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Thinking about having a baby? Talk to your doctor! Here is what men and women can do to increase their chance of getting pregnant and having a healthy baby.

1. Learn about the top five factors. 2. Complete the ‘Preconception health checklist’ at www.yourfertility.org.au to take to your doctor. 3. Visit your doctor to discuss how to optimise your chance of conceiving and having a healthy baby. 4. Visit www.yourfertility.org.au for more information.

Top Five Fertility Factors

Age Weight

Fertility declines with age, so if you are thinking about Size matters! Studies show that fertility and the health having a baby, consider trying sooner rather than later. of a baby at birth and into adulthood are affected by the health of the parents even before conception. On average, women’s fertility starts to decline in their early thirties and declines more rapidly after age 35. • Being overweight can result in imbalances The monthly chance of conceiving is about 20% for a that affect and quality. in her twenties. By age 40 it is only 5%. • Being very overweight lowers fertility and increases the risk of complications. Men’s fertility starts to decline at about age 45. Men over the age of 40 are 30% less likely than younger men • A healthy diet together with regular exercise can help to achieve conception within a year. reduce and maintain weight in the healthy range. • Your doctor can point you in the right direction if you Consider seeing a fertility specialist if: want to lose weight. • the partner is younger than 35 and you have tried to get pregnant for a year or more • the female partner is older than 35 and you have tried to get pregnant for six months or more. Smoking General health

Smoking has damaging effects on the whole body, Here are other factors that can affect male and female including and sperm. It also increases the risks fertility and the health of the baby: of pregnancy complications and health problems for • some medical conditions and medications, including the baby. Quitting before conception is the only way to herbal or alternative medicines reduce these risks. • untreated sexually transmitted infections (STIs) • a history of genital surgery or having mumps as an adult Alcohol • recreational drugs and the use of anabolic steroids For women, not drinking alcohol is the safest option • exposure to pesticides, heavy metals, toxic chemicals, if you are pregnant or trying to have a baby. harmful plastics or radiation, all of which can affect fertility.

For men, avoid drinking excessive amounts of alcohol Talk to your doctor if any of these factors apply to you. to improve your sperm quality. Here are some things you can do to give your baby the Timing of best start in life: • for women, taking folic acid tablets for the two months When you want to have a baby you can improve the odds or more before conception and in the first three months of this happening if you have sex during the ‘fertile of pregnancy to reduce the risk of birth defects window’ of the . • for women, German Measles (Rubella) in pregnancy can cause severe birth defects. Your doctor will order a Ovulation is when an is released from the ovary. test to make sure you are immune to Rubella and if you This happens two weeks before a period starts. Technically, are not, you should be vaccinated before you conceive pregnancy is possible during the six days leading up to and including ovulation. But, the likelihood of pregnancy • for women and men, avoiding exposure to chemicals is dramatically increased if you have intercourse at home and at work. during the three days leading up to and including the day of ovulation. Questions to ask your doctor The length of a woman’s menstrual cycle determines when ovulation occurs: • in 28 day cycles the most fertile days are days 12 to 14 • in 24 day cycles the most fertile days are days 8 to 10 • in 35 day cycles the most fertile days are between days 19 and 21.

For women with irregular cycles, your doctor can order blood tests to check if you are ovulating.

If all this seems too complicated, an alternative is to have sex every two to three days - that way you are sure to cover all bases without getting too technical about when the chance of conceiving is greatest.

Visit www.yourfertility.org.au for more information about the ‘fertile window’ and an ovulation calculator.

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10% TI ON A VU L O elihood of conceiving 0% 0% % li k

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Most fertile days Fertile window

Day of intercourse relative to ovulation Your Fertility is a national public education campaign funded by the Australian Government Department of Health. Fertility facts for health professionals

Most people want and expect to Facts about fertility to share with patients have children sometime in their life. This is a summary of existing scientific evidence For some, age and lifestyle factors about the ‘Top 5 Fertility Factors’. A reference list reduce their chance of having a baby. is available at www.yourfertility.org.au. In addition to these, many other factors influence fertility and Health care professionals are in an reproductive outcomes including sexually ideal to raise awareness transmitted infection (STIs), environmental toxins, about the effects of age and lifestyle diet, and exercise. on fertility and pregnancy outcomes and the importance of preconception health. Age

• Women’s fertility declines gradually starting at You can help your patients by asking about 32 years of age. It decreases more rapidly them if they wish to have children and after 35 years of age. making them aware of the factors that • The risk of miscarriage increases as a woman will help or hinder being able to conceive gets older. and have a healthy baby. Consultations • The quantity and quality of sperm declines as about matters men get older, starting at about 45 years of age. provide an opportunity to begin a • Female partners of men over the age of 45 take conversation about fertility. five times longer to conceive compared to partners of men aged 25 or less. The Your Fertility program aims to give • As men get older, the risk of chromosomal abnormalities and birth defects in the children women and men who want to become they father increases. Also, children of older fathers parents the information they need to have an increased risk of having an autism spectrum optimize their chance of achieving this. disorder. www.yourfertility.org.au provides clear • Postponing parenthood increases the risk of and accurate information for the general involuntary childlessness and smaller families than desired. public and health professionals about the factors that influence fertility and • Assisted reproductive treatment (ART) cannot overcome age-related . pregnancy health. • The risks of pregnancy complications such as gestational diabetes, pre-eclampsia, placental abruption, intrauterine growth restriction, premature birth, stillbirth, and caesarean section increase as women get older. Fertility facts for health professionals

Weight Alcohol

• Obesity in women can cause hormonal changes that • There is a negative relationship between the chance interfere with ovulation and reduce a woman’s fertility. of conception and the amount of alcohol consumed. • Obese women take significantly longer to conceive • Partners of men who consume more than 20 drinks than women in the healthy weight range. of alcohol per week take longer to conceive than partners of men who drink less. • The chance of success with ART treatment is significantly lower for obese women than for women • The National Health and Medical Research Council in the healthy weight range. advises that for women who are pregnant or planning a pregnancy, not drinking alcohol is the safest option. • In men, obesity is associated with lower fertility. This is likely due to a combination of factors including hormone problems, sexual dysfunction and/or other Timing of sex health conditions linked to obesity. • Obesity in women increases the risk of miscarriage, • While conception is theoretically possible during gestational diabetes, hypertension, and premature the ‘fertile window’ which is the six days leading up birth, congenital abnormalities, high birth weight, to ovulation, the chance of conception is dramatically stillbirth and perinatal death. increased if intercourse occurs during the three days leading up to and the day of ovulation. • Children born to obese mothers have poorer health outcomes at birth and into adulthood than those with • Time of ovulation can be calculated by subtracting mothers in the healthy weight range. 14 days from the average cycle length. • Paying attention to the appearance of cervical mucus changes can help identify the fertile window. A few Smoking days before ovulation, the cervical mucus increases and becomes clear, stretchy and slippery. • Smokers are more likely to be infertile. • An ovulation calculator is available at • Women exposed to passive smoking take longer www.yourfertility.org.au to conceive. • Women who smoke reach earlier. • Maternal smoking increases the risk of low birth weight and birth defects. • Smoking can damage sperm DNA.

Your Fertility is a national public education campaign funded by the Australian Government Department of Health. Fertility factors reference list

This list of references reflects current evidence about the impact of parental age and lifestyle factors on: fertility; chance of success with assisted reproductive technology (ART) treatment; pregnancy health; and the health of the baby at birth and into adulthood. The list also includes references relating to the fertile window in the menstrual cycle. In addition to these, many other factors influence fertility and reproductive outcomes including sexually transmitted infection (STIs), environmental toxins, diet, and exercise. Visit www.yourfertility.org.au for more information about fertility and preconception health.

Age Cooke, Lynne, and Scott M. Nelson. Reproductive Ageing and Fertility in an Ageing Population. The Obstetrician & Gynaecologist. 2011;13(3): 161-68. de Graaff AA, Land JA, Kessels AGH, Evers JLH. Demographic age shift toward later conception results in an increased age in the subfertile population and an increased demand for medical care. Fertility and Sterility. 2011;95(1):61-7. D’Onofrio, B. M., M. E. Rickert, E. Frans, R. Kuja-Halkola, C. Almqvist, A. Sjolander, H. Larsson, and P. Lichtenstein. Paternal age at childbearing and offspring psychiatric and academic morbidity. JAMA Psychiatry. 2014;71(4);432-8. Lawson, Gerald, and Richard Fletcher. Delayed fatherhood. Journal of and Reproductive Health Care. 2014;40(4):283-88. Mazza D, Cannold L, Nagle C, McKay F, Brijnath B. Making decisions about fertility: Three facts GPs need to communicate to women. Australian Family Physician. 2012;41: 343-46. Ramasamy, Ranjith, Koji Chiba, Peter Butler, and Dolores J. Lamb. Male biological clock: A critical analysis of advanced paternal age. Fertility and Sterility. 2015;doi: 10.1016/j.fertnstert.2015.03.011. Schmidt L, Sobotka T, Bentzen JG, Nyboe Andersen A. Demographic and medical consequences of the postponement of parenthood. Update. 2011;18(1):29-43.

Weight Derbyshire, E. Preparing for Pregnancy: A body weight perspective and update of the literature. Current and Food Science. 2011;7:216-20. Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Human Reproduction. 2007;22(2):414-20. Hammoud A, Carrell D, Gibson M, Peterson C, Meikle A. Updates on the relation of weight excess and reproductive function in men: sleep apnea as a new area of interest. Asian Journal of . 2012;14:77-81. Koepp, UM, LF Andersen, K Dahl-Joergensen, H Stigum, O Nass, and W Nystad. Maternal pre-pregnant body mass index, maternal weight change and offspring birth weight. Acta Obstetrica et Gynecologica Scandinavica. 2012;91(2):243-49. Lane M, Robker RL, Robertson SA. from before conception. Science. 2014;345(6198):756-60. Fertility factors reference list

Marchi, J., Berg, M., Dencker, A., Olander, E.K., Begley, C., Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obesity Reviews 2015; DOI: 10.1111/obr.12288. Maftei O, Whitrow MJ, Davies MJ, Giles LC, Owens JA, Moore VM. Maternal body size prior to pregnancy, gestational diabetes and weight gain: associations with insulin resistance in children at 9-10 years. Diabetic Medicine. 2014; 32(2):174-80. Moragianni AA, Jones S-ML, Ryley DA. The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertility and Sterility. 2012;98(1):102-8. Tennant PWG, Rankin J, Bell R. Maternal body mass index and the risk of fetal and death: a cohort study from the North of England. Human Reproduction. 2011;26(6):1501-11. Smoking Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Human Reproduction. 1998;13(6):1532-9. Dechanet C, Anahory T, Mathieu Daude JC, Quantin X, Reyftmann L, Hamamah S, et al. Effects of cigarette smoking on reproduction. Human Reproduction Update. 2011;17(1):76-95. Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Human Reproduction Update. 2011;17(5):589-604. Homan GF, Davies MJ, Norman RJ. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Human Reproduction Update. 2007;13(3):209-23. Hull MGR, North K, Taylor, Farrow A, Ford C. Delayed conception and active and passive smoking. Fertility and Sterility. 2000;74(4):725-33. Alcohol Floyd L, Jack B, Cefalo R, Atrash H, Mahoney J, et al. The clinical content of preconception care: alcohol, tobacco, and illicit drug exposures. American Journal of Obstetrics and Gynecology 2008;December:s333-s39. Hassan MAM, Killick SR. Negative lifestyle is associated with significant reduction in fecundity. Fertility and Sterility. 2004;81(2):384-92. Homan GF, Davies MJ, Norman RJ. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Human Reproduction Update. 2007;13(3):209-23. Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C. Effects of maternal and paternal alcohol consumption on the success of in vitro fertilization and intrafallopian transfer. Fertility and Sterility. 2003;79(2):330-9. Timing of sex Berglund Scherwitzl E, Linden Hirschberg A, Scherwitzl R. Identification and prediction of the fertile window using Natural Cycles. The European Journal of Contraception and Reproductive Health Care. 2015;Jan 16:1-6. Ecochard R, Duterque O, Leiva R, Bouchard T, Vigil P. Self-identification of the clinical fertile window and the ovulation period. Fertility and Sterility. 2015;103(5):1319-25.e3. Practice Committee of the American Society for in collaboration with the Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility. Fertility and Sterility. 2008;90(Suppl 3):S1-S6. Stanford JB. Revisiting the fertile window. Fertility and Sterility. 2015;103(5):1152-3.

Your Fertility is a national public education campaign funded by the Australian Government Department of Health.