Recognising the signs of postnatal depression and anxiety

mother sitting on couch with newborn baby on her lap holding her head and looking down and perplexed

This post was contributed by Diabetes Educator and Registered Nurse/midwife, Jenny van Gemert MNurs GDipMid GDipEd (Facebook and Insta).

What is postnatal depression and anxiety?

Postnatal depression or anxiety refers to depression or anxiety that develops in either the mother or the father within a year of giving birth.

The symptoms of postnatal depression and anxiety are the same as those experienced when depression and anxiety occur at any other time in life. Depression is characterised by a low or depressed mood for most of the time for two weeks or more. In addition to a depressed mood, those with depression may lose interest in activities they previously enjoyed, experience changes in their sleep or appetite, feel fatigued or agitated, and lack concentration. They may also experience feelings of guilt, shame or worthlessness.

Anxiety is characterised by excessive worry for most of the time for two weeks or more. The worry is difficult to control and may be accompanied by fatigue, restlessness, difficulty concentrating, irritability, muscle tension and sleep disturbance. Some individuals with anxiety may also have panic attacks, where an abrupt surge of intense fear and discomfort is experienced. This manifests with a range of physical symptoms, including sweating, trembling, palpitations, nausea and chest pain.

Postnatal depression and anxiety may occur together, and the symptoms of each condition can overlap. In more severe cases of postnatal depression and anxiety, people may experience thoughts of suicide or harming themselves or their baby.

While postnatal depression and anxiety are the most common mental health conditions that occur in the period surrounding a baby’s birth, postnatal psychosis (puerperal psychosis) can also occur. This serious mental health conditions affects 1–2 in every 1000 mothers. It leads to marked changes in a mother’s behaviour and a woman with postnatal psychosis may experience symptoms such as delusions and hallucinations.

How do I know if I have postnatal depression and/or anxiety?

Diagnosing postnatal depression and anxiety can be difficult. Firstly, it must be differentiated from the ‘baby blues’. The ‘baby blues’ refers to a common experience of many women, where they may feel teary, overwhelmed and fatigued for a number of days following birth. These symptoms resolve within two weeks of onset and can be managed through support and care from loved ones, as well as extra sleep. While it’s not certain why the ‘baby blues’ happens, it may be partly attributed to the hormonal changes and exhaustion that occur before and after birth.

Postnatal depression must also be differentiated from the normal reality of becoming a new parent. During this time, the immense life changes and the lack of sleep can leave anyone feeling exhausted and overwhelmed. However, those who are coping can still maintain a positive outlook on life, still experience joy and acknowledge that things will improve. In contrast, those with postnatal depression can’t recognise the temporary nature of their situation, can’t experience joy and will see no light at the end of the tunnel.

If you’re consistently feeling down or anxious, or feel like you’re not coping, you may be experiencing postnatal depression or anxiety. Furthermore, if your loved ones are concerned, this may indicate it’s time to seek help – sooner rather than later.

What should I do if I think I have postnatal depression and/or anxiety?

Initially, there are a number of people you can talk to. You can raise how you’ve been feeling at your regular appointment with your Maternal and Child Health Nurse, or make an appointment with your GP. Alternatively, you can discuss how you’ve been coping with your obstetrician – by contacting them directly or at your six-week check-up. These healthcare professionals will likely ask you to complete a questionnaire about your mental health, most commonly the Edinburgh Postnatal Depression Scale.

Talking to a healthcare professional can feel daunting, or intrusive. However, you shouldn’t feel embarrassed or ashamed to be honest with your feelings. They encounter people in your situation more often than you’d think. Furthermore, it’s best they understand how severe your postnatal depression and/or anxiety is in order for them to give appropriate guidance on your next steps.

If you don’t wish to talk to someone face-to-face, there are also a number of organisations that provide a phone service (see the list provided at the end of this article).

What are the treatment options for postnatal depression and/or anxiety?

Upon a diagnosis of post-natal depression and/or anxiety, there are a number of different treatment options.

Firstly, it’s important to ensure that you have sufficient emotional and practical support. Following this, your doctor may recommend psychological therapy (counselling). This may be provided by a psychiatrist or a psychologist. If you decide to see a psychologist, your GP can create a Mental Health Plan for you. This allows you to receive a Medicare rebate for ten appointments, meaning your appointment will be bulk-billed or subsidised, depending on who you are referred to.

In many cases, psychological therapy is sufficient. However, some patients may require medication to feel better. There are a number of medications that are safe to use when breastfeeding, and your doctor will advise which medicatiom is right for you. Your GP may prescribe the medication, or they may refer you to a psychiatrist (mental health specialist). The length of time you need to remain on this medication will depend on your own situation and will be determined with your doctor. When the time is right, they’ll talk to you about the safest option for discontinuing therapy.

Lastly, for very severe cases of postnatal depression and/or anxiety, or cases of postnatal psychosis, you may be referred to a mother-baby unit in a hospital. This allows your baby to stay with you at hospital while you are treated as an inpatient. This may occur in a public or private hospital. However, if you have no private health insurance, a stay in a private hospital will incur a cost.

Will postnatal depression or anxiety occur again if I have another baby?

If you’ve had postnatal depression or anxiety in a previous pregnancy, or experienced depression or anxiety during another stage in life, you do have a higher likelihood of experiencing it again with your next baby. However, it’s not a given. It’s important to let your doctor know early in your next pregnancy, so steps can be taken to help prevent it from reoccurring. If you do experience postnatal depression and/or anxiety again, your previous experience will ensure you’re better prepared for it and have greater insight into the condition.

Where else can I seek help?

As well as your Maternal and Child Health Nurse, GP and obstetrician, there are several organisations that can help you. These include:

  • Perinatal Anxiety and Depression Australia (PANDA):
  • Beyond Blue:
  • Maternal and Child Health Line:
    • 13 22 29 (24hr telephone service)

6 signs you may have uterine fibroids

woman standing outdoors holding her belly with both hands

Uterine fibroids (also called leiomyomas or myomas) are common, non-cancerous growths of muscle and fibrous tissue that can develop in a woman’s womb (uterus). Fibroids are most common during a woman’s reproductive years – between 70–80% of women will have one or more fibroids by the age of 50. However, only about 30% of these women will experience symptoms, with most not requiring any treatment at all.1,2

When fibroids do produce symptoms, they can be painful and debilitating. Unfortunately, many women who have fibroid symptoms delay reporting them. By doing so, they forego treatment, which could improve their quality of life and put an end to related health problems, such as anaemia and iron deficiency. If you have one or more of the following symptoms, fibroids could be to blame. A gynaecologist can assess if this is the case and if so, explain the treatment options available to you.

1. Prolonged, painful or heavy periods

Abnormal menstrual activity is the most common symptom of fibroids. Fibroids can cause periods that are extremely painful, with heavy bleeding (menorrhagia) that lasts longer than seven days.

Menstruation (your period) is essentially the break down and removal of the inner lining of your womb (uterus), which builds up each month in preparation for a potential pregnancy. If fibroids grow within this lining, they cause it to enlarge, leading to heavier and longer bleeding when you menstruate.

2. Anaemia, i.e. low red blood cell count (with or without iron deficiency)

Periods associated with heavy bleeding can lead to a low red blood cell count (anaemia). If you have anaemia, you may feel tired, run down and short of breath, particularly when you exercise. This is because red blood cells help store and carry oxygen in the blood. If you have fewer red blood cells than normal, your organ and tissues, e.g. heart and lungs, won’t be getting as much oxygen as usual.

Over time, ongoing, heavy blood loss may also lead to low iron levels (iron deficiency). Without iron, your body is unable to make new, functional red blood cells – this is called iron deficiency anaemia. Left untreated, iron deficiency anaemia can lead to heart problems and other complications.

3. Non-cyclic bleeding and pain

Mild pelvic or lower back pain is not uncommon during menstruation. However, fibroids can produce pain at any time of the month. This pain tends to be more severe than period pain, particularly if the fibroids are large and putting physical pressure on the uterus. If blood vessels within the fibroids rupture, this may also cause bleeding at other times of the month. If you are experiencing pelvic pain and/or bleeding on and off throughout your entire cycle, it could be due to fibroids.

4. Pain during intercourse

Fibroids may increase the size of the uterus or grow in the cervix (close to your vaginal tract). When they grow in these areas, they can produce pressure and significant pain during sexual intercourse.

5. Abdominal bloating

Larger fibroids may push into your lower abdomen, causing a feeling of fullness unrelated to food consumption or bowel motions. If they continue to grow, the lower abdomen may even protrude (bulge out), creating an almost pregnant appearance.

6. Bowel and bladder issues

Fibroids may also put pressure on your bowel and bladder. Depending on their exact location, you may experience constipation, a frequent urge to urinate, an inability to urinate, or pain when attempting to use the toilet.

The location of your fibroids will determine the symptoms you experience

Uterine fibroids: Anatomy chart of a uterus identifying areas fibroids can form along the uterine wall: intramural, pedunculated, submucosal, subserous as well as key parts of the uterus, cervix and vagina

Fibroids are classified by where they grow in relation to the uterus. There are 4 different kinds of fibroids:

1. Intramural fibroids grow within the wall of the uterus.

All fibroids start growing within the wall of the uterus. Then, depending on which direction they grow (inside or outside the uterus), they turn into one of the other types of fibroids described below. Intramural fibroids are the most common and do not usually cause symptoms, unless they reach a significant size.

2. Subserosal fibroids grow outside the uterus.

Subserosal fibroids grow outwards from the uterus, into the abdominal cavity. These are the largest type of fibroid and can even weigh multiple kilograms. Your gynaecologist may be able to feel or even see them during a pelvic exam.

Usually, symptoms from these fibroids are due to the pressure they produce on nearby structures in the abdomen such as the bladder or bowel, e.g. you may experience back and pelvic pain or bowel and urinary issues.

3. Submucosal fibroids grow inside the uterus.

Because the inside of your uterus is so small (about 7 cm), submucosal fibroids do not have to reach a large size to cause significant symptoms. Submucosal fibroids tend to produce a lot of bleeding, pain and excessively long periods.

In very rare instances, submucosal fibroids may alter the shape of the uterus. This can lead to fertility issues or recurrent miscarriages.3 In this case, help from a fertility specialist may be required to fall pregnant or to assess the womb’s ability to carry a pregnancy to term.

4. Pedunculated fibroids are attached to the uterus via a stalk (peduncle).

This type of fibroid is defined by the stalk that attaches it to the uterus. Pedunculated fibroids usually cause mild to moderate pain, not unlike menstrual cramping. However, large pedunculated fibroids may twist on their stalk, producing sudden and severe pain.

If I’ve been diagnosed with uterine fibroids, should I be concerned?

If you’ve been diagnosed with fibroids but are symptom free, there is little cause for concern – the vast majority never cause symptoms and don’t impact on fertility. Fibroids can also wax and wane over time (and typically shrink after menopause), so sometimes symptoms will resolve on their own.

However, when symptoms do occur, they can be debilitating – particularly if they are affecting your ability to keep up with work and other day-to-day commitments. In this case, it is worth consulting a gynaecologist to understand the treatment options available to you.

For advice specific to your circumstances, you can make an appointment with me by calling (03) 9418 8299 or by booking online.

References:


  1. Fibroids, Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fibroids. Accessed March 13, 2019.  ↩
  2. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–107.  ↩
  3. Farquhar C. Do uterine fibroids cause infertility and should they be removed to increase fertility? BMJ. 2009;338:b126. doi:10.1136/bmj.b126  ↩

Expressing breast milk prior to giving birth

several breast pads and a breast express pump on a table

This post was contributed by Diabetes Educator and Registered Nurse/midwife, Jenny van Gemert MNurs GDipMid GDipEd (Facebook and Insta).

When is it beneficial to express breast milk prior to giving birth?

While some women like the security of having colostrum (early breast milk) stored prior to giving birth, it is particularly beneficial for women who have diabetes.

Mothers with all types of diabetes (pre-existing or gestational diabetes) have relatively higher blood glucose (sugar) levels during their pregnancy – even when their diabetes is well treated. This glucose crosses the placenta to the baby. In response, the baby makes more of the hormone, insulin, which lowers the baby’s blood glucose to the perfect level. Over the course of the pregnancy, the baby’s body becomes used to making more insulin.

After delivery, babies born to women with diabetes are at a higher risk of hypoglycaemia (low blood glucose levels). This occurs because these babies continue to produce large amounts of insulin after birth, even though their supply of glucose from their mother, through the placenta, has ceased. This results in an overcorrection of glucose levels, dropping them to potentially unsafe levels.

Rest assured that if you have diabetes, it is standard protocol for your midwife to check your baby’s blood glucose level after birth. If your baby’s blood glucose level is too low, your midwife will encourage you to breastfeed. This initial feed is usually enough to raise the baby’s glucose level. Your midwife will continue checking your baby’s blood glucose level until there are three readings in the appropriate range.

If the initial breastfeed is unsuccessful in maintaining your baby’s blood glucose level, your midwife will seek your permission to give your baby a small amount of formula. At this point, you may prefer to give your baby pre-expressed colostrum. Therefore, expressing breast milk prior to birth allows this option for women who wish to avoid giving their baby formula.

If pre-expressed colostrum or formula does not raise your baby’s blood glucose levels, glucose can be given to your baby – orally or through a drip. However, this is not commonly required.

Is it safe to express?

In 2017, a world-first study about antenatal expressing of colostrum was published in The Lancet – a renowned medical journal. The study found that pregnant diabetic women without complications can safely express breast milk towards the end of their third trimester. You can read more about the study in this article by the Royal Women’s Hospital.

When should I start expressing?

Ideally, you should start expressing between 36–37 weeks of your pregnancy. However, always seek the approval of your obstetrician prior to expressing. In some, albeit rare, cases, nipple stimulation can induce labour. Therefore, it’s important to ensure that your body is ready should this occur.

How do I express?

I recommend watching one of the many excellent online demonstrations, such as this one. 
 
I do recommend hand expressing, rather than using a breast pump. While pumps are excellent for postnatal expressing (when your milk has come in), hand expressing is much more successful for antenatal expressing.

What if I can’t do it?

Initially, keep trying! I recommend that you hand express for at least five minutes per side, every day, for at least a week. Be mindful that it does not always work. However, this does not mean that you won’t be able to breastfeed – there is no evidence to suggest that an inability to express in the antenatal period predicts your ability to breastfeed after birth.

Additionally, keep in mind that there is no set amount of colostrum that you need. The amount collected varies from woman to woman, ranging from 0.5mL to 25mL or more. Any expressed colostrum is considered ‘liquid gold’; therefore, no amount is too small – just do your best.

How do I store the breast milk? 

Breast milk can be stored in sterile containers or 1–3mL syringes. If you’re storing the breast milk in a syringe, the syringe can suction the milk up after it is hand-expressed into a sterile container. Once suctioned, a cap should be placed on the syringe. No needle is required in the process. Both sterile containers and syringes can be bought over the counter at the chemist. Alternatively, if you have an appointment with myself or Dr Chris Russell, you can request that I mail these items to you. You can also collect them from the office after your next appointment with Dr Chris Russell.

Once filled, label the syringe or sterile container with your full name, date of birth and the date it was expressed. The breast milk should be frozen, until it’s time to head to the hospital for delivery. The frozen breast milk can be transported to the hospital with an ice brick in a cooler bag. Upon arrival, give your frozen breast milk to your midwife. A small quantity of expressed breast milk will not take long to defrost, and your midwife is well trained in the preparation of expressed milk.

What should I do if I need more help?

If you would like, you can make a 45-minute appointment with me. As a diabetes educator, registered nurse and midwife, I can teach and assist you to express breast milk. These appointments are $90 and can be arranged by calling 9418 8299.

Can fertility surgery improve my chances of conceiving?

Woman laying in hospital bed with man sitting by her side holding her hand

Some causes of fertility problems (e.g. endometriosis, polycystic ovary syndrome) can be diagnosed and/or treated via special surgical techniques. Where suitable, surgery may help women avoid the need for assisted reproductive treatments (ART) or in vitro fertilisation (IVF) – or improve pregnancy outcomes from these procedures. Further, if a younger woman has a well-defined, physical cause of infertility, surgery may resolve her fertility issues entirely for years to come (allowing multiple natural pregnancies).

Common surgical procedures which may be used to diagnose and treat fertility issues include:

Hysteroscopy

A hysteroscopy is a procedure used to examine the inner lining of the uterus (womb). It involves a long telescope (hysteroscope) with a light and camera on the end. The hysteroscope passes through the cervix into the uterus, allowing the surgeon to see inside the uterus without having to make any cuts or incisions. If any abnormal tissue is seen by the surgeon during this procedure, he/she will typically try to remove it (preventing the need for a second operation).

Dilatation and curettage (D&C)

A D&C is one way that a surgeon can remove abnormal uterine tissue such as polyps or endometrial hyperplasia (benign thickening of the uterine wall). During this procedure – which may be performed as part of a hysteroscopy – a small instrument is used to first dilate (i.e. open) the cervix. Next, a surgical instrument called a curette is passed through the opened cervix into the uterus, allowing the surgeon to remove abnormal tissue.

Laparoscopy

A laparoscopy is similar to a hysteroscopy, in that both procedures are initially diagnostic and use a thin telescope-like instrument to examine the uterus. However, a laparoscopy examines the outside of the uterus and surrounding abdominal structures – therefore, it requires a small incision within the belly button. A second incision near the bikini line is also made to allow the use of other surgical instruments. A laparoscope allows the surgeon to identify and remove any abnormal growths on the outside of the uterus or within the abdominal cavity (such as fibroids, cysts or endometriomas) that may be affecting your fertility. Tubal flushing may also be performed during a laparoscopy (see below).

Tubal flushing

The fallopian tubes are where the sperm meets and fertilises an egg. The resulting embryo can then implant and grow in the uterus. However, if the fallopian tube is blocked, fertilisation and/or implantation may not be possible. There are many causes of fallopian tube blockage, including:

  • STI infection (chlamydia or gonorrhoea)
  • Pelvic inflammatory disease
  • Scar tissue
  • Endometrial growths
  • Fibroids
  • Previous abdominal surgery
  • Mucous

Tubal flushing aims to clear out any blockages by gently flushing the tubes with liquid – typically water or lipiodol (poppy seed oil). This helps to optimise the health of the fallopian tubes, improving the chances of future successful fertilisation.

Ovarian drilling

Ovarian drilling is specifically used for cases of polycystic ovary syndrome (PCOS). In PCOS, tissue on the surface of the ovaries produces androgens (male hormones) which can reduce a woman’s fertility. This treatment is exactly what it sounds like – the drilling of small holes into the surface of the ovary. This removes the surface tissue responsible for producing the male hormones, helping to stabilise hormone production. This can restore normal ovulation, increasing the chance of pregnancy.

Surgical correction of anatomical issues (polyps, fibroids, uterine septum)

A uterine septum is the most common anatomical issue affecting fertility. This is a congenital abnormality (i.e. an abnormality present from birth), whereby extra tissue grows within the uterus, splitting it into two. Uterine septa have been linked to both infertility and miscarriage. Surgery can be used to physically remove the septum, resolving infertility. Other anatomical issues that may affect fertility include polyps, fibroids or endometrial growths. As mentioned earlier, these are often removed at the time of a diagnostic hysteroscopy or laparoscopy.

Tubal reconstruction surgery/vasectomy reversal

Tubal ligation and vasectomy are two of the most effective and common forms of contraception in Australia, especially in those with an established family. While these are designed to be permanent, it’s not entirely uncommon for people to change their minds and request the procedure to be reversed. Surgical reversal (the re-joining of the fallopian tubes) is not always possible, as it depends on how the tubes were initially disconnected. When it is possible, couples can expect a 50–80% pregnancy success rate. IVF may be a better option than reversal surgery for some, especially if a couple is over 35 years old or have other factors affecting their fertility. If the couple is younger with high fertility levels, reversal surgery may prove to be the more affordable option.

Wondering if fertility surgery could be right for you?

If you would like a personal assessment of your fertility or advice about ways to optimise your chances of conceiving, you can make an appointment with me by calling my rooms on (03) 9418 8299 or by booking online.

What affects men’s fertility?

Man with goatee staring out a window

Much emphasis is placed on the woman during a couple’s fertility journey. However, while it may seem obvious, the woman is only one part of the equation. In Australia, it’s estimated that 40% of infertility can be attributed to men.1,2 Furthermore, according to the Australian Institute of Health and Welfare, 8% of males over the age of 40 have tried unsuccessfully to have children.2

What does normal fertility in men require?

Fertility in men firstly relies upon the normal production of sperm, a process which is under hormonal control. Sperm must be produced in an adequate amount and be of normal shape and structure. This is vital in ensuring a sufficient number of sperm are able to propel forward and survive in the female reproductive tract, in order to reach and fertilise the egg.

Fertility in men also depends on the normal transportation of sperm from its site of production in the testicles. Sperm must be able to pass through a series of open passages so that it can exit via the urethra (the channel in the penis) during ejaculation.

What are the causes of male infertility?

Any abnormality in the production or transportation of sperm can result in male infertility. The specific causes of male infertility fall into four broad categories:

1. Abnormal sperm production

For the majority of men with abnormalities in sperm number, shape or motility (the ability of the sperm to move), there is no identifiable cause. However, there are a number of congenital and acquired causes of abnormal sperm production that may be responsible.

If abnormal sperm production is congenital, it means the condition causing the abnormality has been present from birth. One of these conditions is Klinefelter syndrome – a genetic condition in which the male has 47 chromosomes (rather than 46). Men with Klinefelter syndrome have small testes and do not produce sperm.

Another congenital condition that can cause abnormal sperm production is cryptorchidism, or undescended testes. Normally, during early development, the testes form in the abdomen and then descend into the scrotum (the sac that contains the testes). If this process does not occur, the testes remain situated in the abdomen – hence the term ‘undescended’. Men with undescended testes usually have lower sperm counts and poorer-quality sperm.

Abnormal sperm production can also be acquired, meaning that it results from events that occur in later life. Infection of the testes, most commonly by the mumps virus, is one acquired cause of sperm production abnormalities. Similarly, some drugs, including chemotherapy agents, can impair normal sperm production.

A condition called varicocoele involves enlargement of the veins of the scrotum. This can lead to scrotal pain, reduced testicle size and in some cases infertility; in other cases, men with varicocoele have normal fertility. In another condition called testicular torsion (twisting of the testis), a lack of blood supply can result in death of the testis, causing permanent loss of sperm production. This condition most commonly occurs in babies or young adolescents.

Finally, any trauma to the testes may also impair sperm production.

2. Sperm transport disorders

Structural abnormalities of the passages that transport sperm (i.e. epididymis, vas deferens, urethra) can cause infertility. As with abnormal sperm production, these abnormalities can be congenital or acquired.

In the vas deferens, blockage can be caused by previous sexually transmitted infections. It may also be the result of a vasectomy, which is a surgical procedure that intentionally cuts and ties the vas deferens as a method of permanent contraception. Although a vasectomy can be reversed surgically, there is no guarantee that fertility will return.

Lastly, difficulties with sexual intercourse can also prevent the passage of sperm into the female reproductive tract. These include erectile dysfunction (impotence) and premature ejaculation.

3. Hormone disorders

Because the production of sperm is driven by hormones, hormonal abnormalities can affect fertility. The main hormones that influence male fertility are gonadotropin releasing hormone (GnRH), LH (lueteinising hormone) and testosterone; abnormalities in these hormones may occur for various reasons. Additionally, imbalances in other hormones not directly involved in the male reproductive system can also affect male fertility.

4. Unknown (idiopathic) male infertility

Some men have consistently normal sperm (as determined by semen analyses), yet still fail to conceive with an apparently fertile female partner. Despite assessment and investigation, no underlying cause is found.

This list does not include all the possible causes of male infertility– however, it gives you a good indication of what a fertility specialist will be looking for in their assessment.

What lifestyle factors affect men’s fertility?

A person’s lifestyle seemingly has an impact on all facets of health – and this includes fertility. Lifestyle factors that may affect men’s fertility include:

  • Diet: Studies have demonstrated that men with healthy dietary habits tend to have better results on semen analyses. Low sugar and carbohydrate eating plans are best.
  • Exercise: Overall, men who are sedentary produce less sperm. They are also more likely to suffer from erectile dysfunction. However, balance is important – too much exercise can also have a negative impact on men’s fertility. Aim to exercise 3 to 4 times per week for 45 minutes.
  • Weight: Men with an abnormally high BMI (body mass index) – i.e. those who are overweight – are less likely to conceive. However, this is also true of men with abnormally low BMIs. Therefore, being in a healthy weight range is important in ensuring optimum fertility.
  • Smoking: Lower sperm quality has been observed in men who smoke. This effect is reversed within a year of quitting.
  • Alcohol: In men, heavy alcohol use can lead to sperm production abnormalities, erectile dysfunction and testosterone abnormalities. Therefore, men who are trying to conceive should reduce their alcohol intake.

Men’s fertility decreases with increasing age

You are probably aware that women become less fertile as they get older, but you may not know that men also experience a decline in their fertility (albeit to a much lesser degree). While it’s true that men continue to produce sperm through the entirety of their life, the quality of their sperm diminishes with age.

What tests are performed to assess male infertility?

The initial test for male infertility is a semen analysis. This assesses the volume of semen (the fluid that contains the sperm), sperm count and concentration, sperm motility and sperm shape. It may also test for the presence of sperm antibodies, which can impair functioning of the sperm. Some sperm analyses also assess the DNA in the sperm. It is important to have your sperm tested at an experienced laboratory.

If the sperm analysis is abnormal, the test may be repeated to confirm the result. If the sperm count is still abnormal in the repeat test, further investigation may be necessary to determine the cause. Usually this involves a series of blood tests and sometimes an ultrasound scan.

Concerned about your fertility?

If you and your partner have been struggling to conceive, it’s better to seek help early. As a fertility specialist, I am experienced in investigating causes of infertility (due to both male and female factors) and can work with you to determine your next steps. Contact my rooms to make an appointment by calling (03) 9418 8299 or booking online.

References:


  1. McLachlam RI, de Kretser DM. Male infertility: the case for continued research. Med J Aust 2001;174:116–117.  ↩
  2. Collins HP, Kalisch D. The health of Australia’s males. Australian Institute of Health and Welfare 2011.  ↩

Travel, sex, saunas, hair dye: what’s safe during pregnancy?

Couple sitting together smiling and reading a tablet screen.

Keeping a growing baby safe and healthy throughout pregnancy is every expecting mother’s highest priority. But what does this mean in terms of keeping up with your usual routines and leisure pursuits? Can you travel? Is hair dye OK? What about exercise? Or sex?

The short answer is: yes, you can do all of these things during pregnancy. However, you may need to take some extra precautions or modify your usual behaviour. And unfortunately, yes, there are some activities it is best to avoid for the duration of your pregnancy.

Travel

Flying

While flying itself doesn’t have any effect on a pregnancy, most airlines will not let you fly if you are over 36 weeks pregnant. Some airlines restrict travel even earlier (e.g. from 28 weeks) and/or require signed medical clearance from a doctor. These restrictions are not based on any real medical concerns but are more about airlines wanting to avoid risk – no one wants a pregnant woman giving birth mid-flight!

Timing your travel

Fatigue and nausea during the first trimester can make travelling uncomfortable. In the third trimester, the extra weight you are carrying can make it physically harder to get around, particularly if you are also suffering from back or pelvic pain. Fatigue and shortness of breath can also be an issue in later pregnancy. As such, most women find the second trimester to be the most comfortable time to travel.

When timing your travel, it’s also important to note that you will require more frequent antenatal visits as your pregnancy progresses – monthly visits up to 28 weeks, then every 2 to 3 weeks until 36 weeks, with weekly visits thereafter. So, if possible, it’s best to avoid periods of extended travel during the last trimester.

If your obstetrician has deemed your pregnancy to be ‘high risk’, he/she may also want to see you more frequently throughout your entire pregnancy.

Long trips and deep vein thrombosis (DVT)

A DVT is when a blood clot forms in a deep vein, typically in your leg. Clots form much more easily when blood flow is slow, e.g. when you don’t move around very much like on a long-haul flight. The risk of clots is also 5–10 times higher during pregnancy due to hormonal changes – this is how your body safeguards itself from losing too much blood after birth.

While DVTs are uncommon, they can lead to life-threatening complications, so take these few simple steps during longer trips to help lower your risk:

  • Walk regularly (every 30 minutes if possible)
  • If you can’t walk around, stretch and exercise your legs regularly while sitting (most airlines provide instructions for leg and ankle exercises in the seat pocket)
  • Drink plenty of water
  • Avoid caffeine (as it dehydrates you).

If you have had a DVT in the past, have a multiple pregnancy, or have other risk factors, your doctor may also advise you to wear compression stockings or take certain medications during your trip.

Travel vaccines

Certain vaccines are recommended prior to travelling to some countries, including most developing nations, due to the increased risk of diseases such as typhoid. Unfortunately, most vaccines are harmful to unborn babies or haven’t been adequately tested for safety on pregnant women. Some vaccines, such as those for yellow fever and typhoid, may be given with caution after the first trimester.

Therefore, it is generally recommended that pregnant women delay any travel to developing nations until after their babies are born. If travel to high-risk countries during pregnancy can’t be avoided, it’s best to consult both your obstetrician and a specialist travel doctor to understand the full breadth of precautions you should take.

For specific advice about avoiding exposure to the Zika virus while travelling, read this article.

Hair dye, cosmetics and aesthetic treatments

Research has shown that hair dye is fine to use during pregnancy, although many women still fear that the chemicals in hair dye may be absorbed through their scalp, leading to developmental abnormalities in their baby. There is no scientific evidence to support this but if you remain concerned, many hairdressers now offer low-chemical dyes or henna alternatives.

Similarly, while you don’t have to stop using your usual make-up or skincare products during pregnancy, some women prefer to switch to toxin-free or natural alternatives. Skin sensitivity can worsen during pregnancy, in which case products specifically formulated for intolerant skin (fragrant-free, preservative-free) can be helpful.

Aesthetic techniques like laser hair removal and laser skin treatments should be avoided during pregnancy and breastfeeding, as should Botox and other injectables, as the risk to a developing baby is either unclear or not well-researched.

Exercise and other leisure activities

Regular exercise throughout pregnancy is highly recommended and you can find some useful tips here. Physical activity is associated with fewer complications during both pregnancy and birth, including a decreased risk of premature birth. Staying active can also help you sleep better, increase your energy levels, and reduce your likelihood of suffering from common pregnancy complaints like varicose veins and swollen feet and ankles.

However, it is important to take into account your pre-pregnancy fitness level. If you were already active prior to becoming pregnant, you can maintain your usual routine until it feels uncomfortable to do so. Most women find that they need to start making some modifications from around 4–5 months on, as the weight of their baby increases, their pelvic muscles start to relax, and shortness of breath kicks in.

If you were inactive prior to pregnancy, it’s a good idea to ease gently into any new exercise routine (after first checking with your GP or obstetrician), with the aim of being active for at least 30 minutes a day, four times a week.

It’s okay to feel hot, sweaty and puffed when you exercise – in fact, this should be your aim, especially during early pregnancy. A good gauge of intensity is that you should still be able to maintain a conversation.

While it is okay to exercise while pregnant, you may need to make some modifications depending on the type of exercise you enjoy doing:

  • After 16 weeks, exercising on your back (e.g. stomach crunches, sit-ups) is no longer recommended. The weight of the baby could press on a major blood vessel, reducing blood flow to your heart and your baby.
  • It is safest to avoid contact sports (e.g. football, hockey, martial arts) and activities with a risk of falling (e.g. skiing, climbing, horse-riding).
  • Scuba diving is not safe during pregnancy, as gas bubbles can cross the placenta and your baby has no protection against decompression sickness.
  • High-altitude training (over 2,500 metres) is not recommended, as it reduces the oxygen supply to you and your baby.
  • To avoid overheating, drink water regularly and avoid exercising in very hot temperatures (no hot yoga!).
  • If you go to an exercise class that’s not specifically for pregnant women, tell the instructor that you’re pregnant, so they can provide you with alternative exercises (e.g. doing crunches while lying on your side rather than on your back). If the instructor panics when you tell them you’re pregnant and/or has no experience with pregnant women, find another class.
  • If weight training, use an incline bench (rather than lifting weights on your back) after the first 12 weeks, swap to weights that feel light to moderate rather than heavy (try more repetitions with lighter weights instead), avoid using heavy bar bells behind your neck after 12 weeks (use dumbbells instead), and don’t hold your breath when lifting. As your pregnancy progresses, it’s also a good idea to avoid deadlifts, clean and press, and upright rows, as it will be hard to maintain correct technique and stop the bar from hitting your bump as the weight and size of your baby increases.
  • If you are suffering from pelvic girdle pain, see this article (insert link to previous blog) for helpful tips and specific moves to avoid, e.g. standing on one leg.
  • If you have any unusual pains while exercising, stop and seek advice from a healthcare professional immediately.

Take a look here for further tips on exercise during pregnancy.

Swimming, spas, baths and saunas

Exposure to extreme or constant heat during pregnancy – even for a short amount of time (e.g. 10 minutes) – can harm your baby’s development and increase the risk of miscarriage. This is particularly true during the first trimester. Dehydration, as a result of heat exposure, can also lower your blood pressure, making you feel unwell or light-headed. For these reasons, it is recommended that pregnant women avoid hot baths, spas and saunas throughout their entire pregnancy.

Swimming on the other hand is a particularly gentle form of exercise, so it is ideal for pregnant women. And unlike some other forms of exercise, there’s no risk of overheating! Just make sure that the pool water is no warmer than 32 degrees (note: while this is usually not an issue in Australia, it’s a good idea to check pool temperatures when travelling abroad). It is also best to stick to pools you know are properly chlorinated or beaches and to avoid smaller, stagnant bodies of water that may carry water-borne illnesses (e.g. dams, rivers).

Sex, drugs and alcohol

Be reassured that sex will not harm your developing baby. It is fine to remain sexually active throughout all stages of your pregnancy. Sex does not cause miscarriage and will not make you go into early labour. Of course, you should continue to protect yourself against sexually transmitted diseases.

While it may seem okay to have a glass of wine now and again, there is actually no safe level of drinking during pregnancy. It is best to abstain from alcohol altogether during pregnancy. Similarly, all illicit drugs should be avoided, as it puts your baby at risk of developmental abnormalities and drug dependency.

When it comes to the use of specific over-the-counter and prescription drugs, as well as natural medicines, it is best to ask your GP, pharmacist or obstetrician for advice. The most common drug I am asked about is paracetamol, which is safe for your growing baby, as long as it is taken as directed. It should be your first port-of-call for pain relief during pregnancy.

Cheese, sashimi and other gourmet foods

As a general rule, it’s recommended that you avoid raw, unpasteurised or pre-prepared foods (like raw fish, soft cheeses and deli 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.

For more detailed guidance on food safety during pregnancy, download my quick and convenient food safety guide, which you can print out and refer to at home and on the go.

High-risk pregnancies

If your obstetrician has deemed your pregnancy to be high-risk, some additional precautions or restrictions may be necessary. Your obstetrician can advise you accordingly.

Last word: if you’re ever unsure, check with your obstetrician

Being pregnant doesn’t mean you can no longer enjoy the good things in life – but you may need to take a few extra precautions or make some modifications to your usual routines and habits. If you are finding it difficult to navigate the world of what is and isn’t baby-friendly, don’t hesitate to ask questions (no matter how silly you think they sound) during your next antenatal appointment. Between appointments, you are always welcome to call my rooms for advice on (03) 9418 8299.

Does having endometriosis mean I’m infertile?

Woman sitting on edge of bed holding her belly in some discomfort

Endometriosis is a condition where tissue similar to the lining of the uterus – called endometrial-like tissue – grows in other parts of the body, like the bowel and bladder. It can also affect reproductive structures like the ovaries and fallopian tubes.

In Australia, around 1 in 10 women suffer from endometriosis. Believe it or not, this means endometriosis is just as common as diabetes. However, because endometriosis commonly goes undiagnosed, this figure may be even higher.

It is important to note that most women who are diagnosed with endometriosis will have no trouble at all becoming pregnant – contrary to the common myth that ‘endometriosis equals infertility’. However, about 1 in 3 women with endometriosis will experience issues with fertility and may struggle to have a successful pregnancy without assistance.

How can endometriosis affect fertility?

There are a number of ways that endometriosis is thought to affect fertility:

Abnormal tissue growth

When endometrial-like tissue grows outside your womb (uterus), it can interfere with the function of other body parts. If this growth occurs within your pelvis, it may affect structures that play an important role in pregnancy – like the ovaries, fallopian tubes and uterus. This can disrupt their normal functions, hindering your ability to conceive.

Inflammation and scarring

One of the ways the body responds to the tissue damage caused by endometriosis is inflammation, leading to irritation and swelling of the affected tissue. While this inflammation represents the body’s attempt to ‘fight off’ the disease, it can also produce scar tissue – known as ‘adhesions’ – which can cause organs to stick to each other. These adhesions can damage the ovaries or fallopian tubes, block the movement of eggs through the fallopian tubes, or prevent sperm from entering the uterus.

Egg quality and quantity

Some experts believe that substances released during inflammation may be toxic to a woman’s eggs, affecting their quality. Hormone imbalances in the ovary (caused by endometriomas – cysts that form in or on the ovary in women with endometriosis) may also affect the development and quality of eggs. Women with endometriomas also typically have fewer eggs (low ‘ovarian reserve’). Scar tissue caused by endometriosis may also starve the ovaries of blood flow and oxygen, resulting in eggs that don’t mature properly. This may affect the ability of your eggs to fertilise, implant and develop in a healthy way.

Medical treatments used to control your symptoms

You can find a summary of common treatments for endometriosis here. Most of these treatments are designed to control symptoms by stopping ovulation, thereby switching off the hormones that stimulate abnormal tissue growth. While these treatments can help control symptoms, they also act to temporarily decrease your fertility. Hence, you will need to pause these kinds of treatments when you are ready to get pregnant.

If I have endometriosis, when should I have my fertility tested?

If you have endometriosis and are now ready to become pregnant, I advise a consultation with your gynaecologist to discuss stopping any medical treatment you may be on (e.g. oral contraceptive) and to identify ways you can optimise your fertility. If you have been seeing your gynaecologist for a long time, he/she will have a good understanding of the severity of your endometriosis (including what pelvic structures are affected from any previous imaging studies/laparoscopes) and will be able to manage your expectations accordingly.

In general, if you have been unable to become pregnant after trying for 6 to 12 months, I recommend a fertility assessment. Women who are ≥ 35 years old should seek help earlier (after 6 months of trying), as age is also a risk factor for fertility issues.

It’s also important to recognise that endometriosis may not be the reason you are having trouble getting pregnant. For example, there are other health conditions, as well as lifestyle factors (such as diet and exercise), that can also affect your ability to conceive. Similarly, it’s prudent that we also assess your partner’s fertility to rule out any male-related fertility issues.

What treatments can aid fertility?

If your assessment does point to endometriosis as the source of your fertility issues, there are a number of treatment options available, depending on what specific problems your endometriosis is causing.

Surgery

Surgery to remove some of the abnormal tissue and adhesions caused by endometriosis has been shown to improve fertility in women with mild to moderate disease.1 Laparoscopic (keyhole) surgery is the most common method for removing this tissue. After surgery, the best chances of conceiving are during the first few months, so women should strive to become pregnant as soon as possible (before the abnormal tissue or scar tissue has time to recur).

IVF

If surgery alone does not lead to a successful pregnancy, IVF may be an option for you. One study found that women with endometriosis who underwent both surgery and IVF were more likely to achieve a pregnancy than women who only had surgery (56.1% vs. 37.4% respectively).2 In severe cases, where egg quality or quantity is an issue, you might need to consider using donor eggs – this is more likely if you are also over 40.

Early detection

There is an average delay of 7–12 years from when a woman first presents with symptoms of endometriosis to when she receives a diagnosis – probably, in part, because both women and doctors tend to ‘normalise’ the symptoms of endometriosis (like painful periods). However, a delayed diagnosis does mean that the disease is more likely to have progressed and caused damage to reproductive structures.

Hence, the best way to maintain fertility is early detection and treatment to help limit the abnormal tissue growth and subsequent damage it causes. Early detection also provides women with additional options. For example, if you are diagnosed at a younger age, you may decide to freeze some of your eggs ‘just in case’, enabling you to focus on symptom control until you are ready for a pregnancy. Then, should fertility issues arise later in life, you have some eggs safe-guarded if you decide to go down the path of IVF.

Other

Other fertility treatments (including those used by women without endometriosis) may also be helpful. You can read about these options in more detail here. For most women, a combination of medical treatment, surgery and lifestyle change will help maintain and optimise fertility in the setting of endometriosis.

Can pregnancy cure endometriosis?

A common myth is that pregnancy cures endometriosis. Hormonal changes during pregnancy may temporarily reduce abnormal tissue growth and improve your symptoms. However, once hormone levels normalise after pregnancy and breastfeeding, you may find that your symptoms return.

What next?

If you have been diagnosed with endometriosis, be reassured that not all women in your position experience fertility issues. However, it is best to seek specialist advice as early as possible, with the aim of preventing fertility from becoming an issue down the track.

For advice specific to your circumstances, you can make an appointment with me by calling (03) 9418 8299 or by booking online.

References


  1. Marcoux S, Maheux R, Bérubé S. Laporoscopic surgery in infertile women with minimal or mild endometriosis. Canadian collaborative group on endometriosis. N Engl J Med.1997 Jul 24;337(4):217-22. (Accessed online 30 January 2019) Available at https://www.ncbi.nlm.nih.gov/pubmed/9227926 
  2. Coccia, M. Elisabetta et al. Endometriosis and infertility. European Journal of Obstetrics and Gynecology and Reproductive Biology, Volume 138, Issue 1, 54-59. (Accessed online 30 January 2019) Available at https://www.ncbi.nlm.nih.gov/pubmed/18243485 

Gestational diabetes

Image of pregnant woman having finger prick test to check blood glucose level

Cases of gestational diabetes (also known as pregnancy diabetes or diabetes in pregnancy) are on the rise, putting pregnant women and their unborn babies at serious risk.

Between 2013 and 2018, the number of women diagnosed with gestational diabetes increased from 22,215 per year to 40,823 per year (112 new cases every day in 2018).*1,2

*as registered with the National Diabetes Services Scheme

Bar

Graph adapted from National Diabetes Services Scheme data1,2

This pattern coincides with an increase in expectant mothers who are older, who are overweight/obese or whose ethnic background puts them at high risk.

What is gestational diabetes?

Gestational diabetes refers to diabetes that first occurs, or is first recognised, during pregnancy.

Hormonal changes due to being pregnant can make your body lose its ability to control the levels of sugar (glucose) in your blood. Uncontrolled blood sugar levels during pregnancy may then lead to a range of health issues for you and your baby.

What causes gestational diabetes?

Your body normally keeps the level of sugar in the blood at a specific level. The hormone insulin is responsible for moving sugar out of your blood and into your muscles and liver, where it can be used as energy.

Unfortunately, the hormones responsible for supporting your pregnancy and the development of your baby make your body resistant to insulin. As your pregnancy progresses, more and more insulin is required to keep your blood sugar at the right level. Most, but not all, women can meet the increased demand for insulin – those who can’t develop gestational diabetes.

What are the symptoms of gestational diabetes?

Almost all women with gestational diabetes have no symptoms. This is why testing is highly recommended for all pregnant woman, not just those who are at high risk.

However, when symptoms occur, some of the more obvious ones include:

  • Increased need to urinate
  • Extreme fatigue
  • Excessive thirst/dry mouth
  • Nausea
  • Yeast (thrush) infections
  • Blurred vision.

As you can see, distinguishing the signs of gestational diabetes from that of a normal pregnancy can be difficult. However, symptoms are usually more severe with gestational diabetes. It’s a good idea to have your diabetes risk assessed early in your pregnancy and follow up with regular reviews by your obstetrician.

Who is at risk of developing gestational diabetes?

We know that various factors may increase your risk, such as a previous history of gestational diabetes, carrying excess weight and older age.

Risk factors

  • Age above 35
  • Being overweight or obese
  • Previous history of gestational diabetes
  • Family history of type 2 diabetes
  • Previous baby weighing over 4.5kg
  • Aboriginal, Torres Strait Islander, Asian, Polynesian, Middle Eastern or Indian ethnicity
  • Excessive weight gain during pregnancy
  • Antipsychotic or steroidal medication
  • Polycystic ovary syndrome (PCOS)

What are the dangers of gestational diabetes?

With early detection and management of gestational diabetes, we would still usually expect a healthy and uneventful pregnancy.

However, if gestational diabetes is left undetected or poorly managed, the following issues can occur:

  • Increased risk of shoulder dystocia during birth (the baby’s head delivers but its shoulders become stuck) – this results from excessive foetal girth and can cause trauma for baby (bone fractures, nerve damage) and mother (vaginal tearing)
  • Increased risk of pre-term delivery
  • Respiratory distress or low blood sugar for your baby, requiring admission to a special-care nursery
  • Pre-eclampsia (high blood pressure, fluid retention and protein in the urine)
  • 1 in 2 risk that you will develop type 2 diabetes later in life
  • Increased chance of your child developing type 2 diabetes later in life.

How is gestational diabetes diagnosed?

The oral glucose tolerance test (OGTT) is the standard test used to diagnose gestational diabetes.

For an average-risk pregnancy, testing is typically performed between 26 and 28 weeks (when gestational diabetes is likely to develop).

If you have a history of gestational diabetes or are considered high risk, testing and management may begin at an earlier stage in your pregnancy.

The OGTT involves:

  • A fasting blood sample in the morning
  • Consuming a concentrated sugary drink
  • Taking blood samples 1 and 2 hours later.

A diagnosis of gestational diabetes is made if your blood sugar level is above the normal range at any point during the testing.

How is gestational diabetes treated?

If you are diagnosed with gestational diabetes, we can often manage it effectively throughout your pregnancy with lifestyle modifications. Timely intervention allows most women to continue on with a normal pregnancy and reduces the chance of complications, such as those listed above.

Managing gestational diabetes

  • Consume a healthy, balanced diet – avoid foods that are high in sugar or processed carbohydrates.
  • Exercise regularly at a level suitable for you
  • Attend all review appointments with your obstetrician, diabetes educator and endocrinologist (if required)

Implementing these changes is usually enough to effectively control blood sugar levels, although medication may be required for some women. More frequent appointments are required to monitor your progress and the condition of your baby.

Depending on the severity of your gestational diabetes, delivery is usually recommended between 38 and 40 weeks. It is generally not advisable to go past your due date.

Once you have given birth, the diabetes will often resolve. However, there is a 50% chance that you may develop type 2 diabetes later so remember to maintain a healthy diet, healthy weight and regular exercise.

Can I prevent gestational diabetes?

Prevention is difficult because many of the causes are out of your control, such as your family history and the hormone levels produced by your placenta.

However, there are also controllable risk factors – namely, high pre-pregnancy weight and excessive weight gain during pregnancy. The best way to manage these is by consuming a diet low in sugar and processed carbohydrates.

Read more about healthy weight gain in pregnancy and pre-pregnancy health

Do you need a specialist opinion?

Early detection and management are essential when it comes to gestational diabetes. If you have any concerns prior to or during your pregnancy, don’t hesitate to call my rooms on (03) 9418 8299 or book an appointment online.

 

References

1. National Diabetes Service Scheme: Gestational Diabetes as at 31 December 2018 (accessed online 16 January 2019). Available at https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/aa517d3a-5d41-4dec-a2ba-6c9a516b781a.pdf

2. National Diabetes Service Scheme: Gestational Diabetes at 31 December 2013 (accessed online 16 January 2019). Available at https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/232cba14-5f2e-49ff-8e07-a14b1e011893.pdf

What is the best age to have a baby?

Image of confused woman with question marks

A straight answer about the perfect age to conceive would make life a lot easier. However, there’s no end of conflicting advice about this contentious topic.

And the reason for this contradictory information?

The ‘best’ age to fall pregnant is not the same for everyone. It all depends on whether you are considering biological or social factors, both of which are very important.

First, let’s understand the biological clock

There’s no denying that a woman’s fertility is time-sensitive. The so-called ‘biological clock’ is something that must be considered when you are deciding whether to try for a baby now or to delay for a few years.

Unfortunately, women cannot produce more eggs. This means that what they are born with – generally between 1 and 2 million eggs – is all that they will ever have in their lifetime. And this ‘ovarian reserve’ steadily declines with age. By puberty, only around 25% of your eggs are left. Your fertility starts to decline around age 32, with the rate of egg loss speeding up again at age 37. By the time you reach menopause, virtually no eggs remain.

 

Graph demonstrating relationship between follicle/egg count and age

Graph adapted from te Velde ER, Pearson PL. The variability of female reproductive ageing. Human Reproduction Update 2002;8(2):141–54.

 

Essentially, your biological clock is the relationship between your age and your egg reserve – and it starts ‘ticking’ louder as you get older.

As an aside, the reason you never hear about men having a biological clock is that they continue to produce sperm throughout their life. However, the quality of their sperm does reduce significantly after age 45.

It’s easier to get pregnant when you are younger

Speaking from a purely biological standpoint, the best age to get pregnant is during your 20s – before the rapid decline in your egg reserve begins. This is when you are most fertile and pregnancies have the greatest chance of success. After this, it will become increasingly difficult to get pregnant – the odds are against women in their late 30s and early 40s.

It’s not only easier to become pregnant when you are younger, but you’re also less likely to suffer from certain pregnancy complications such as gestational diabetes (where hormonal changes make it harder for your body to keep blood sugar levels in check). Younger mums also have a reduced risk of having a miscarriage and having a child with Down Syndrome.

But it’s not just age that impacts pregnancy outcomes

When it comes to the best age to have a baby, the answer is different if you consider it from a sociological point of view. These days, many women wait until they are a bit older to have a baby so that they can establish or advance their career, or own a home before starting their family. And waiting longer has its own set of benefits.

Various studies have looked at health outcomes depending on maternal age. The findings suggest that women who were older when they had a baby had better long-term health outcomes (e.g. longer life expectancy) and so did their babies (e.g. lower infant mortality rate). It’s likely that this is because older mums come from higher-income households and income is linked to health.

So, when is the right time to get pregnant?

As much as I’d like to give you a simple answer, there is no ‘perfect’ time to get pregnant. You need to find a balance between your age (and fertility) and being in a good position to start a family. This will depend heavily on your personal circumstances.

Sometimes what’s happening in your personal life means that having a baby isn’t an option right now – but you may want to start a family in the future. An option for women in this situation is to have their eggs frozen (normally before you are 35). Doing so means you give yourself the option of IVF at a later date.

And rest assured that advances in fertility treatments and antenatal testing mean that most older women can still get pregnant and have healthy pregnancies and babies. Having said that, it’s important to understand that success rates of IVF also decline with age.

If you are not ready to start trying for a baby by the age of 30–32, my advice is to start thinking about freezing your eggs.

Thinking ahead helps

Whether or not you feel ready to have a baby right now, there’s never any harm in thinking ahead. As a gynaecologist and fertility specialist, I can help you understand the right timing for you to conceive.

As well as performing tests to estimate how many eggs you have (your ovarian reserve), we will have a comprehensive discussion about:

  • any health conditions that may impact your chance of getting pregnant
  • what your fertility treatment options are (or would be in the future)
  • any other relevant personal circumstances.

If you would like some advice, please don’t hesitate to call my rooms on (03) 9418 8299 and make an appointment.

Pelvic inflammatory disease explained

woman in jeans and t-shirt with hands crossed over her pelvic region

Some women’s health matters don’t get the attention they deserve – often because there’s a general lack of awareness about the condition. This can even occur for fairly common conditions such as pelvic inflammatory disease (PID).

Haven’t heard of PID? You’re not alone.

But every year in Australia, around 10,000 women are treated for PID in hospital and anywhere between 100,000 and 300,000 women are treated as outpatients by their GP or gynaecologist. PID is most common among sexually active women aged 20–29.

Read on to learn about this potentially devastating condition and how you can protect yourself from the long-term complications.

What is pelvic inflammatory disease?

As its name suggests, PID refers to inflammation of the organs and tissues in the pelvis. This includes the uterus, fallopian tubes and cervix.

The inflammation is caused by a bacterial infection. In most cases, the infection enters the body through the vagina and make its way up the cervix to organs in the pelvic region. Over time, the inflammation damages the tissue and causes scarring.

What causes pelvic inflammatory disease?

The most common causes of PID are the sexually transmitted infections (STIs) chlamydia, gonnorhoea and Mycoplasma genitalium. Infection of the female reproductive tract can also occur during an abortion, insertion of a contraceptive intrauterine device (IUD) or following childbirth. Other causes of PID include a ruptured appendix or bowel infection (gastroenteritis).

What are the symptoms of pelvic inflammatory disease?

PID is often referred to as a ‘silent epidemic’ because in many cases women can have an infection without having any signs or symptoms – we refer to this as being asymptomatic. The trouble is that even if you don’t have any symptoms, tissue damage is still occuring and this can cause serious health consequences in the long term.

When symptoms do occur, they can include any or all of the following:

  • Abnormal vaginal discharge
  • Unusual bleeding
  • Pain in the pelvis or lower abdomen
  • Pain during or after sex
  • Bleeding after sex
  • Increased period pain
  • Abnormal periods
  • Fever.

How is pelvic inflammatory disease diagnosed and treated?

A diagnosis of PID can be difficult to confirm. Diagnosis may involve testing for the presence of bacteria that cause PID and/or looking for evidence of inflammation in the pelvic region.

We can check whether certain bacteria (e.g. chlamydia) are present in the vagina and cervix by taking a swab from these areas or testing a urine sample – this is standard practice for the common STIs. If either test comes back positive, prompt treatment with antibiotics will clear up the infection. However, antibiotics cannot reverse any damage already done to the tissue. For this reason, early diagnosis and treatment is very important to minimise the long-term effects of PID.

Further testing may be required for some patients. This can involve blood tests, a pelvic exam and/or a pelvic ultrasound. Sometimes a laparoscopy is necessary. During this keyhole surgical procedure, a camera is used to examine inside the pelvis. This allows your doctor to detect the presence and severity of PID and is generally reserved for women who have more severe symptoms.

Remember that not everyone will develop symptoms from PID, which is why it is so important to have routine STI tests if you are sexually active and also if you have a new sexual partner. Regular testing can ensure that an infection is detected and treated early.

What happens if pelvic inflammatory disease goes untreated?

It is very important that PID is treated early to prevent long-term complications, including fertility issues and chronic pelvic pain.

In order to fall pregnant, an egg needs to travel from the ovary to the uterus via the fallopian tubes. PID can lead to scarring of the fallopian tubes, which blocks this path and causes subfertility.

PID not only reduces fertility, it can also be dangerous to your health because it greatly increases the risk of an ectopic pregnancy (where a pregnancy develops in the fallopian tube). Ectopic pregnancy can lead to a ruptured fallopian tube, which is a medical emergency.

The risk of long-term complications depends on how long the condition has gone untreated and the number of times you develop PID – repeated bouts significantly increase your risk.

How can I avoid getting pelvic inflammatory disease?

The best way to protect yourself from developing PID is to ALWAYS practise safe sex and have regular STI checks. If you have been diagnosed with an STI, your male partner should be treated as well to make sure you don’t get re-infected.

Also have any medical procedures (e.g. IUD insertion) performed at a reputable clinic with good hygiene and safety standards.

If you have symptoms, don’t ignore them!

In addition to having routine STI tests, it’s important that you always seek medical help if you have any symptoms related to your reproductive health (e.g. abnormal bleeding or pain). Don’t hesitate to call my rooms on (03) 9418 8299 or book online to make an appointment if you need a specialist opinion on any women’s health matters.