Facebook Live : Talking fertility and falling pregnant

Natalie Hudson from Eastern Suburbs is talking about fertility and falling pregnant with local fertility specialist & gynaecologist Dr Rebecca Deans.

                                   FERTILITY AND FAILING PREGNANT

Natalie Hudson:  Eastern Suburbs’ Moms. Welcome to our, this is our third or fourth Facebook Live, where we feature and talk to local experts and professionals regarding their certain area of expertise. And tonight we welcome Dr. Rebecca Deans. Hi Rebecca

Dr Rebecca Deans:  Hello. Thank you for having me

Natalie Hudson:  Very happy to have you. Now Rebecca is here tonight to talk about pregnancy, and falling pregnant and also pregnancy. She’s a fertility expert and Gynecologist and you can tell us a little bit about yourself, if you like, you know

Dr Rebecca Deans:  Absolutely. I’m a mom myself. I’m a mother of four living in the Eastern Suburbs. So this is a topic very close to my heart. I see a lot of women who come to meet me for fertility issues. I work at Woollahra Health and Beauty. We’re a multi-disciplinary practice where it’s health and beauty services. So we have a whole gamete of women’s issues actually. So myself I’m a doctor, we have a beautician onsite, who does the non-invasive treatments. We have more invasive beauty treatments and also we have plastic surgeons

Natalie Hudson:  Okay. So great one-stop shop for women’s needs really

Dr Rebecca Deans:  Absolutely

Natalie Hudson:  So tonight, we’re going to have a good chat. Please make sure you like us. Just press the “Like” button the “Love” button so you know you can hear us. Also we encourage you to post questions regarding pregnancy, falling pregnant or fertility. If it’s something that you don’t feel comfortable with, maybe just get a friend to post for you. I’d be really happy to have those questions come up. So definitely let us know that you’re listening just by pressing “Like”.

So, first of all Rebecca. What are the current statistics about fertility? And I’ll cover fertility first. Now there’s {Unclear 01:51} of the media lately about men’s fertility in the Western world. So can you tell us a little bit about fertility for Australians?

Dr Rebecca Deans:  Absolutely! So we know that one in six couples actually seek help for conception. So that one in six couples sort of tried and not got pregnant and go to the clinic and got help. Now not all those couples ultimately require any medical assistance,

Natalie Hudson:  Okay

Dr Rebecca Deans:  But it affects a big proportion of Australian population. We know that when you divide up the reasons for the infertility, there is about a third that are female factor that you can identify. In fact there are about a third that are male factors and that’s all for that.

Natalie Hudson:  Yeah

Dr Rebecca Deans:  And here we are aware we don’t really consider this a problem, women always tend to blame themselves and couples tend to get the female factors that {unclear 02:38} but actually a third is man and about a third id unexplained where we do all the tests that we can and find no reason for that couples infertility

Natalie Hudson:  Okay I see. So one in six is interesting. It’s in couples, not just women and men which is really important. But I think it’s been portrayed about the women that they are the ones with the issues but that’s really interesting tonight about the statistics.

So what in regards to one in six couples, what sort of problems do you see or challenges do you see for those couples? If I was those one of those six, and I was a couple, what would be the process to come and see

Dr Rebecca Deans:  Okay. So normally we just go through a basic history about what they’ve had in their lives. So have either one ever been pregnant or had a pregnancy to a former relationship? Because that is important to assess their base fertility.

Natalie Hudson:  Okay

Dr Rebecca Deans:  And if you have been pregnant once or as a male if you’ve have a pregnancy in a relationship, that’s good prognostic factor which means that you would more likely be able to do it again.

Natalie Hudson:  Okay

Dr Rebecca Deans:  And again

Natalie Hudson:  So the “falling pregnant” aspect is very important

Dr Rebecca Deans:  That’s right

Natalie Hudson:  If you’ve fallen pregnant before in a previous relationship or you were able to get another person pregnant

Dr Rebecca Deans:  Exactly

Natalie Hudson:  That shows that your bodies

Dr Rebecca Deans:  Can do it

Natalie Hudson:  Can do it. Okay

Dr Rebecca Deans:  So that’s one of the big tick already

Natalie Hudson:  Yeah, yeah

Dr Rebecca Deans:  If he can do that. And then I’ll go through some basic questions for both the male and the female or for you know, the same sex couple, depending on who wants to carry it, who wants to donate it; with all other conversation

Natalie Hudson:  Yeah

Dr Rebecca Deans:  And but for heterosexual couples coming in, I’ll ask about the woman’s menstrual cycle, ask about pain around the menstrual cycle, whether they feel an ovulation pain or not. I’ll ask about other hormonal symptoms that they may experience

Natalie Hudson:  Okay

Dr Rebecca Deans:  I’ll ask about whether they’ve ever had any infections, particularly pelvic infections and just to look for reasons why she might not be getting pregnant. She might not be ovulating, she might have painful period and have a thing called Endometriosis, where the lining of the womb sits outside of the womb. And that’s a way that women can find it difficult to get pregnant, not that they cannot get pregnant, but they can take a little longer.

If a woman had had a Clymidia infection and her Fallopian tubes are blocked, that can block the sort of transportation of the sperm to the eggs.

Natalie Hudson:  Okay

Dr Rebecca Deans:  And that could be a fertility factor

Natalie Hudson:  So with all those factors that Dr. Deans was explaining, what are the things we can do in everyday life to enhance your fertility? So as you said, some women, they actually fall pregnant quite easily, for whatever reason, others seem to have more challenges. If you know, there is a blanket thing that everyone can try do to increase their chances for better outcomes I suppose.

Dr Rebecca Deans:  Absolutely. So I mean I think it’s just all about those healthy living lessons, isn’t it?

Natalie Hudson:  Yeah

Dr Rebecca Deans:  So I’m obviously trying to

Natalie Hudson:  It’s what the research shows?

Dr Rebecca Deans:  Absolutely!

Natalie Hudson:  Okay

Dr Rebecca Deans:  So for instance smoking

Natalie Hudson:  Yeah

Dr Rebecca Deans:  It can be very detrimental, if for anything, the partner. It can affect some of their egg quality, embryo quality.

So I think it’s important to not smoke, to minimize alcohol intake,

Natalie Hudson:  Yeah

Dr Rebecca Deans:  Excessive caffeine can also have an impact, particularly miscarriages, if it’s really excessive

Natalie Hudson:  Yeah

Dr Rebecca Deans:  And just eating a healthy diet, not being overweight

Natalie Hudson:  Okay

Dr Rebecca Deans:  Exercise, it works to an extent but not over exercise. As you know, over exercise. If a woman over exercises, it could actually makes her period go away.

Natalie Hudson:  Because your body fat percentage is low

Dr Rebecca Deans:  Exactly. Your body fat percentage and also the water and brain chemicals can interact with the actual, when you exercise and they can affect your ovulation. So a lot of the elite athletes in the world don’t ovulate at all

Natalie Hudson:  Yeah. Okay

Dr Rebecca Deans:  And then with the men also, they need to lead a relatively healthy lifestyle as well as other factors as excess weight and alcohol and smoking can have impact on his sperm.

Natalie Hudson:  As we’re talking before we came on, can you place “Like Us” guys so we can know that you’re listening to this? Do tag a friend in the discussion.

We talked about this stress effect. Because that’s a question I just heard of in Australia that may be common but Rebecca was explaining.

Dr Rebecca Deans:  You know, I don’t think there’s anything I have for us to show to prove that stress does impact

Natalie Hudson:  It’s interesting

Dr Rebecca Deans:  Certainly some people’s periods can be altered by stress

Natalie Hudson:  Okay

Dr Rebecca Deans:  And if your periods are altered and it can change your ovulation, then certainly that can have an impact on conception. But a lot of people put a lot of emphasis on things like stress and working really long hours. And in fact, it might have a subtle impact on some people, but there’s no hard doubt {unclear 07:26 – 07:27}

Natalie Hudson:  That’s good to know for the people who could be worried if stress has been a major factor.

Hi Dallas, from East saying “Hello” he’s kind of supposed to be your friend

Dr Rebecca Deans:  Hi Dallas

Natalie Hudson:  Please share and tag a friend. This is a really important discussion about fertility, falling pregnant and what you need to look out for. We’ve got an expert Gynecologist here.

So if people are having challenges, what’s sort of the time frames you’ll need to start thinking whether I might need to come see someone like Dr Rebecca?

Dr Rebecca Deans:  So it’s a little bit age related. Sometimes in the past we used to say one to two years of trying without success and that was when couples were trying to start their families in their twenties

Natalie Hudson:  Okay

Dr Rebecca Deans:  And we know that as a woman gets a bit older particularly, that time can take a little bit longer. And you don’t want to lose that window of opportunity so saying if you’re starting in your mid to late thirties. If you wait for one or two years, instead of pushing to late thirties, and then can become harder to manage and harder to get you pregnant, even with the IVF or other reproductive technologies we can use.

Natalie Hudson:  Okay

Dr Rebecca Deans:  So we often say now, really under thirty, a year of trying and not conceiving; and then over thirty, particularly over thirty five, about six months really.

Natalie Hudson:  Six months. Okay

Dr Rebecca Deans:  You should come in and seek some investigation because it takes longer than you think by the time you go to your GP, get booked in to see a specialist, have your tests done, suddenly, six months is gone by, another six months

Natalie Hudson:  And you might be forty, thirty seven or whatever it is

Dr Rebecca Deans:  That’s right and you’re always chasing time

Natalie Hudson:  Yeah

Dr Rebecca Deans:  And that’s one of the issues

Natalie Hudson:  And then it applies to both the male and the female

Dr Rebecca Deans:  Absolutely

Natalie Hudson:  And what sort of tests are available to people if they’re having challenges? I don’t have any idea about what that would be.

Dr Rebecca Deans:  Yeah. So really they are about ovulation and your egg reserve

Natalie Hudson:  Okay

Dr Rebecca Deans:  As we would count so

Natalie Hudson:  Okay

Dr Rebecca Deans:  I would do, a fertility specialist would do tests to look at whether you’re ovulating or not. We also do tests to check whether your Fallopian Tubes are open, there are actually infections that can block your Fallopian Tubes. So if they’re blocked, you would need something like an IVF to help you get pregnant. If they’re not, then you can use other techniques to help you get pregnant.

Then another more recent test is the AMH test, which is a blood test and that tells us the number of eggs you have in your ovule and it tells us a bit about your ovarian reserve.

Natalie Hudson:  Okay

Dr Rebecca Deans:  We can also do an Ultra Sound to check the follicles in the ovaries and that gives us an indication of your ovarian reserve.

Natalie Hudson:  Okay

Dr Rebecca Deans:  And we know that if you have a lot of eggs, then that’s a good sign, in terms of reproduction. It doesn’t tell us about egg quality, so even a woman that is bit {unclear 10:19}

Natalie Hudson:  You know you’ve talked about that before. Egg quality is something that I think, you know, I do remember as well, you know if you first get your period, you have four hundred eggs

Dr Rebecca Deans:  Yes

Natalie Hudson:  Roughly between when you’re a teenager and that’s a four hundred chance of being pregnant

Dr Rebecca Deans:  Of falling pregnant

Natalie Hudson:  But it’s all about the egg quality

Dr Rebecca Deans:  Absolutely

Natalie Hudson:  Okay. That’s interesting

Dr Rebecca Deans:  It’s a combination. But certainly egg quality is a very important factor and we don’t have a test for it. The best we have is a woman’s age.

Natalie Hudson:  Okay

Dr Rebecca Deans:  So the older you are, the poorer the quality. So even an older woman who’s got a good AMH or a good ovarian reserve

Natalie Hudson:  What’s an AMH?

Dr Rebecca Deans:  AMH is that test, the blood test

Natalie Hudson:  Okay the blood test. Yeah

Dr Rebecca Deans:  that I talked about before, it’s sometimes called the {unclear 11:00} test if you Google it.

Natalie Hudson:  Okay

Dr Rebecca Deans:  Then even with the good AMH, the quality can be poor and it just makes it harder for that woman to get pregnant.

Natalie Hudson:  Okay. Thanks Dallas, Greg and Faye just shared their Body Fabulous Pregnancy Fitness Page. Thanks Dallas, Greg.

Please anyone else, you have a question, don’t be shy. Happy to answer you with our specialist or you can keep on listening to if you’re just happy listening.

Okay, so

Dr Rebecca Deans:  Tests for men?

Natalie Hudson:  Tests for men

Dr Rebecca Deans:  Tests for men normally is a blood test and a semen analysis.

Natalie Hudson:  Okay

Dr Rebecca Deans:  So we can actually look at the sperm, look at the number, look at the way they’re moving and look at their morphology, the appearance of them and that can give us an indication whether there’s a male factor problem or not.

Natalie Hudson:  Okay and that’s great to know. So, “Hey Rebecca. What can you do to improve” Maya, thanks. Hi Maya. Thanks for asking your question. “What can you do to improve your egg quality, if at all?

Dr Rebecca Deans:  I get asked that question a lot. So there are some treatments that a lot of women use, although there’s no real hard evidence behind them. So treatments like CoQ10, Androgens or bio-hormone supplementation,

Natalie Hudson:  Okay

Dr Rebecca Deans:  All lot of women are actually swayed by them, but there is no hard data. It’s really about getting that good quality embryo

Natalie Hudson:  Okay

Dr Rebecca Deans:  Because in a batch you’ll usually have one. That’s why a treatment like IVF usually tends to accelerate your chances of getting pregnant because you get multiple eggs in one month.

Natalie Hudson:  Okay

Dr Rebecca Deans:  And then you’ll, of that batch, you’ll hopefully get some them of good quality

Natalie Hudson:  Okay

Dr Rebecca Deans:  And it’s a sort of embryo screening technique

Natalie Hudson:  Okay. Alright that’s interesting to know. Thanks Maya. I hope that answer answered your question.

You talked about male testing. You said that’s what they do to test the

Dr Rebecca Deans:  The sperm

Natalie Hudson:  The sperm test. Well we’ve just got some questions that one of us wants to ask. I want you to just, some people have written in prior to Eastern Suburb Moms, so I thought we could ask them so you could have a take.

So this is Julia, and we used to have this tendency, you know, people feel “How can I talk about this?” but we’ve got an expert here so it’s a really great opportunity to ask those questions.

So she and her partner met six months ago, she’s thirty eight old and she wants to find out what tests she should have, should she be concerned?

So it’s a bit like when you were talking about a better age

Dr Rebecca Deans:  Absolutely. So I think we know that female fertility starts to really fall after thirty eight. I think it starts to fall really any time after thirty or thirty five. But there’s a bit of steep decline after thirty eight and another steep decline after forty two when we know that it just becomes that much harder.

So definitely, if she’s serious about this relationship and wants to get on and have a baby, she should have a test early

Natalie Hudson:  Yeah

Dr Rebecca Deans:  Very similar, probably seeking advice from a fertility specialist or even a GP as a starting point

Natalie Hudson:  Okay. So she should go to a GP first and then get a referral.

Dr Rebecca Deans:  Absolutely

Natalie Hudson:  Okay

Dr Rebecca Deans:  And some GPs are really great and are really interested in it and would take you through all of the processes and some of the tests. But during that, those ovarian reserve tests would be important and taking that history and finding out whether there could possibly be a problem, such as having a very painful periods or I a thing called Endometriosis.

Natalie Hudson:  What about irregular periods, would that affect?

Dr Rebecca Deans:  So irregular periods, certainly because if you have irregular periods, it might mean that you’re not ovulating every month

Natalie Hudson:  Okay

Dr Rebecca Deans:  Necessarily. Then you go from having twelve chances in a month, if you have a twenty eight day cycle that means twelve cycles in a year, not a month, you might end up having three or four ovulations

Natalie Hudson:  Okay

Dr Rebecca Deans:  Excuse me in a year that then can have an impact because you’re going to need as many chances to get pregnant.

Natalie Hudson:  Okay, great. Let’s hope that helps you Julie, if you’re listening in. we have another question from Abbey. Abbey is twenty-five years old, she split up from her long-time boyfriend. She’s got a question about freezing eggs.

Dr Rebecca Deans:  So I do get asked this question a lot.

Natalie Hudson:  Okay. So there some of you may know of, some people may not know about freezing eggs. What’s involved?

Dr Rebecca Deans:  That’s right

Natalie Hudson:  Who do you talk to?

Dr Rebecca Deans:  That’s right

Natalie Hudson:  Yeah

Dr Rebecca Deans:  So once again, GP and a fertility specialist. And this process requires essentially an IVF cycle.

Natalie Hudson:  Okay

Dr Rebecca Deans:  It’s a good technique really. In the past we didn’t recommend it freezing because we thought by the time we thawed the eggs and fertilize them, there’d be no good for conception. Now we are working with a company called Genea, an IVF company. They do technical vitrification, which all of the other IVF companies do these days, where we rapidly freeze the eggs.

And we know that when we thaw those eggs and fertilize them, they have a good chance. The chance of freezing and thawing eggs is almost as good as sn IVF cycle. And the advantage of freezing your eggs when you’re thirty four, thirty five, is that you preserve the egg quality at that age rather than waiting to meet you Mr. Right at forty two. Then you know, it just sort of by passes that time period when we know that that quality can drop right off

Natalie Hudson:  Okay. It’s interesting. So you’re talking before about, I don’t mean this one to be a trivial one, you know, a couple might just come and see you maybe after six months of trying, or not getting pregnant. What about the situation where women are having regular miscarriages and things like that, what’s the time like because you talked about people getting pregnant, so the body can do it.

Dr Rebecca Deans:  Yes

Natalie Hudson:  So what would you recommend? I know that this is sort of a sensitive question for someone but it might be a bit of help to have Rebecca explain around {Unclear 16:43}

Dr Rebecca Deans:  Absolutely. And it is a sensitive topic. So obviously getting pregnant you’ve already by-passed the first hurdle but then to actually take that pregnancy through the term is another big hurdle

Natalie Hudson:  Yeah

Dr Rebecca Deans:  For particularly the woman to be able to carry that pregnancy. Certainly if a woman has had two or more miscarriages, or three or more miscarriages, depending on which definition you use there becomes Reoccurring Miscarriages. And we know that if you get to that point, you’ll more likely to then have another miscarriage.

Natalie Hudson:  Okay

Dr Rebecca Deans:  So the first one out of the two miscarriages is just bad luck. A lot of women have had miscarriages in their lives. More women have probably had miscarriages than there haven’t.

Natalie Hudson:  I see

Dr Rebecca Deans:  So it’s nothing to get concerned about. But once it gets into that recurrence of a miscarriage thing, then could be a problem. And so at that point we might need to look for underlying issue and it might be about the woman having diabetes that she doesn’t know about, or checking if she has a blood clotting disorder, and she would {unclear 17:41} with the baby here implants.

Natalie Hudson:  And is it something that you would help her kind of with?

Dr Rebecca Deans:  Absolutely. That’s right so you know you’ll

Natalie Hudson:  Yeah, okay. So you’ll Go and see a fertility specialist

Dr Rebecca Deans:  That’s right. They’ll take you those basic tests

Natalie Hudson:  Okay

Dr Rebecca Deans:  the most common reason is, I think the Karyotypic Abnormality. Where the baby has something like Down Syndrome or too many copies of the chromosome or too few copies of the chromosome. And that happens in nature

Natalie Hudson:  Yeah

Dr Rebecca Deans:  All the time, and it happens more as a woman gets older particularly. So you’re more likely to have pregnancies that would result in these errors and the body is doing exactly what it’s programmed to do and not allowing those pregnancies to continue.

Natalie Hudson:  Okay

Dr Rebecca Deans:  But if you’re having miscarriages, one of the treatments that we can do is part of the IVF where we actually test the embryos

Natalie Hudson:  Okay

Dr Rebecca Deans:  And you can test for those abnormalities and if you, then we’ll {unclear 18:34} ones that have the normal carrier type.

Natalie Hudson:  And how popular, you’ve talked about IVF before because it’s obviously about pregnancy and fertility. How popular is IVF now in Australia? What sort of statistics are we seeing?

Dr Rebecca Deans:  It’s pretty high. It’s about one child in every classroom would be IVF baby. So it’s about one in thirty

Natalie Hudson:  It’s kind of wow!

Dr Rebecca Deans:  Children born. It’s very well used technology and well proven technology. And then you were asking me about what other things you can do to improve embryo quality

Natalie Hudson:  Yes

Dr Rebecca Deans:  There is some data for some things to measure, but there is nothing like doing something like IVF to really improve your chances.

Natalie Hudson:  Okay

Dr Rebecca Deans:  That’s right. But not to say that IVF is the only treatment either

Natalie Hudson:  Yeah

Dr Rebecca Deans:  So for instance, as I mentioned Endomitriosis before. We know that if a woman has Endomitriosis, we do a laboscropy and remove it. That doubles their chance of spontaneous conception afterwards.

Natalie Hudson:  Okay

Dr Rebecca Deans:  And we know if there’s an ovulatory problem, we can give a tablet or injection to help ovulation. And that is also a very successful technique

Natalie Hudson:  That’s okay.

Dr Rebecca Deans:  It’s really important to try and get to the root cause of the problem

Natalie Hudson:  Yeah to try and to trace that

Dr Rebecca Deans:  Exactly, that female problem and if we can finally should and treat that.

But if it’s a male problem, often it is something like IVF or ICSI, where we inject the sperm into the egg because then we know that that sperm can get into the egg

Natalie Hudson: Okay

Dr Rebecca Deans:  And can fertilize it. it might be a fertilization issue, and then if it’s unexplained, often it is a combination of female or male age and something that IVF can sometimes overcome just because it gives you those more embryos per cycle.

Natalie Hudson:  Okay. I think we’re sort of nearing our check, we just so we have a better chatted for twenty minutes!

Dr Rebecca Deans:  Oh goodness!

Natalie Hudson:  And I think we’ve got quite a lot of eyes watching, I think if you’re not watching technically listening. I think, thanks for talking with Rebecca. I think obviously, if people want to find out about our discussion, you’re welcome to make an appointment with Dr. Deans her at Woollahra Health and Beauty. She’s a mom of four, ass you can see the babies on the back of the wall here, all of them.

And I’ll take you through what might be some of your problems and your partner’s challenges. And so you know, I was just, before we end, we were talking to you about single women.

Dr Rebecca Deans:  Absolutely

Natalie Hudson:  There might be some of them listening on here.

Dr Rebecca Deans:  That’s right and it’s just hard these days with women trying to meet that right person for them and with careers and trying to find that right person and worrying about their fertility. That’s why sometimes, freezing eggs, I just find a lot of women say it takes the pressure off because as they approach relationships, they feel like they’ve done something about their fertility

Natalie Hudson:  Isn’t that good?

Dr Rebecca Deans:  Absolutely

Natalie Hudson:  Yeah

Dr Rebecca Deans:  At a time when we hope the age quality would be good and therefore they can approach relationships like they may do when they’re twenty rather than approach it as a thirty-five or thirty-six year old thinking “Oh gosh! My time is running out. I need to quickly get a baby.” Because that finally puts a lot of pressure on relationships sometimes that they will continue which is such a shame

Natalie Hudson:  So we’re hoping you’ve really enjoyed this really thorough and detailed explanation by Dr. Deans. So any questions? You’ll post it up the details in the comments. You can also get into contact with Woollahra Beauty and Health like I said. I hope we’ll have Rebecca back to talk soon because she’s Gynecologist so we’ve got some other interesting topics here and I touched on today. So I think it’d be quite relevant for mothers with teenage daughters.

Dr Rebecca Deans:  {Laughs}

Natalie Hudson:  {Laughs} So come back to you. Thanks everyone and make sure you “Like” us and Share. We’ll talk soon. Have a good night. Bye bye!

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