“I’m sorry,” he said, glancing down at the print out he held in his hand. “All of your embryos were abnormal.”
“What do you mean?” I said.
My full bladder, which had settled into a dull ache, suddenly surged, and I had to clench my muscles desperately to prevent any urine escaping.
“It’s the chromosomes,” the doctor said. “There needs to be 23 normal pairs.”
I looked down at the white plastic band encircling my wrist, like a handcuff, with my name and date of birth printed on it in tiny black letters.
Only a moment ago I’d been so full of hope, being ushered into the “Embryo Transfer” room, the nurse bustling away with a smile, telling me she’d be back with the consent forms shortly.
My hand with the band started trembling.
“None of the embryos are normal?” I said.
“That’s correct,” the doctor said. “It’s not that uncommon for some embryos to be abnormal. But when you’re over 35, the odds of there being abnormalities increase substantially.”
“Could it be my sperm?” my husband asked.
The doctor shook his head.
“It’s the eggs,” he said, keeping his eyes on me.
In the war against time, I had lost a key battle. A woman’s fertility starts to decline after the age of 30, and falls exponentially after the age of 38.
The Gynecological Endocrinology Journal reports that a 29 year old woman has a 40% chance of becoming pregnant through assisted reproductive technology (ART). By the age of 36, this chance has dropped to 32% and, by the age of 46, it is almost zero. Under natural conditions, the same pattern follows. Each month, a 30 year old woman has a 20% chance of conceiving but once you hit 40, that chance has shrunk to 5%.
Gold Coast GP Dr Mark Jeffery is a clinician with more than 30 years’ experience. He provides antenatal shared care with the Gold Coast University Hospital and says he frequently sees what he calls “career infertility”.
“People delay their pregnancies thinking that they can have them later and when they are finally ready they’re not falling pregnant,” he says. “Many of these women have been on the pill for a long time and when they stop they’re not conceiving. If they’re in their thirties I’m inclined to refer them to a fertility clinic straight away.”
This was certainly true for me. I had been on the pill until the age of 34 and, when I finally stopped taking it, I didn’t get a period for over a year.
It took the drug Clomid to kickstart my ovaries again and, thankfully, I gave birth to my daughter a year later. The second time around, however, things weren’t going to plan.
Nat Kringoudis is a doctor in Chinese medicine, acupuncturist and natural fertility educator. She says that taking the contraceptive pill can put our hormones “offline” and can deplete our body of essential vitamin and mineral stores as well as being detrimental to our gut microbiome.
Her advice for women who have been on the pill is to start supporting your body.
“There’s nothing you need to ‘wait’ for,” she says. “Gut health is paramount, as well as cutting down on stress.”
Kringoudis says that fertility is an extension of our health and we need to appreciate it more. “It isn’t a switch that is turned on when we are ready but something we need to nurture. It’s what you do each and every day that counts. Reclaiming fertility doesn’t have to be torturous.”
Heidi van Maanenberg, who is a yoga teacher and owner of yoga studio b.Yoga in Euroa, Victoria, says that yoga is an excellent way to nurture our fertility by encouraging our bodies to rest and reset.
“A regular practice helps support a healthy immune system, aids hormonal balance and creates an environment where the student has a sense of being that is more grounded and more in tune to their body,” she says.
“Students who have become pregnant often incorporated other holistic choices into their lifestyle such as cleaner eating, massages and meditation.”
Dr Alex Polyakov is a fertility specialist based in Melbourne. He agrees that a healthy lifestyle is the best thing we can do to support our fertility. “My advice is always to have a normal BMI (body mass index), do moderate exercise, have a healthy diet and avoid smoking, drinking and environmental toxins,” he says. “Most people would get enough nutrients from their diet but if they are vegetarian or if they have allergies, or they don’t eat certain things, then they may not. So I would always recommend a multivitamin as well as an iron and folate supplement.”
Polyakov says there is good evidence that the quality of eggs in women who are vitamin D deficient can be impaired, so he also advises women to take a Vitamin D supplement as well as getting some exposure to natural sunlight and eating foods that are high in Vitamin D such as salmon, sardines, spinach and kale.
Importance of weight
The most important factor affecting fertility, and the quality of a woman’s eggs, however, he says, is their weight.
“People are often overweight and this has a huge impact on fertility. Women underestimate how detrimental it is to the quality of their eggs.”
Chinese medicine practitioner and acupuncturist Waveny Holland echoes this sentiment and says that being overweight is often an overlooked cause of infertility. “Losing just five kilograms can improve chances of conception,” she says. “Nutrition, lifestyle and exercise play a big part. Making sure the whole of body environment is as potentially good as possible is the most important thing to do to improve a woman’s chance at conceiving.”
Holland, who is also a registered nurse and midwife, explains that Chinese medicine aims to balance what is called the Yin – or substances like blood, fluids and tissue – with the Yang – or action potential, heat and energy in the body. “By nourishing a woman’s Yin with acupuncture and herbs, a Chinese medicine practitioner can improve the environment within the body that allows eggs the best potential for growth and healthy development,” she explains.
Dr Norbert Gleicher, Medical Director and Chief Scientist at The Center for Human Reproduction in New York, has over 40 years’ experience as an obstetrician and gynaecologist and is considered a luminary in reproductive endocrinology and infertility.
He believes that a woman can improve her fertility by combining two key supplements: dehydroepiandrosterone (DHEA) – a hormone produced by the adrenal glands which the body converts into testosterone and oestrogen – and Coenzyme Q10 (CoQ10) – a compound that produces energy in cells and serves as an antioxidant and whose age-related decline appears to effect egg quality.
“DHEA and CoQ10 have been an integral part of our center’s success with women with low ovarian reserve, whether due to premature ovarian ageing among young women or due to age,” he says. “We recently had a patient who delivered a healthy baby. She was just two months shy of 48 when she had her IVF cycle, and we believe she is the oldest woman who delivered after an IVF cycle with her own eggs.”
In a 2015 study involving more than 10,000 IVF cycles, researchers found that combining DHEA and CoQ10 supplementation significantly increased ovarian responsiveness (3)
This was backed up by another study in 2016 involving 330 intrauterine insemination cycles and 78 IVF cycles which again showed that supplementing with both DHEA and CoQ10 significantly improved the response of the ovaries (4)
In Australia, CoQ10 can be easily purchased from most pharmacies and health supplements’ stores. DHEA, on the other hand, is a prohibited substance under Australian Customs legislation. Technically, it can only be obtained in Australia if it’s prescribed by a doctor and made up by a compounding pharmacist; however, many Australians have been easily able to source it by purchasing small quantities from overseas via sites such as eBay. This is something that the Therapeutic Goods Administration allows as long as the imported substance is for personal use only and its quantity is less than three months’ supply.
First time older mother Carmella Lee, 43, is thankful she was proactive about her fertility. Despite suffering from severe endometriosis and having only one functional ovary at the age of 41, she credits taking CoQ10 with helping her fall pregnant on only her second IVF cycle with her now one year old daughter.
“I believe couples need to do their own research into how to improve their fertility, and we are fortunate to have access to forums, articles, websites and support groups,” she told me. “I read a lot of forums and websites about improving fertility and egg quality, and whilst there was quite a list of supplements which people take, I was only keen to take those which had some evidence.”
Three months after my own devastating news I found myself standing in the neighbourhood playground, staring out at the river’s waters.
Sun speckled off the wavelets created by a passing speedboat, casting bursts of candlelight-like glow over the nearby trees and my daughter’s strawberry-blonde curls.
“Faster Mum-mum, faster,” she told me sternly, detecting a lull in the swing’s momentum.
“Sorry darling,” I said, giving the black rubber harness a gentle shove. “I was busy daydreaming.”
The air rang with shrieks and high pitched laughter. Children on the roundabout, clamouring over the climbing net, running on the grass. Mothers, almost all younger than me, hovered nearby or sat on park benches, glued to their iPhones.
“What’s day –” my daughter paused.
“Daydreaming,” I said, giving her swing another push. “It means thinking.”
“Oh,” my daughter said, fine strands of her hair wavering in the air like silk.
And as I stood there, gently propelling my daughter back and forth, I kept thinking, while the chain links squeaked, and the children shouted.
I thought about the line of bottles on my pantry shelf. The multivitamins, the Vitamin D, the DHEA and the CoQ10.
I thought about the salmon and Greek salad I was planning for dinner. I thought about the half an hour of treadmill time I was going to have to squeeze in after putting my daughter to bed.
I watched a mother near the river’s bank, struggling to fit her uncooperative toddler son into the bottom of a tandem stroller whilst his baby sister lay bawling in the top half.
I thought about the line of Gonal-F injection pens sitting in my fridge, waiting for my next IVF cycle to begin.
I thought about how, although it wouldn’t be the end of the world if I didn’t have a second child, I still wanted one. And while my ovaries were still producing eggs I shouldn’t give up hope.
Foods and supplements shown to improve fertility
Item: Recommended serves per day
Fresh vegetables especially green vegetables - Five
(Best raw, steamed or cooked in olive oil)
Fresh fruit - Two
Raw unsalted nuts especially walnuts - One handful (approx 30gm)
Olive oil or olives - Two tablespoons of oil
Fish rich in Omega 3 fatty acids - Twice per week
(especially salmon, sardines and herring)
Coenzyme Q10 - 600 mg
(May help improve embryo quality)
Melatonin - 3mg per night
(May help improve egg quality)
Multivitamin containing at least 500mcg folic acid - One tablet
(Needs to be taken at least 3 months before trying to conceive. Reduces risk of fetal spina bifida and neural tube defects.)
Things to avoid
Alcohol - None
Smoking - None
Caffeine - One cup of coffee or tea
Excessive exercise - Limit strenuous exercise to half hour per day
Red meat - Two serves per week at most
Cheese and butter - Three serves per week at most
Salt - Avoid adding to food and avoid processed food high in salt
Omega 6 fatty acids - May decrease fertility; found in high concentrations in corn, soy and sesame
Suvi Mahonen is a journalist and freelance writer whose publication credits include stories in The Weekend Australian Magazine, The Establishment and The Best Australian Stories.