (03) 9418 8299 or book online.

What are my chances of having a baby through IVF?

woman laying on hospital bed with ultrasound monitor in background with man holding her hand

If you want to have a baby but are struggling to get pregnant, IVF is here to help. In fact, it’s estimated that over 5 million babies have been born worldwide thanks to this procedure.

So, what is IVF? IVF stands for In Vitro Fertilisation and it is a type of assisted reproductive technology. For pregnancy to occur, a sperm must fertilise an egg. Put simply, it is a way of facilitating fertilisation outside of the body, in a laboratory dish or test tube.

Each year, over 70,000 IVF treatment cycles are performed in Australia and New Zealand.

What is an IVF treatment cycle?

A typical cycle has several steps:

  1. Stimulation phase: You’ll self-administer injections for 8–14 days to stimulate your ovaries to produce multiple eggs (rather than one egg as in a normal menstrual cycle). After monitoring your progress via blood tests and ultrasounds, your fertility specialist will tell you when to administer a ‘trigger injection’ to get the eggs ready for retrieval.
  2. Retrieving your eggs: The fertility specialist will use a needle to collect the eggs from your ovaries, guided by ultrasound technology. The surgery takes 20–30 minutes and you will be given a general anaesthetic, but you do not need to stay overnight in hospital. On average, 8–15 eggs are collected.
  3. Fertilising your eggs with sperm: In a lab, specially trained scientists prepare the eggs and either place them in a dish with your partner’s (or donor) sperm or inject one healthy sperm into each egg. The fertilised egg becomes an embryo – an unborn baby in the very early stage of development. Not all eggs will be fertilised – some are immature and not suitable for fertilisation and others fail to be fertilised despite the scientist’s attempts.
  4. Growing your embryos: If fertilisation is successful, the embryo is put in an incubator in conditions that mimic the body to allow it to start growing. Over the next 5–6 days, the embryo will ideally reach the ‘blastocyst’ stage (where around 200 cells start to form a complex structure), at which point it is ready to be transferred into your womb. Unfortunately, not all embryos will survive and be fit for implantation.
  5. Transferring an embryo into your womb: This is a simple process that takes around 5 minutes. There is no use of anaesthetic and afterwards you are able to get on with your day. The procedure feels similar to a pap smear – the fertility specialist places a fine catheter through your cervix to implant an embryo in your uterus, which will hopefully start a pregnancy.
  6. Freezing extra embryos: If more than one embryo developed successfully at step 4, there is advanced technology that allows us to freeze the embryo until it may be needed in a subsequent cycle.
  7. The final blood test: After a two-week wait, you’ll have a blood test to see if you are pregnant. This can be an anxious waiting period, so it’s important to make sure you surround yourself with plenty of support at this time.

What are the success rates for IVF?

It can be difficult to understand the success rates for IVF and to compare these between clinics because of the different ways clinics measure and report their patient outcomes.

Clinics tend to report success rates per cycle. In reality, if you are undergoing IVF, you may need multiple cycles to become pregnant and the more meaningful measure of success is the likelihood of a having a baby from one or more cycles.

A recent study reported IVF success rates based on data from the Australian and New Zealand Assisted Reproductive Technology Database. This database includes information on all IVF cycles performed in the two countries.

After analysing data from over 55,000 women who started IVF treatment for the first time (which included a total of 120,930 cycles), the researchers reported two findings. The first was the live-birth rate after one cycle of IVF – the standard measure many clinics use. The second was the cumulative live-birth rate from up to eight cycles – in other words, how likely it was for a woman to get pregnant from several attempts at IVF.

They found that one-third of women had a baby after one cycle of IVF, and this increased to 54–77% after multiple cycles. Because age has a big impact on how easy it is for women to get pregnant via IVF, they also determined success rates for different age groups. As expected, the rates were higher for women aged 30 or younger – 44% had a baby after one cycle and 69–93% had a baby from up to seven cycles. The rates were the lowest for women aged 40–44, with 11% having a baby after the first cycle, and 21–38% after multiple cycles.

These results show that the chances of having a baby from IVF increase if you have multiple cycles. However, IVF takes a considerable investment in time, energy and money. For some people, it may be feasible to continue with multiple cycles, while for others it won’t. It’s important to remember that every couple is different and your chance of successful IVF will depend on the individual factors specific to you and your partner.

What influences my chances of having a baby through IVF?

Individual circumstances, as well as your choice of fertility specialist and clinic, will play a role in your chance of becoming pregnant through IVF. The main factors that affect your chances are:

  • Your age
  • Your genetics
  • Your fertility history
  • Your lifestyle factors (e.g. your weight and whether you smoke)
  • The quality of your eggs and the number of eggs recovered in a cycle
  • The quality of sperm
  • The expertise of the team and the laboratory conditions.

I always undertake a thorough assessment with my patients so that I can explain the success rates, advantages and disadvantages of undertaking IVF specific to them. My patients undergo treatment at Newlife IVF in Box Hill, a world leader in live-birth success rates.

Who can have IVF?

IVF is a treatment option for couples with fertility problems. But it can also be a way for same-sex couples or single women to become pregnant, with the use of donor sperm (something my clinic can help facilitate). Whatever your situation, it’s good to get expert advice as soon as possible to determine the best way to help you conceive.

Looking for an IVF specialist in Melbourne?

If you need help to have a baby, IVF is just one of the fertility treatments I provide for my patients. By booking a consultation, I can thoroughly assess your individual circumstances and discuss the available treatment options with you, whether that be IVF or a non-IVF treatment. Your GP can advise if a referral is the right next step.

To make an appointment, call (03) 9418 8299 or book online.

Down syndrome

a happy baby laying face-forward propped on elbows looking at camera

Down syndrome occurs if a baby has three copies of its 21st chromosome instead of two copies. A chromosome is a bundle of genetic material, and if you have too many or too few of these bundles, severe abnormalities can result. In the case of Down syndrome, these include abnormalities of the intellect, heart, thyroid and other endocrine systems, facial appearance and others.

The likelihood of you having a baby with Down syndrome increases with age, as shown in the graph below.

Down syndrome increase with age
Source: American Family Physician

Through consideration of your age and additional tests, it’s possible to detect early in the pregnancy whether your baby might be at higher risk of having Down syndrome.

The additional tests are Combined First Trimester Screening (CFTS) and Non-Invasive Prenatal Screening (NIPS).

It is important to realise that both of these tests are considered to be ‘screening tests’. This means they won’t tell you ‘yes, your baby has Down syndrome’ or ‘no, it definitely does not have Down syndrome’. They will, however, say if your baby is at high risk of having Down syndrome, in which case you should have a diagnostic test.

A diagnostic test is one that will tell you ‘yes’ or ‘no’.

NIPS is the best test available to screen for Down syndrome. It directly tests the baby’s cells that can be found in the mother’s blood stream. As such, all that is required is a maternal blood sample. The results are almost as accurate as CVS (chorionic villi sampling) or amniocentesis, both of which are invasive, requiring the insertion of a needle into the pregnancy. NIPS is quite expensive, costing about $480, and no Medicare or insurance rebate applies. NIPS will also report whether the baby is a boy or a girl, although we will only tell you this result if you want to know.

CFTS requires a blood test at 10 weeks and an ultrasound between 12 and 13 weeks. The blood test looks at hormone levels that are produced by the placenta, while the ultrasound assesses the thickness of a fluid pocket behind the baby’s neck. Thus, CFTS looks at indirect markers of Down syndrome, whereas NIPS looks directly for the chromosomal abnormality. The cost of the blood test component of CFTS is $110, and no Medicare rebate applies.

The 12 week anatomy ultrasound is absolutely essential when doing CFTS. While it is not a requirement for NIPS, it is still an essential test for other reasons.

What test should I do?

The vast majority of patients in my practice prefer the NIPS; however, it is less important if you are younger than 30 years old. I will discuss these options with you in detail at your first pregnancy appointment.

It’s important to realise that there are lots of brands of NIPS — my recommendation is to opt for percept NIPS through VCGS, Victoria’s premier genetic testing laboratory.

To make an appointment with me, call (03) 9418 8299 or book online.

Changes to the cervical screening program

top down view of a woman holding her groin with crossed hands

As 2017 drew to a close, so too did the era of the traditional Pap test. From 1 December 2017, Australia became just the second country in the world, behind the Netherlands, to incorporate a 5-yearly human papilloma virus (HPV) test into its National Cervical Screening Program.

How is HPV linked to cervical cancer?

HPV is perhaps most often recognised as the sexually transmitted infection (STI) responsible for causing genital warts. While this is certainly the case, there are actually more than 40 different types of genital HPV that can be spread through sexual contact. HPV affects both men and women, and it’s surprisingly common, even in young women who have had just one sexual partner.

In fact, nearly half of all women will be infected with HPV within three years of becoming sexually active. In most cases, HPV is cleared by the immune system within one or two years without causing any symptoms or lasting effects.

However, in a small number of women, an ongoing HPV infection can lead to cellular changes in the cervix, known as cervical intraepithelial neoplasia (CIN). If left untreated, CIN can lead to cervical cancer, but this usually occurs slowly over 10 to 15 years. A cervical screening program exists to detect any cellular changes early.

What parts of testing are the same?

To check for changes and abnormalities – such as CIN – your gynaecologist (or other specialised healthcare professional) will conduct a vaginal examination to collect cells from your cervix. Under the new screening program, this internal examination will be the same as it was at your previous Pap test appointments.

The main difference is that your cells will be placed into a container of liquid, rather than being ‘smeared’ onto a slide. This will allow the pathology lab to conduct all standard screening tests on a single sample of your cells.

What parts of testing have changed?

More than 99% of cervical cancers are caused by HPV. Out of the 40-plus different types of genital HPV, there are two particular types that cause around 70% of all cervical cancers. These two types are HPV 16 and 18.

HPV testing

Based on this known link between HPV and cancer, you will now be screened for HPV infection using a method that tests for DNA from the virus itself. This method accurately confirms whether your cells are positive or negative for the HPV virus, so it’s more reliable than the traditional Pap test.

In comparison, your previous Pap tests would have involved a pathologist looking closely at your cells under a microscope for any changes or abnormalities. Also known as cytology, this test relied on a visual assessment alone, and it didn’t test for HPV infection.

Partial genotyping

From now on, testing for HPV infection will now also be supported by what is known as partial genotyping. This method is used to check if you have a ‘high-risk’ type of HPV that is more likely to cause cervical cancer. In particular, partial genotyping is used to test for HPV 16 and 18.

For reference, there are two HPV vaccines approved for use in Australia (Gardasil and Cervarix), and both protect against HPV 16 and 18. However, these vaccines don’t protect against all types of HPV that can cause cervical cancer, so it’s important to continue having regular screening tests, even if you’ve been vaccinated.

Liquid-based cytology

If you test positive for HPV infection, the pathology lab will conduct another test called liquid-based cytology (LBC) on your initial cell sample. LBC is similar to a Pap test in that it involves examination of your cells under a microscope for any changes or abnormalities.

Screening age

Although HPV infection is common among young women, there’s a very low rate of cervical cancer in women under 25 years old. If HPV infection does progress to cervical cancer, it usually takes place over decades, with most cases occurring between 35 and 55 years old.

Additionally, there is no evidence to suggest that screening women under 25 is effective or that it reduces deaths from cervical cancer. In fact, screening women under 25 may lead to unnecessary treatments, some of which can increase the risk of pregnancy complications later in life.

For these reasons, the starting age for cervical screening has increased from 18 to 25 years old. Between the age of 70 and 74 years old, you will be invited to have your final screening test, at which time you will exit the program if you return a negative result.

Under the new program, you will receive all invitations and reminder letters from a new National Cancer Screening Register (NCSR), rather than from your local State or Territory service (such as the Victorian Cytology Service).

Self-collection

More than 80% of women with cervical cancer are at least six months overdue for a cervical screening test or have been never been screened at the time of diagnosis. To help improve screening rates, there is now a self-collection option available to women aged 30 years and over who also: have never participated in screening, or; are at least two years overdue for screening.

If you fit into one of these categories, your gynaecologist will be able to provide you with a self-collection kit and instructions for use. However, you will still need to perform the collection at your medical or healthcare clinic.

What if my test is negative for HPV infection?

Low-risk result – next test in 5 years

If you return a negative result (i.e. HPV infection is not detected), you’re considered to be at ‘low risk’. Your next cervical screening test will be due in five years, rather than in two years, as was previously the case with a Pap test.

What if my test is positive for HPV infection?

Intermediate risk – next test in 12 months

If partial genotyping shows that your infection is not caused by HPV 16 or 18, but your LBC test shows negative or low-grade changes, you’re considered to be at ‘intermediate risk’. You will be invited to attend a follow-up cervical screening test in 12 months.

Higher risk – attend a colposcopy

If you’re considered to be at a ‘higher risk’ of developing cervical cancer, you will be asked to arrange another appointment to have a colposcopy. This group includes the following test results:

  • Partial genotyping shows that your infection is caused by HPV 16 or 18
  • Partial genotyping shows that your infection is not caused by HPV 16 or 18, but your LBC test shows possible or confirmed high-grade changes.

During a colposcopy, your gynaecologist will insert a speculum into your vagina and then apply iodine and acetic acid solutions to your cervix to highlight any abnormal areas. A close examination of your cervix will follow using a specialised microscope, known as a colposcope.

Summary of changes

New HPV test Previous Pap test
Testing method

DNA test, with:

  • partial HPV genotyping
  • liquid-based cytology
 Cytology (i.e. examination of your cells under a microscope)
Standard screening frequency Every five years Every two years
Start From 25 years old From 18-20 years old
Finish At 70-74 years old At 69 years old
Self-collection Yes No

Where do you fit into the new cervical screening program?

To find out how changes to the cervical cancer screening program affect you – or to arrange your next HPV screening test or a colposcopy – please feel free to call my rooms on (03) 9418 8299 or book an appointment online.

You don’t have to put up with painful periods

woman resting in pyjamas with hot water bottle on belly

If you suffer from period pain, don’t just grin and bear it. Severe period cramps not only affect your quality of life – they may actually be a sign of other reproductive health issues that need medical attention.

First off, what causes period pain?

To understand why we get a monthly period – and the cramps that accompany it – it’s helpful to appreciate what your body’s reproductive cycle is trying to achieve. Every month, your uterus (or womb) grows a thick lining with a rich blood supply so that a fertilised egg can implant and establish a pregnancy. If this doesn’t happen, your body produces chemical signals that make your uterine muscles contract to shed that lining from your uterus – this is your period. When the muscles of your uterus contract, it can cause a cramping sensation or pain in your lower abdomen. The chemicals that trigger the muscle contractions are called prostaglandins. Women have varying levels of prostaglandins (and differing sensitivity to them), which is why some women have pain-free periods and others suffer from debilitating cramps every month. Although it’s normal to experience some discomfort during your period, not all period pain is normal.

Is my period pain normal?

This is a tricky question, because pain is really subjective (meaning that everyone’s tolerance to pain is different). Here are a few questions that will help you get a sense of what is abnormal and when you should seek help.

How severe is the pain?

We can gauge how bad your pain is by understanding what you’d normally do to cope with it. If you need to take over-the-counter medications such as ibuprofen or use a hot water bottle but then you can get on with normal daily life, you probably don’t need to worry about your period pain being abnormal. On the other hand, if your period causes you so much pain that you can’t play sport or you need a sick day, or if it is accompanied by vomiting, nausea or diarrhoea, that’s a level of pain you shouldn’t tolerate every month.

When does the pain occur?

There’s a window of time in which it is normal for period cramps to occur – it’s normal to feel pain or discomfort around one day before the bleeding starts, and for it to last another 2–3 days. Pain shouldn’t last longer than this, and you definitely shouldn’t have cramps when you don’t have your period.

Has the pain changed over time?

If you’ve always suffered from period pain, you may just have a ‘painful normal’. However, if you’ve only just started to have sore cramps or they are getting worse, you may be suffering from another condition that is actually causing the pain, or making it more intense. We call this secondary dysmenorrhoea – meaning that it is caused by something else – whereas primary dysmenorrhoea is the term used for common period cramps. Other symptoms that suggest you may have secondary dysmenorrhoea are:

  • The pain occurs more to the sides of your abdomen (not centrally)
  • You experience pain during sex
  • It hurts to use your bowels or bladder, especially when your period is present.

Other health conditions can make period pain worse

Really bad period pain can be a symptom of some serious conditions that affect your reproductive organs. The most common of these are:

  • Fibroids – these are benign (non-cancerous) growths on the inside of your uterus. Some fibroids don’t cause any symptoms and can be left alone, but others can cause heavy periods and severe menstrual cramps, in which case they can be removed.
  • Endometriosis – this is a condition in which cells that belong in the lining of the uterus (the endometrial tissue) start to grow in other places, such as outside the uterus, the ovaries and the fallopian tubes. The tissue still grows, sheds and bleeds as it would in the uterus, but because it is not in the correct place, it can’t leave the body as it normally would (through your period). This causes bleeding and inflammation which, over time, can create scar tissue and cause pain or fertility problems. Read more »
  • Adenomyosis – this is similar to endometriosis, but the uterus-lining cells start to grow into the uterine muscle. Every month this tissue bleeds as it would inside the uterus, but in this case blood enters the uterine muscle. Because of this, your uterine muscle has to contract even more than it normally would during your period to get rid of the blood, which can cause more severe cramping pains.

Having severe period pain doesn’t necessarily mean you have one of these conditions, but the sooner they are diagnosed the better. And if your pain is not due to a secondary condition, there are still ways to make your time of the month much easier to manage.

Menstruation shouldn’t be unbearable, period.

Period pain is a valid medical issue that can be treated. So, whether you’ve always suffered from your period and need help managing the pain, or your worsening cramps have you worried, call my rooms on (03) 9418 8299 or book online to make an appointment.