Breaking the cycle: Eight fertility myths debunked  

• Myth 1: You don’t need to worry about female fertility until after age 35

Women are most fertile in their early 20s, and their fertility starts to reduce after 30, and this reduction is more rapid after 35, says the HSE. “Infertility is a couple’s thing,” says Dr Hans Arce, reproductive medicine consultant for ReproMed Dublin. “You can have women — and men — infertile at 25. It can be a problem at any age, though age-related fertility in females does drop faster after age 35.”

Dr Marta Moschetta, clinical director at Sims IVF (Clonskeagh clinic), says female fertility should, on average, be fine until age 35. “But in practice, it depends: On factors like sperm, number of egg follicles in the ovary, and on conditions that can affect egg quality, like PCOS and endometriosis, which can certainly impact women under 30.”

PCOS signs and symptoms usually appear during the late teens or early 20s. The WHO says PCOS can cause hormonal imbalances, irregular periods, excess androgen and cysts in the ovaries.

Irregular periods, usually with a lack of ovulation, can make it difficult to become pregnant. “With an irregular cycle, you don’t know when you’re ovulating, or whether you do ovulate,” says Moschetta.

• Myth 2: Fertility struggles are always due to female factors

An analysis that compared sperm samples from 1970 and 2011 found that men are ejaculating 60% less sperm today. “Does that sound like a female problem?” asks Arce.

Testicles seem to be sponges for microplastics, which are oestrogen disruptors.

Arce says: “They’re in dust, in the air, in water, in what we eat: We store all our food in plastic.”

Moschetta says female age is a significant factor in fertility, but so is sperm quality.

An initial semen-analysis test checks for quantity and concentration of sperm, motility (how it moves), and its shape.

“But there’s an additional DNA-fragmentation test that analyses the genetic part of the sperm. When there’s high DNA fragmentation — around 20%, 25% — it can affect embryo quality. It’s related to a higher risk of miscarriage.”

With damage to sperm DNA quality often caused by poor lifestyle, it is “pretty common”, says Moschetta, for men to have DNA fragmentation of 20%, particularly if aged over 30.

“Smoking, drinking a lot, not exercising, eating a lot of junk food can all be factors. Also, if you have diabetes or insulin resistance. We see it, too, in men who cycle a lot: Temperature of testicles increases, which can change sperm DNA.”

A normal semen-analysis test does not mean a man will have little DNA fragmentation.

“Sometimes, the semen-analysis test isn’t good and yet DNA fragmentation is normal and vice versa,” Moschetta says, adding that, for men with high sperm-DNA fragmentation, a lab technique called ICSI is used, which selects the best sperm to fertilise the egg.

• Myth 3: Male fertility is unaffected by age

“Not as much as female fertility, but it is affected by age,” says Arce. “With age, men start having more erectile dysfunction, lower sperm counts and lower sperm motility, as well as lower sex drive. DNA fragmentation increases with age, too, making sperm less fertile.”

Men over 45 were almost five times more likely to take a year to conceive than men under 25, according to British research involving more than 2,000 couples.

• Myth 4: Pregnancy loss, or miscarriage, is always a chromosomal issue

“With age, we know the most common cause of miscarriage is chromosomal abnormality,” says Moschetta. “But, sometimes, there are other causes: It’s why we test for underlying conditions, like anatomical problems in the uterus, endometriosis, infection, immunological reasons.”

One study found that about 55% of recurrent miscarriages are caused by pro-coagulant defects that bring about a failure in blood supply to placental vessels.

This study also showed that, of recurrent miscarriages, about 7% are caused by chromosome defects, 15% by hormonal defects, and 10-15% by anatomical defects.

• Myth 5: Women trying to conceive need only take folic acid

“Telling women they only need to take folic acid or B9, often in quite high levels — just one B vitamin — isn’t a good idea. B vitamins work as a team,” says nutritional therapist Jessica Bourke, who advises taking folic acid as part of a B complex.

Bourke, who trained with the International Institute of Nutritional Health — her dissertation focused on the beneficial effects of antioxidants in treating male factor infertility — cites other impactful pregnancy-promoting vitamins and minerals, including vitamin D.

Studies find both male and female vitamin-D levels play a role in fertility, and affect IVF outcomes. Bourke recommends anyone trying to conceive to get their vitamin-D levels checked. “It’s so closely linked to pregnancy success.”

She frequently sees iron deficiency in women trying to conceive and says being iron deficient can prevent pregnancy.

Research links iron deficiency to ovulatory infertility, miscarriage, low birth weight and pre-term labour.

• Myth 6: Without symptoms, you cannot have endometriosis, a condition that affects 10% of women

Silent endometriosis can affect 30% to 40% of endometriosis sufferers, Serena Massey, CEO of Endo Ireland, says.

“Silent endo won’t cause you pain or discomfort, yet it could be causing untold damage to reproductive organs.”

IVF clinics often ask prospective patients to complete a questionnaire that would potentially flag endo symptoms, but this process could easily miss women with silent endometriosis, Massey says.

“No red flag may be highlighted. If you’re a silent sufferer and not conceiving, you could go through one, two or three rounds of IVF. And nothing will change, because this hasn’t been fixed.”

Whether the endometriosis is discovered can depend on the surgeon’s experience.

“If there’s no obvious reason for [failure to conceive], they might choose to explore further and recommend laparoscopy.”

• Myth 7: You’ve had a baby: You’ll have no problem conceiving another

“Secondary infertility is more common than we think,” says Moschetta, who says stress may be a factor.

“The couple’s lifestyle is now completely different from when they had their first child. There’s [stress] in dealing with work and a young child. [Imagine] trying to have intercourse and the baby’s crying in the next room.”

The type of delivery the woman previously had may also affect her ability to conceive naturally the second time around, says Moschetta, whether the delivery was “complicated” or involved manipulation “that could have affected uterus or ovaries”.

Another factor is weight gain. “You put weight on during your pregnancy and maybe you didn’t lose it: Weight can affect ovulation, the thyroid.”

• Myth 8: IVF is for women who’ve left it too late.

Arce says “loose comments” like ‘you’ve left it too long’ add guilt to an already difficult journey. “IVF is a medical treatment: For women with fallopian-tube issues, for men and women with genetic problems, for men whose sperm count or motility is poor.”

Moschetta focuses on the fact that egg quality decreases as women age. She says the expression that ‘the 40s are the old 30s’ may lead some women to think, ‘I can wait until 40 because I’m going to do IVF’.

But once egg quality deteriorates, it can’t be improved, says Moschetta. “At 40 or so, your chances are not at zero. Chances are always present, but they’re lower. It’s not automatic that, at 40, you can do IVF and get pregnant.”

The HSE says chances of pregnancy after one fresh cycle (not frozen) of IVF treatment is one in three for 18- to 34-year-olds, one in four for 35- to 37-year-olds, one in six for 38- to 39-year-olds, one in 10 for those aged 40-42, and one in 25 for women aged 43-44.