Do you have questions about conceiving or fertility? Ask The Fertility Partnership - £200 voucher to be won

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Whether you’ve experienced problems conceiving in the past or you’re exploring IVF options for the first time, finding the right fertility treatment for you or your partner can seem like a confusing and difficult process. With this in mind, the Fertility Partnership’s expert, Professor Tim Child, is on hand to help answer your questions.

Meet Professor Tim Child:
Tim Child is Medical Director of Oxford Fertility and Group Medical Director of The Fertility Partnership, Associate Professor at the University of Oxford, and Honorary Consultant Gynaecologist at the Oxford University Hospitals NHS Foundation Trust. As of 2021, he was appointed to the board of the Human Fertilisation and Embryology Authority (HFEA) - the Government regulator responsible for making sure fertility clinics and research centres comply with the law.

Here’s what The Fertility Partnership has to say:
“Thinking about fertility treatment can be daunting at the best of times and it's natural to have lots of questions. While there are plenty of small changes you can make to help you conceive, if you need advice about fertility treatment, we’re here to offer understanding and expertise.”

So whatever your question about conceiving or understanding the fertility treatments available to you, please post your questions on this thread for Tim to answer. Tim will be back on the 20th April to answer your questions.

All who share a question on the thread below will be entered into a prize draw where one Mumsnet user will win a £200 voucher for a store of their choice (from a list).

Thanks and good luck!

MNHQ

Insight Terms and Conditions apply

*Please note this thread does not constitute personal medical advice, and please do not disclose personal health information on this forum. You should always speak to a GP/healthcare professional in person for advice specific to your situation.

I have a changing luteal phase, it ranges from 9 to 17 days which I know Isn't normal, but my gp just dismissed it and said this can happen with age. I just turned 42 but all tests so far have come back ok apart from low iron which is now back up to almost normal. I suspect I may have endometriosis can this effect Lp?

@Sarahplane

I've been diagnosed with early menopause at 35. Is IVF possible? Is there any point in trying to harvest any eggs I have left? Also do private clinics have the same rules about BMI as NHS?

Hi @Sarahplane. The two main factors affecting the chance of IVF working are the age of the woman (since this is the main factor affecting the genetic quality of the eggs) and also the number of eggs in the ovaries. Having early menopause means that there will be a very low number of eggs in the ovaries. It may be difficult to harvest eggs during an IVF cycle as the ovaries may not respond to the stimulation drugs. This will depend on the degree of reduced ovarian reserve that you have. Your fertility clinic will be able to discuss this with you. For NHS IVF funding the BMI needs to be less than 30. For self-funded patients, IVF clinics will have their own BMI limits. Often this is 35, though some clinics will accept a higher BMI. BMI limits are used as a higher BMI affects the response to stimulation, which in turn reduces success rates. Pregnancies are also at higher risk as the BMI increases.

@Rae1000

Does suffering with endometriosis (particularly on ovaries) mean you always have a high FSH? At what level does it normally mean you won't be able to conceive naturally?

Also if you have a high FSH does it mean you will go through or more likely to go through an early menopause?

Hello @Rae1000. Having endometriosis in the pelvis does not necessarily affect ovarian reserve. If there are endometriosis ovarian cysts ('endometriomas') then this can sometimes lead to damage and a reduced number of eggs. A more accurate predictor of ovarian reserve is an AMH test which is better than FSH. AMH can be taken on any day of the menstrual cycle. There is no strict level at which an AMH and FSH tell us that a woman would not conceive naturally. If a woman is having regular menstrual cycles at the moment, then this is a more important predictor of the chance of natural conception than a blood test result. Having a high FSH and/or very low AMH (both are indicators of reduced ovarian reserve) can be linked to earlier menopause.

@RoloM610

What causes fragmentation in embryos during ivf? And what can be done to prevent this in future cycles?

Hi @RoloM610. As cells divide during embryo development, parts of the cytoplasm within can split off and can appear as fragmentation. It is therefore a normal part of embryo development. The higher the amount of fragmentation, then the lower the quality of the embryo. Some people will tend to produce embryos of reduced quality and there may not be a great deal that can be done to change that. It is however important to remember that embryos with higher amounts of fragmentation can still implant and lead to the birth of a healthy child. Lifestyle factors, including weight, diet and taking fertility supplements, can always be optimised. During an IVF cycle, different types of stimulation drugs can also be considered, as well as the use of continuous culture (such as in a time-lapse embryoscope). The man could also consider having a sperm DNA fragmentation test.

How many cycles of IVF do you get on the NHS? Can you still go private if NHS cycles didnt work?

@LTsMum1

How will fibroids in the uterus area (identified by a scan) affect pregnancy?

Hi @LTsMum1, fibroids are incredibly common. I often explain that they are a bit like a knot of wood in a tree. The uterus is made of muscle fibres and a fibroid is like a knot of muscle. Around 40% of women in their forties will have fibroids on an ultrasound scan. The smaller the fibroid and the further away it is from the endometrial cavity, then the less likely it is to impact on fertility. If a fibroid is distorting the endometrial cavity, then there should be a discussion about removing it via the cervix. If there is a fibroid of more than 3 or 4 centimetres in the wall of the uterus (close to the endometrial cavity) and the woman has fertility issues then the pros and cons of removal should be discussed with a reproductive specialist. Importantly, the majority of women with fibroids do not have any issues and the fibroids are an incidental finding. Just because a fibroid has been seen certainly does not mean that it has to be removed.

@pushchairprincess

My partner has a low sperm count (diagnosed through testing 9 million sperm per millilitre. with non-progressive motility) we have been TTC but feel it is a putting a strain on us both, we have both considered donor sperm insemination as an alternative - but want this to be the last resort, would you think there is any hope for us ?

Hi @pushchairprincess. With a low sperm count, it is important to consider the male's lifestyle. Different factors could be playing a part, consider optimising BMI, stopping smoking and improving diet. That said, sometimes these changes do not improve the sperm count and treatment will depend on using the sperm in such a way to maximise the chance of the female partner conceiving. Certainly, a sperm count of 9 million is not too bad. Regarding non-progressive motility or an abnormal sperm test, it is always important to repeat the test to be sure. Certainly, with male factor fertility, the best treatment may be one such as IVF, potentially with ICSI (injecting the sperm into the retrieved egg). The success rate of IVF mostly depends on the age of the woman, rather than the sperm quality. It would be unusual to consider sperm donation for a couple in your situation, where there is an abnormal but not too bad sperm count. I would certainly advise you to have another discussion with a fertility specialist.

@KiansKuddles

Can ovarian cysts affect fertillity at all?

Hi @KiansKuddles. There are many different types of ovarian cysts, they also often come and go. If an ovarian cyst is benign but large and is persisting then this could affect fertility by affecting ovulation or the chance of the fallopian tube picking up the egg from the ovary. If the ovarian cyst is endometriosis then its removal can improve the chance of natural conception. Therefore, the answer will depend on the size of the cyst, how it looks on scan and the nature of it.

@zindeggeh

What would you recommend to those suffering from PCOS?

Hi @zindeggeh, please do check out our 3 part series on PCOS: Part 1 - www.instagram.com/tv/CFacyxIhtkJ/ Part 2 - www.instagram.com/tv/CFciDTkB2yP/ Part 3 - www.instagram.com/tv/CFcigBoB5rr/

@Sandcastles24

Hi, How long do you need to wait after having a baby before you can have another frozen egg transfer and does breastfeeding effect this? Thanks

Hi there @Sandcastles24, IVF clinics will vary on their approach to having IVF during or after breastfeeding. The majority will say that a woman will need to stop breastfeeding for a couple of months before commencing IVF drugs, as they are concerned that the raised hormones associated with breastfeeding may affect the ovarian response. There may also be concerns that the drugs may affect the breast milk and be passed to the baby. Data in this area is however very limited. This is why a number of clinics will say that they are happy for their patients to breastfeed and have IVF. You will need to have a discussion on this with your own fertility clinic and consider their advice.

@LaurenNH

For women with multiple miscarriages, is it worth taking Ubiquinol?

Hi @LaurenNH. Women with multiple miscarriages should be investigated in a specialised recurrent miscarriage clinic, along with their partner. Tests will include a detailed clotting screen and an ultrasound scan for the woman. Lifestyle improvements should be considered, including optimising BMI and diet, and certainly the couple should not smoke. It has not been shown that taking supplements will reduce the chance of miscarriage. Most miscarriages are due to a chance chromosomal problem in the embryo coming from the egg or the sperm, which is why the miscarriage rate is related to the age of the female and male. As supplements, such as Ubiquinol are not drugs, they haven't really been studied and it's not possible to say whether they have a beneficial effect on outcomes such the chance of miscarriage. They are unlikely to cause harm however so I wouldn't have an issue with a patient taking them.

@WineAndMassage

Hello, is there a correlation between IVF and tumour development in women over 40? I've heard of few cases when women post 40 had tumours after having IVF babies. Thank you

Hi @WineAndMassage. IVF has been around for over 40 years now and there have been a number of large long-term follow-up studies. There is no evidence that IVF leads to a higher risk of breast or uterine cancer. Importantly women who have never had a baby do have a slightly higher risk of breast and ovarian cancer. So IVF patients are perhaps in a very slightly higher risk group, as most haven't previously had children, than the general population. However, this difference is very small. It is possible that there is a very slight increased risk of a type of ovarian cyst (called a borderline ovarian tumour), though the possible risk increase is very low.

@WhoTookAllTheGoodNames

Is there a link between soya products (soya milk) and fertility. I’m 32 and wanting to get pregnant in near future but I drink soya milk and wondering if I should stop

Hi @WhoTookAllTheGoodNames. I'm not aware of any evidence that taking supplements such as soy would improve fertility.

@Freshair85

Any tips for trying to conceive when your periods haven't returned from having your last baby?

Hi there @Freshair85. During pregnancy, the reproductive hormones completely shut down. It can take some time for them to start working again, particularly if you have been breastfeeding (since this also affects the hormones). If there has been a weight change, then this could be affecting ovulation. If your periods were regular before your last pregnancy and as far as you can tell, nothing has changed then it would be worth having a check of your reproductive hormones via your GP (FSH, LH, Testosterone, Prolactin, TSH, AMH). A pregnancy itself would not cause any long-term problems in regards to stopping periods from returning.

@MaryMashedThem

If it took you a long time to regularly ovulate after coming off the pill, is it more likely to also take a long time after you stop breastfeeding? And a related question: what can breastfeeding mothers do to improve their fertility without fully weaning?

Hi there @MaryMashedThem. It probably is correct that if you took a long time to regularly ovulate after coming off the pill then the same may be true after stopping breastfeeding. The reproductive hormones are suppressed during pill use and also when breastfeeding. There may not be a lot that you can do to improve fertility, without fully weaning apart from checking that your lifestyle factors are optimal including maintaining a healthy weight and diet. Certainly, there are no drug medications that could be taken to help.

@2021hwg

Are women who have Ivf statistically more likely to need a c section

Hi @2021hwg. Caesarean sections are often performed routinely for women with twin pregnancies and this is more common after IVF (due to two embryos being transferred) compared to natural conception. Also, older women in their first pregnancy may be more likely to have a Caesarean section due to complications during pregnancy, such as high blood pressure. The IVF procedure itself does not lead to an increased chance of Cesarean section, apart from if two embryos are transferred. The chance of needing a Caesarean section comes down to the characteristics of the woman undergoing IVF.

@acabbagecalledtortoise

Is there any evidence that having had a relatively mild case of Covid-19, male fertility (previously fine), can be affected in the short term?

Hi @acabbagecalledtortoise. There is no evidence that Covid-19 affects fertility in the medium or long term. If a man had a temperature with his Covid diagnosis, as for any illness causing a fever, then this can affect sperm production for a couple of months. In the UK, the advice is that people should not have treatment until 28 days after their recovery from Covid-19. That said, if someone conceives during or very soon after a Covid infection then there is no evidence that this leads to any problems during pregnancy.

@Quietvoiceplease

When there seems a delay to conceiving, how long should one wait before asking for referral for investigation/fertility treatment?

Hi @Quietvoiceplease. As a rule of thumb, if you have been trying to conceive for over a year you should see a specialist.

@CausingChaos2

Could short cycles (between 22-25 days) with a 12/14 day luteal phase be a barrier to conception? Do short cycles affect long term fertility in terms of eggs being used up more quickly than women with average 28 day cycles? Thank you.

Hi @CausingChaos2. Women with a short cycle, generally still have the same duration of 12-14 days between ovulation and the subsequent period. That is, having a short cycle means that the time from day one of the period until ovulation is the part that is shorter. There is no link between having a short, regular cycle and a lower chance per cycle of conception. In fact, having a short cycle means that you will have more ovulations per year than women with a longer cycle, therefore your overall chance of conception should be higher. There is also no concern, over running out of eggs due to a short cycle. Women are born with 2 or 3 million eggs in their ovaries and they do not have 2 or 3 million periods. The vast majority of eggs that women are born with die off through natural cell loss, so a woman's fertility is not affected by the number of previous menstrual (or IVF) cycles.

@Daisypod

I have seen a lot of discussions both on Mumsnet and other forums about Soy Isoflavones being nature's clomid. Is there any truth to this and can this supplement help fertility if taken on the correct days in your cycle? Thank you

Hi there @Daisypod. I'm not aware of any evidence that taking supplements such as soy would improve fertility. Soy contains oestrogen, whereas Clomid blocks oestrogen. I think that if someone is concerned regarding their fertility, then it is important to have appropriate investigations and a discussion with a GP or fertility specialist regarding treatment options. I don't think that taking soy will improve the situation.

@StarryHannah

Unexplained infertility... what would you suggest you and my husband do in order to 'fix' this or find out the cause? Do you think my tilted cervix and uterus could be the cause?

We are currently waiting for our first IVF embryo transfer which will be frozen.

Thank you :)

Hi @StarryHannah, thank you for the question. A diagnosis of unexplained infertility is very frustrating for any couple and their fertility team. It means that all investigations have returned as normal, though this does not mean that there is no underlying issue. It just means that we currently do not have knowledge of the appropriate investigations to diagnose a cause, or we do not understand all of the possible causes of infertility (something which is very likely). If your fallopian tubes have only been checked by a HyCoSy scan or HSG, then you could consider asking about a laparoscopy operation to fully assess the pelvis, including looking for conditions such as endometriosis or adhesions. Certainly, there is no link between a tilted cervix and uterus and fertility. I can reassure you that the chance of success during IVF is no different for couples with unexplained infertility than it is for people who have a diagnosed cause of infertility. A positive aspect of an unexplained diagnosis is that it means there is a chance of natural conception, so the outlook is better than for couples with completely blocked fallopian tubes or where sperm are absent. Good luck with your IVF cycle.

@Palavah

I'm nearly 40, never tried to conceive before, finally in a position to do so. If I can have children I'd hope to have two. Is there any point in trying to harvest eggs for the 2nd even if I can have the first without intervention, given I'd likely be nearly 42 or older when trying for the 2nd?

Hi @Palavah. I think that as you are nearly 40 and are just about to start trying to conceive for the first time, then I would focus on that rather than freezing embryos. It is normal to take up to 12 months to conceive. If you reach 6 to 12 months and have not conceived then a discussion with a fertility specialist would be worthwhile. In your situation I do not think it would be beneficial to begin your fertility journey with an IVF cycle to try and freeze eggs/embryos for possible future use. If you have not conceived by 12 months, then you could discuss moving onto IVF to conceive at that time and hopefully have some spare embryos to store for later use.

@Yeval

Hello. I'm 37 years old. My sister is 41 and was in the menopause by 40 (not peri - actual menopause). My partner and I have been trying to conceive our first baby for 6 months. I've been measuring my LH levels and tracking my temperature. I don't ever seem to get an LH peak, but my temperature dips just before my supposed ovulation date, and then increases afterwards. Does this suggest to you that I am ovulating?

Hi @Yeval. I think that as you have a family history of premature menopause and as you are trying to conceive at the moment, then it would be worth having a check of your ovarian reserve. This would be best done by an AMH blood test and perhaps also a pelvic scan including a check of the antral follicle count within the ovaries. Monitoring for ovulation using a temperature chart is very unreliable and would not be requested by a fertility specialist. If you are having regular cycles, then it is highly likely that you are ovulating. The best test for this will be a progesterone blood test, around 7 days before the expected period date. I suspect a discussion with a fertility specialist may be beneficial for you, due to your family history and because you have been trying for a few months.

Hi @TimChildTFP you didn’t actually answer my question about soya products - because of the estrogen in soya milk, il should I STOP drinking soya milk and eating soya products? Is there a chance this would DECReASE my fertility? I wasn’t asking if they improve fertility and whether I should start taking it.