Can losing weight really help me fall pregnant?

Young woman trying to choose between apple and donut

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

It may be difficult (and frustrating) to hear but did you know that weight loss may represent one of the best ways to improve your chances of having a baby? While weight gain is considered a good sign during pregnancy, carrying excess weight before you are pregnant can actually make you less fertile. That’s because extra weight can disrupt the balance of insulin and other hormones in your body, leading to ovulatory issues (your ability to release an egg from your ovaries each month).

Interestingly, weight loss doesn’t always have to be drastic in order to improve fertility. Research has shown that even a 5% drop in body weight can greatly increase a woman’s chances of falling pregnant.1 That’s not to mention the many other benefits linked to losing weight, such as a reduced risk of conditions like diabetes and heart disease, and a lower rate of complications once you do become pregnant.2

However, when you are having difficulty conceiving, attempting to lose weight on top of this may seem like an impossible task. You may also be confused about the best way to go about losing weight and be worried about how long it could take you to achieve the weight loss your doctor recommends. The first thing to remember is that you are not alone in this – many women struggle with both their fertility and weight.3 The good news is that a little persistence and determination can go a long way in helping you achieve your goals. Being aware of how important weight loss is for improving your chances of having a baby may well be all the motivation you need to finally shed some of those extra kilos.

Where to start?

The best place to start is to understand that the key to weight loss is to lower your calorie intake (decrease the amount of energy you take in through food and drink) while increasing your physical activity levels (so that you burn off more energy). To achieve weight loss, ‘energy in’ must be less than ‘energy out’. We discuss some strategies for achieving this below.

Change the way you eat

For many years, the low-fat diet was the most widely-accepted and recommended weight loss method. However, recent studies have raised some questions around the long-term effectiveness of this diet, shining light on the low-carb diet as a better option for weight loss.4,5,6

As the name implies, a low-carbohydrate or ‘low-carb’ diet involves eating fewer carbohydrates, such as those found in starchy vegetables, fruits and grains. Lowering your carbohydrate intake decreases the amount of insulin your body releases in response to food. This prompts your body to burn through its fat stores for energy, resulting in weight loss.

Eating low-carb doesn’t mean eating no carbs – it’s all about moderation and making better choices, e.g. choosing to have a slice of grainy bread, rather than a large white roll. In general, a low-carb diet involves eating foods that are protein-rich (chicken, salmon), high in ‘good’ fats (like nuts and avocado) and low in starch (cauliflower versus potato). Unlike many fad diets, a low-carb diet can be much easier to stick to because it allows you to eat a variety of foods. After a while, you may even find that it just becomes the way you eat rather than a diet per se, making it easier to sustain a healthy weight over the long-run (including during and after a pregnancy!).

When you choose a low-carb diet, you’ll naturally avoid foods and drinks that are high in sugar, including fruit juice, soft drinks, lollies, cakes and biscuits. You’ll also tend to eat much smaller portions of starchy vegetables like potatoes, pumpkin and corn. Avoiding sneaky ‘side carbs’ like naan bread, bread rolls, corn chips and garlic bread can also be very helpful for triggering weight loss. If you’re serving rice and pasta dishes, a good tip is to put more of the sauce (filled with meat and vegetables) on your plate rather than the carbohydrate.

The more familiar you become with a low-carb diet, the more you’ll learn about tasty, low-carbohydrate alternatives (e.g. cakes made from almond or hazelnut meal rather than flour). Over the longer term, you may even find that you prefer these options. But when you’re just starting out, avoid temptation by being extra careful with what you put in your shopping trolley and by avoiding supermarket runs on an empty stomach! And remember that home-cooked meals are often better than shop-bought, packaged foods, which tend to be higher in sugar and other chemicals.

What else can you do to trigger weight loss and improve your fertility?

  • Increase your level of physical activity – resistance exercise and cardio are great but also try to work coincidental exercise in whenever you can, e.g. taking the stairs, parking further from your destination so you walk more, doing squats every time you visit the toilet. Be mindful that high-intensity exercise can affect your menstrual cycle.
  • Get enough sleep – studies show that poor sleep is one of the strongest factors affecting weight gain because sleep deprivation impacts the daily fluctuations in appetite hormones.7
  • Fast intermittently – intermittent fasting involves interchangeable periods of fasting and eating. It has been linked to weight loss and numerous other health benefits.8
  • Eat more fibre – foods high in fibre may help with weight loss by delaying stomach emptying and increasing feelings of fullness.9
  • Practise mindful eating – this involves making conscious food choices while developing a greater awareness of your feelings of fullness and hunger. It has been shown to help with weight loss, particularly if you tend to binge or engage in emotional eating.10
  • Choose foods that are good for fertility – these include vegetables, protein and healthy fats.

The bottom line

Research shows that weight loss can have a dramatic impact on a woman’s ability to fall pregnant. A healthy weight will also set you up for a healthy pregnancy and ensure you give your baby’s health the best start in life. If you have concerns about your fertility or the role your weight or other factors may be playing in your ability to conceive, you can make an appointment with me by calling (03) 9418 8299 or by booking online.


  1. Balen AH et al. Hum Fertil. 2007;10:195–206. ↩︎
  2. Ma C et al. BMJ. 2017;359: j4849. ↩︎
  3. Australian Bureau of Statistics. National Health Survey: First Results, 2017–18. ↩︎
  4. McClemon FJ et al. Obesity. 2007;15:182–187. ↩︎
  5. Tobias DJ et al. Lancet Diabetes Endocrinol. 2015;12:968–979. ↩︎
  6. Foster GD et al. N Engl J Med. 2003;348:2082–2090. ↩︎
  7. Nedeltcheva MD et al. Ann Intern Med; 2010;153:435–441. ↩︎
  8. Alirezaei M et al. Autophagy. 2010;6:702–710. ↩︎
  9. Rebello CJ et al. Nutr J. 2014;28:49. ↩︎
  10. Katterman SN et al. Eat Behav. 2014;15:197–204. ↩︎

Chris’ Christmas gift guide for all the women in your life

Mother with baby during Christmas decorating with fairy lights, wearing Father Christmas hat and antlers.

Without doubt, Christmas is my favourite time of year. To make things even more special, this year will be my son’s first Christmas. With both the birth of my son and Newlife IVF in 2019, it’s been a pretty hectic year on all fronts for my family. I’ll be sure to give my wife and two girls something a little extra special this year to thank them for all their love and support during these busy times.

It’s probably no surprise to you that as an obstetrician, gynaecologist and fertility specialist, I get to meet a lot of different women from every stage of life. I have the privilege of watching these women deal with a range of challenges unique to women’s health, infertility and motherhood. Observing how they get on with life while managing their way through and over these hurdles is what inspired me to put the following list of gift ideas together.

I’ve tried to only recommend products that you can source locally, that are sustainable and crap-free. And yes, I admit it, a few good women may have helped me with some (or all!) of these ideas.

For first-time mums

Many a patient has told me that when you spend your days changing nappies and dodging drool, the simple things in life (like taking a shower) can become a real luxury. For these women, I reckon that an amazing hand cream is the go. My sources tell me that the Empire Australia range is a beautiful brand, designed and produced right here in Melbourne.

I also have it on good authority that new mums sometimes need a hand to swap out their professional workwear for more casual wear. If the woman you are buying for needs some help turning her wardrobe from ‘office chic’  to ‘mumsy chic’, my suggestion is a pair of Bared’s ‘Weaver’ sneakers. A little birdie tells me that paired with some jeans and a long sleeve tee, these minimalist sneakers will do the trick in dressing down any old work blazer. And all men know that shoes are the way to a woman’s heart, right? You can find these particular beauties in-store (CBD or Armadale) or online.

For mums who have just popped out Baby #2 or 3 or 4 …

There’s busy, then there’s super-busy. I’m thinking that what these mums really need is an extra pair of hands. I’m not a plastic surgeon, so the next best thing is to help them be hands-free, which is where this Hoopla crossbody box bag comes in (did you like how that just rolled off my tongue?). I’m told that this bag is a busy mum’s perfect companion because it’s small enough to wear while playing at the park, doing the shopping, etc., but also big enough to hold all the essentials (phone, purse, lip balm, sultanas, baby wipes, tissues, random Thomas train …). I’m also told that they come in a great range of colours! You can find them at Coconut Home & Co, a boutique retail store based in Surrey Hills, Melbourne (visit them in store or order online).

For mums-to-be

For mums-to-be, we’re loving this modern take on a baby memory book from Peachly, a husband and wife duo based on the Sunshine Coast. Billed as ‘the baby book you’ll actually complete’, it’s easy to fill out and is also designed to suit every type of family, so it’s LGBTQ and adoptive-family friendly. For example, instead of saying ‘Mummy and Daddy’s reactions to seeing you for the first time’, the book says: ‘Our reactions to seeing you for the first time’. And if memory books aren’t your thing, Peachly also has a great range of bamboo swaddles – all original designs, so you can be sure your present won’t be a double-up!

For women trying to conceive

Christmas can be an awkward time of year for women trying to get pregnant, especially if they are undergoing fertility treatment. You’ll need to use your judgment to decide what type of gift will be most appreciated.

Women dealing with infertility are often meticulously tracking dates, so a beautifully designed yearly diary or planner can make a nice gift without screaming ‘I know you’re trying to get pregnant’. Try these designs from Bespoke Press.

If your friend is undergoing IVF and is open with you about their experiences, you may like to go for a gift that helps them to be mindful rather than mind-full throughout their IVF journey, like a set of affirmation cards. Robyn Birkin, a Perth-based mum who hosts the award-winning Fertility Warriors podcast (inspired by her own fertility journey), gives some great suggestions for these and other gift ideas here.

Alternatively, I think these watercolour art prints of IVF embryos are amazing and they can be custom designed. While these prints are not Australian made, they are created by a fellow IVF mum, Pamela Gallegos, who lives in Florida.

For working mums

All kudos to these mums who are just trying to fit it all in. There are a few ways you can go here:

  1. Help them fit more in to their day, e.g. buy them a subscription for Les Mills On-Demand so they can stream video work-outs at-home anytime. And because it’s Les Mills, it has a huge variety of programs (e.g. HIITs, Cardio, Core, BARRE, BODYPUMP, Yoga, Body Balance) so they can choose the work-out style they enjoy most. Classes also come in all kinds of formats so if they only have 15 minutes spare, they’ve still got time to squeeze in one of the super-quick short programs.
  2. Give them some down time, e.g. tee them up for a massage or facial. Just make sure you choose somewhere local, so they can get there easily.
  3. Make the everyday a little less ho-hum, e.g. buy her a crazy cool workbag (like this Melbourne tote from Australian brand bellroy) that makes her feel ‘put together’ even as she struggles to clean baby food off her blouse while getting a pram in the door of an already-full train during rush-hour as her child cries because Bluey the soft toy has just fallen into the clutches of a scary-looking … you get the picture.

 

For single women and same-sex lesbian couples wanting to have children of their own

What these women want most in the world is donor sperm to help them start or build their own family. Victorian legislation means that single women and same-sex couples can now legally access assisted conception techniques like intra-uterine insemination (IUI) and IVF to do so. However, a shortage of donor sperm means that these women often have a very short list of donors to choose from. This can present a real problem if they are looking for a specific nationality or culture to align with their own background. In many cases, these women have to import sperm from an international sperm bank, which can be a much more expensive process.

So, the best Christmas gift you can give these women is a well-stocked local sperm bank that gives them lots of home-grown, Victorian men to choose from. If you know a man who would make a great donor, ask him to consider giving the gift of life this Christmas. Our sperm collection centre in Box Hill makes donating a really simple and seamless process. For all the deets, get your favourite male specimen to check out the Newlife IVF website.

For mums who have ‘lost their mojo’

There is only one way to go here and that’s to buy something fun, frivolous and carefree. My little birdie tells me that a cracker pick-me-up is a bright and cheerful nail polish – like Essie’s ‘play date‘, which judging by its name, aims to put the fun back into play dates! Or if the woman in your life is a lover of all things royal, try Essie’s ‘ballet slippers’ instead, which is the nail colour Meghan Markle supposedly wore on her wedding day (dropping that fun fact is also sure to earn you some extra Brownie points!).

For breastfeeding mums

These mums are living in an alternate universe right now: day becomes night, night becomes day, then all their days and nights seem to meld into one. What I think these women would really appreciate is some super-comfy, super-groovy lounge wear that takes them from day to night to day, and back again. You know, an outfit they can sleep in but, if necessary, also do the school run in. For an ethical, sustainable, organic brand with a great range, try Organic Crew available online or from their store in Malvern.

For every other woman on your list

Okay, so for all the other women in your life, here are a few other suggestions that might tickle your fancy (and theirs):

Right, now that we’ve got the Christmas shopping sorted, I’d say it’s time for a refreshing mojito mocktail – it’s low-carb and alcohol free, so suitable for women who are pregnant or trying to conceive. Cheers!

Disclaimer: I fully admit that I had an extreme amount of help in putting this article together. As the old adage goes, a woman knows what a woman wants – and I’m not one to argue with that. That said, I hope you enjoyed it!

When breastfeeding hurts

a smiling mother breastfeeding her baby

This post was contributed by Dr Candice O’Sullivan. Previously a medical practitioner, Candice now owns a healthcare communications agency, helping doctors and other healthcare providers to produce high-quality patient information.

My breastfeeding story

When I was pregnant with my first child, I assumed that breastfeeding would come naturally and just work. Even so, I still did a lot of reading on the topic, so by my third trimester, I felt well-educated and well-prepared.

Then four weeks before my due date, my waters broke unexpectedly, and I ended up having an emergency caesarean in the middle of the night. My little boy came out ‘borderline small’, meaning he wasn’t quite small enough for the special care nursery, so we stayed on an ordinary maternity ward. And therein began my very long, lonely, painful battle to breastfeed a tiny baby with a tiny mouth who couldn’t latch properly.

I won’t go into the ins and outs of what happened next and all the different things we tried but suffice to say, it would take months before latching on became a seamless process for him, and breastfeeding became ‘natural’ for us both. I distinctly remember giving my son a bedtime feed when he was around 9 months old and feeling amazed at how easy and ‘natural’ breastfeeding had finally become. In the end, I breastfed my first son for a little over 13 months. This was a massive achievement given where we had started.

When I was pregnant with my second son, yet again I assumed that breastfeeding would come easily. What I didn’t take into consideration was the possibility that I could come up against a whole other range of breastfeeding issues. You see, my second son could latch brilliantly, but by about Week 3, breastfeeding not only hurt – it was pure agony. I couldn’t understand why until I was diagnosed with thrush, which not only affected my nipples but also the milk ducts inside my breasts. This led to an 18-month battle with recurrent thrush. I ended up on some heavy-duty medication, taking it for weeks and sometimes months at a time, to try and keep the infection under control. It wasn’t pleasant but when the infection was at bay, breastfeeding was easy and painless, so I kept going even though I had to deal with recurrent flares. This time round, I ended up breastfeeding even longer, for around 22 months.

The ‘moral’ of my experiences is that breastfeeding doesn’t always come easy. It can be really hard work but it can become second nature if you receive the right information and support. So if, like me, you want to persist with breastfeeding despite any challenges you may be facing – and you have the energy and ‘mental space’ to keep trying for a little while longer – there are people who can help you and your baby to figure it all out. Or to at least give it a good old try.

Common causes of pain with breastfeeding

Some of the most common causes of pain during breastfeeding include:

Poor latch: Latch problems are the most common cause of breastfeeding pain. They usually involve a latch that is too shallow, meaning that your baby’s tongue rubs against your nipple when feeding rather than your breast. Milk engorgement can make latching difficult, so sometimes it can help to express some milk before putting baby on your breast. Other times, a small change in positioning can make a huge difference.

Thrush (yeast infection): An overgrowth of yeast can lead to thrush around your nipples and/or in your milk ducts. This is often described as a burning pain, or sharp and stabbing, and is usually accompanied by a rash. The skin over your breast may also look smooth and shiny.

Tongue-tie: When you look inside baby’s mouth, you see that the thong of skin under baby’s tongue (the frenulum) is tight or short, and the baby isn’t able to stick his tongue out or lift it up. That means he can’t bring it forward or cup the breast as he needs to, and his tongue rubs against the end of the nipple, causing pain.

Vasospasm: This is when blood vessels in the nipple tighten and go into spasm, so that blood does not flow normally. You will usually feel sharp pain, burning or stinging in the nipple. It is typically accompanied by sudden whitening of the nipple, followed by a colour change from red to blue.

Plugged duct: This is a sore, tender area in the breast. It may feel like a lump under the skin and the skin may look red. This usually indicates that a milk duct has become blocked. The milk backs up and creates pressure behind the plug.

Mastitis: You will have a hot, red, very tender area on your breast. You will also usually have a fever and feel unwell. Mastitis may develop suddenly or may follow an unresolved plugged duct. When a plugged duct stops the milk from flowing, bacteria may grow in the milk leading to an infection and inflammation. Sometimes cracked nipples may also allow bacteria to enter the breast. If you suspect you have mastitis, call Chris on (03) 9418 8299 for advice.

Where to seek help

Your local lactation consultant or clinic: the hospital you gave birth in will usually have a specialist lactation nurse or clinic who can assess and diagnose your breastfeeding issues. If Chris delivered your baby at Epworth Freemasons, you can contact the Freemasons Lactation Clinic on (03) 9418 8310. You can book a face-to-face consultation or the lactation consultants may be able to provide all the help you need just by talking things through with you over the phone. If you delivered elsewhere, call Chris’ rooms on (03) 9418 8299 for a list of lactation consultants he recommends in your area;

Your maternal child health nurse: you’ll have appointments with a maternal child health nurse at Weeks 1 (home), 2, 4 and 8. This is a great time to ask questions and find out where you may be going wrong with your feeds;

The Australian Breastfeeding Association (ABA): this website has lots of useful information for women at every stage of breastfeeding;

The sisterhood: mums, mums-in-laws, sisters, etc. can relay their own experiences, but they can also just be there to make you a cup of tea or hold baby while you take some time for yourself;

Online baby and motherhood forums: while you do need to fact-check the advice of non-professionals, peer-to-peer support can reassure you that you are not the only person facing these types of issues. They can also help pinpoint the source of your problem and guide you in the direction of where to seek help;

Your mother’s group: these women can be a great source of useful tips and hints, as you all muddle through this new experience together.

What to remember in the middle of the night

Everything always seems worse in the middle of the night, especially when you are sleep deprived. This is when you need to tell yourself that this moment in time will pass and that you will look back one day and think: ‘I can’t believe I got through that’. But for now, while you are caught up in the midst of it all, just breathe, then keep doing what only you can do best: love your baby and love yourself. If you can just keep doing that, you will find a way to get through. It may not always be pretty or graceful or elegant. In fact, it will probably be downright messy, particularly if you throw in another kid or two and a needy husband, but you will get there.

And if you really do need a laugh, imagine what the lovely Kate Middleton might look like if she didn’t have people to do her hair, organise her outfits, take care of her children, cook all her meals, and give her time to exercise. Blimey, it would be a bloody shambles!

Jokes aside, it’s also important to be able to recognise the possible signs of postnatal depression and anxiety. If you think the sleep deprivation and stress of breastfeeding are catching up with you, don’t be afraid to reach out for help. After all, we’re all in this together.

Lastly, don’t forget your 6-week post-partum visit with Chris

Every new mum should have an appointment with their obstetrician 6-weeks post-partum. This booking will usually be made before you leave hospital. If you need to contact Chris before this time, please call (03) 9418 8299 or simply book online.

Managing labour pain – what are your options?

pregnant woman managing labour pain by sitting on an exercise ball holding her belly with eyes closed

Labour can be painful, but there are many options available that can help you manage the pain. It’s good to learn about what these are before you go into labour.

You’re having a baby! You may be feeling excited, a little nervous and likely wondering how much labour will hurt and how you are going to cope with the pain. Fortunately, there are many different methods to help ease the pain of labour, including a variety of medicines and natural pain relief options that have been tried and tested over the years.

Pain is a normal part of labour and is experienced differently by every woman. It is often described as a unique feeling, and of course it is associated with a wonderful and meaningful life event – the birth of a new baby. You can help prepare yourself for labour pain by gaining a better understanding of your options for pain relief, how they work, and the effect they will have on you and your baby.

Just like the experience of labour itself, your pain management choices are very personal and should be based on your physical and emotional needs. You may already have a very clear idea of the pain relief you want or don’t want, but it can be helpful to keep an open mind – depending on how your labour progresses, you may choose to change your pain management plan or use a combination of methods. Whatever happens on the day, your midwife and/or doctor will be on-hand to support you with what is best for you and your baby at the time.

Here are some of the most common options for managing labour pain:

Natural relief for labour pain

1. Active birth

Thanks to what we often see on TV and in movies, many women still expect to spend labour reclined in a hospital bed. But studies have shown that actively moving around by walking, changing positions, rolling on a birthing ball or swaying can help ease pain.1 Being in an upright position can help support the baby’s movement as it moves through the birth canal, while gently rocking your pelvis can ease the discomfort of contractions. These movements can be done almost anywhere and can be used with other complementary therapies. However, movement alone is unlikely to completely relieve you of pain.2

2. Massage

Massage and touch can be calming, can help ease tension and may act as a distraction from labour pain. In a recent study, women who received massage from a physiotherapist during labour reported significantly less pain than those who didn’t, although massage did not change the characteristics of the pain.3

If your partner is likely to be there during childbirth, you can practise being massaged before the birth to discover what feels most comfortable. During some stages of labour, you may find that massage feels good, while at other times it may be distracting or even annoying.

3. Relaxation and breathing

One of the most important parts of your body to relax during labour is your mind. If you’re calm and less anxious, you will be more physically relaxed, which can help reduce the pain. Deep breathing and concentrating inward often come as natural responses for women during contractions. Breathing in through the nose and out through the mouth can help you get into a relaxed state and help you cope better with labour.4 You can find out more about this in antenatal classes, which often cover breathing and relaxation techniques. Your midwife will also help you with these techniques during labour.

Medical relief for labour pain

1. Epidural

This is the most common and effective type of pain relief used in labour.5 If you choose to have an epidural, an anaesthetist will insert a needle and a tiny tube, called a catheter, in the lower part of your back. An anaesthetic will then be administered via this tube, which usually numbs only the lower section of your body. The aim of an epidural is to make you completely pain free during labour and delivery.

There are a few possible side-effects of epidural anaesthesia to be aware of, including temporary muscle weakness or numbness from the waist down, a lengthened second stage of labour, and tenderness around the injection site. However, epidurals are considered very safe, with serious complications being rare.6 An epidural does not increase your chances of needing a caesarean. However, an epidural may increase the chances of forceps being used to help deliver your baby.

2. Opioids

If you’re interested in a form of pain relief that doesn’t cause a total loss of sensation in part of your body or increase your chances of needing assisted delivery, you may want to consider opioids. An opioid, such as morphine, is usually injected into your thigh or buttock – it relieves pain by having an analgesic effect, which means it dulls your feelings of pain but doesn’t have a deep-numbing effect. Opioids normally take about 20 minutes to work after the injection and can last between 2 and 4 hours.

Opioids can sometimes make you feel disorientated or sick, so anti-nausea treatment is often given at the same time. Opioids cross the placenta, which can affect the baby’s breathing, but this can be reversed by another drug should this become a problem.7 Morphine can take the edge off your pain, but it won’t take the pain away completely.

3. Nitrous oxide

Nitrous oxide gas, often referred to as ‘laughing gas’, acts quickly and doesn’t affect contractions or stay in the baby or mother’s body. Many women like this option because it’s easy to use and self-controlled – you simply hold the mask and take deep breaths whenever necessary.

On the whole, nitrous oxide is considered a safe pain management option during labour. It won’t remove all the pain but can take the ‘edge’ off it and make it more bearable.

Alternative methods of pain relief

There are various alternative options that may be of interest to you. These include reflexology, hypnosis, massage, aromatherapy, TENS and acupuncture. It’s worth bearing in mind that there is little research proving the effectiveness of some of these treatments, but some women do find them helpful.

Talk through your options with your obstetrician

Childbirth can be an amazing experience, and there are many options for managing the pain associated with it. Although you can’t predict how much pain you will have during labour and delivery, you can prepare yourself for it by discussing the options available to you with your obstetrician beforehand. My patients are welcome to chat to me about this at any of their appointments. To make an appointment, call (03) 9418 8299 or book online.

References


  1. Shilling T et al. J Perinat Educ 2007;16:21–24. ↩︎

  2. Ondeck M et al. J Perinat Educ 2014;23:188–193. ↩︎

  3. Gallo et al. Journal of Physio 2013;59:109–116. ↩︎

  4. Smith CA et al. Cochrane Database Syst Rev 2018;3:CD009514. ↩︎

  5. Anim-Somuah M et al. Cochrane Database Syst Rev 2011;12:CD000331. ↩︎

  6. Benzon HT et al. JAMA 2015;313:1713–1714. ↩︎

  7. Smith LA et al. Cochrane Database Syst Rev 2018;6:CD007396. ↩︎

Common fertility myths and misconceptions

a series of 4 sets of legs sticking up with various coloured socks on each

When you are struggling to fall pregnant, it can feel like the whole world is against you. You’ll try anything if it means you’ll fall pregnant faster. Unfortunately, this is when myths and old wives’ tales can be dangerous. While there are certainly ways you can prepare your body for pregnancy and improve your fertility, it’s best to keep to methods backed up by research, rather than hearsay. Below, we explore the theories behind 5 common pregnancy myths and reveal whether they are indeed fact, or fiction.

1. Drinking cough syrup will help you conceive

This idea has been around since the 1980s. The theory is that the common ingredient in cough syrup, guaifenesin, can thin cervical mucus (in the same way that it thins the mucus in your nasal passages when used to provide relief from cough). With thinner cervical mucus, sperm will supposedly find it easier to travel through the female reproductive tract and reach a woman’s eggs.

The source of this theory is a single study from 1982 involving 40 couples with signs of ‘hostile mucus’. While an improvement in mucus quality was documented for 23 of these couples, 15 of whom went on to become pregnant within 6 months of the female starting guaifenesin, no further studies have been done to validate these results. With such little evidence to support its use, it’s not an approach we can recommend. Its benefits remain speculative and are likely to only apply to a very small group of patients for whom cervical quality has been clearly diagnosed as the cause of infertility.

It’s also important to note that cough syrups and other over-the-counter medicines can be harmful when used for reasons other than intended. If you are taking any medications – including natural supplements like vitamins and minerals – it’s best to ask your GP or gynaecologist if these could be helping or hindering your fertility. And always check the label!

2. Eating yams will help you to conceive twins

Yams have earned their reputation as a twin-maker after researchers started investigating why the African village of Igbo-Ora had one of the highest rates of twin births in the world. The researchers speculated that this was probably due to the tribe’s genetics. However, after studying their findings, they concluded that multiple births in the region could, in fact, be due to the villagers’ eating habits. The village diet commonly features cassava and yam tubers, which both contain high levels of phytoestrogens. While research is inconclusive, it’s thought that phytoestrogens may stimulate multiple ovulation. This is when more than one egg is released from the ovaries each month. If this happens, there is the chance that more than one egg will be fertilised by sperm, leading to a twin pregnancy.

While it is certainly true that diet can have an impact on ovulation, loading up on one food group, vitamin or mineral can have unintended consequences. In general, eating a well-balanced, nutrient-dense diet will help you maintain a healthy weight and optimise your hormonal balance – thereby improving your fertility.

3. Keeping your legs in the air for 20 minutes after sex will help you get pregnant

The theory behind this myth is that when you place your legs in this position, you tilt your pelvis, thereby helping any sperm that have been released during sex to travel up your reproductive tract and reach your eggs. The truth is, sperm are programmed to swim through pretty tough conditions in order to get to your eggs, regardless of what position you are in after sex. Leg-raising, handstands and any other gravity-defying positions are only going to make you uncomfortable. So instead of flooding your body with stress hormones after sex, find a comfy position, relax and get some sleep!

4. Drinking alcohol will harm your fertility

Unfortunately, this one is entirely true. Studies have shown that even light drinking can increase the amount of time it takes to get pregnant and reduce your chances of having a healthy baby. If you are planning a pregnancy, the safest option is to avoid drinking altogether, in line with the latest safe drinking guidelines. Along with reducing your alcohol intake, there are other dietary and lifestyle changes you can also make to increase your chances of falling pregnant.

5. Being on the pill for too long will affect your fertility

There are many different types of contraception, most of which are intended to be reversible, meaning that your fertility will be restored once you stop using them. The combined contraceptive pill is one of the most common forms of contraception and it’s not uncommon for women to remain on it for a long time – often years, sometimes decades. This is particularly true for women choosing to delay pregnancy until their mid to late 30s. Even if you are on the pill for a prolonged period, be reassured that once you stop taking the pill, your period and fertility will soon return to what is normal for you. While everyone responds differently, most women will find themselves ovulating again within 1–3 cycles, i.e. 1–3 months. If you are finding it difficult to fall pregnant more than six monthsafter stopping the pill, there may be other factors affecting your fertility that need to be addressed. In this case, it’s best to see a fertility specialist sooner, rather than later.

Planning a pregnancy and want to optimise your fertility?

If you are planning a pregnancy and want personalised advice about how to improve your fertility, you can make an appointment with me by calling (03) 9418 8299 or by booking online.

Dealing with problem periods

feminine hygiene pad with red sequins scattered over it in representative pattern of a period

If you are experiencing problems with your period, understanding what is happening to your body each month is a good first step to getting your head around what may be happening.

What is your menstrual cycle?

Your menstrual cycle is the monthly series of changes your body goes through to prepare itself for a possible pregnancy. It includes menstruation (i.e. your period), the process by which your uterus (or womb) sheds its lining each month – which you experience as vaginal bleeding. Your cycle also involves ovulation, the process by which an egg is released from your ovaries each month. Ovulation is what enables a potential pregnancy – if the released egg is fertilised by sperm, it can develop into the first stages of a new life, i.e. an embryo. All of these cyclic changes are driven and controlled by hormones, including oestrogen and progesterone.

On average, a girl will first get her period between the ages of 11 and 14. This first period is referred to as menarche and is usually preceded by other signs of puberty, such as breast development and the appearance of pubic hair. Interestingly, in developed countries, menarche is tending to occur earlier in a girl’s life (as young as 8). This is thought to be due to the increased weight that children and adolescents now carry compared to previous generations, but the precise cause is unknown.

A woman’s cycle generally lasts for 28–35 days. However, at the beginning and end of a woman’s fertile years (i.e. menarche and menopause), there may be more variability in the length of the cycle. Additionally, some women will always have cycles of variable length, and will consequently have irregular periods.

What are the phases of the menstrual cycle?

The menstrual cycle is divided into two phases:

Follicular phase

If fertilisation has not occurred (i.e. you are not pregnant), you will have your period for 3–7 days. This marks the beginning of the follicular phase.

During this phase, hormones will stimulate your ovaries to produce a number of follicles, each of which contain an egg. Eventually, one follicle will dominate and the development of all other follicles will be suppressed. The dominant follicle will then release its egg in the process of ovulation.

During the follicular phase, the lining of your uterus will also thicken (after your period has finished), in preparation for a possible pregnancy.

Luteal phase

After ovulation, the luteal phase begins. The length of this phase is 14 days and its end is marked by the start of your period. Therefore, you can determine when you ovulated by subtracting 14 days from the first day of your period. If your cycle is regular and you’re trying to get pregnant, this can help you determine when you’re most fertile.

Once ovulation has occurred, the follicle from which the egg was released develops into a structure called the corpus luteum. The corpus luteum produces hormones – mainly progesterone, along with small amounts of oestrogen. Progesterone ensures that the thickened lining of the uterus is maintained, in preparation for implantation of a fertilised egg.

If the egg is successfully fertilised after ovulation and implants into the lining of the uterus, the fertilised egg will produce beta hCG – the hormone that is tested for in a pregnancy test. This hormone supports the corpus luteum, which then continues to produce the progesterone required to maintain the lining of the uterus. Maintenance of the uterine lining is important if you’re pregnant.

If fertilisation does not occur, no beta hCG is produced and the corpus luteum will degenerate and die – in which case, the levels of progesterone will drop. This leads to shedding of the uterine lining (menstruation), and the cycle begins again.

What are common problems related to the menstrual cycle?

  • Painful periods (dysmenorrhoea): Painful periods are relatively common. If severe, they can interfere with your daily activities. The pain may be attributable to a particular condition (e.g. endometriosis, fibroids), but it may also occur in the absence of any condition. Most commonly, period pain is crampy and occurs in the lower abdomen. Depending on the cause, it may be treatable with simple pain medication (e.g. naproxen, mefenamic acid, ibuprofen) or the combined oral contraceptive pill.
  • Abnormal uterine bleeding: Abnormal uterine bleeding refers to periods that are of an abnormal quantity, duration or schedule. Most commonly, it refers to periods that are abnormally heavy or prolonged (also referred to as menorrhagia), but may also refer to abnormal bleeding between periods. There is a wide range of causes for abnormal uterine bleeding and the cause may be determined by investigations such as blood tests, an ultrasound or hysteroscopy. Treatment is often directed at the underlying cause, but it may be as simple as taking the combined oral contraceptive pill. Treatment may also need to address anaemia (low number of red blood cells in your body), which can result from abnormally heavy bleeding.
  • No periods (amenorrhoea): There are two forms of amenorrhoea. Primary amenorrhoea is when a girl has not had her first period by the age of 16. Secondary amenorrhoea is when a woman who has previously had her period stops having her period for 3 months (if she has a regular cycle) or 6 months (if she has an irregular cycle). There are many different reasons for the two forms of amenorrhoea, ranging from excessive exercise and stress to conditions such as polycystic ovary syndrome. Treatment is directed at the underlying cause, but in some cases amenorrhoea cannot be treated.

Having problems with your period?

If you have problems with your period that are worrying you or interfering with your daily activities, it’s wise to seek professional advice. As a gynaecologist, I can help treat and manage your symptoms while also investigating for underlying causes. To make an appointment, call (03) 9418 8299 or book online.

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 medication 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.