When couples have trouble conceiving, it's natural to suspect a glitch in one partner's reproductive system – but it might be something to do with lifestyle.
"If couples are prepared to tackle issues like being overweight, smoking and alcohol intake they can save a lot of heartache and money – and may not need IVF. But although some fertility clinics look at lifestyle factors before recommending treatment, that's not the case with all clinics," says fertility expert Dr Raphael Kuhn, a former chairman of Melbourne IVF Human Research and Ethics Committee.
Dr Kuhn, the author of a new guide to optimising the chances of conceiving via IVF, emphasises the need to take a realistic look at lifestyle habits before opting for fertility treatment that can be costly and stressful.
Too much weight?
Sometimes all it takes to boost fertility is weight loss, he says.
His book, IVF Success. An evidence-based guide to getting pregnant and why you're not pregnant now, includes the story of 28-year old Tanya who became pregnant with her first attempt at IVF – only to have a miscarriage.
Besides having polycystic ovarian syndrome (a problem that can affect fertility), Tanya had a BMI of 31 that put her into the obese category. Losing weight would give her a better chance of pregnancy, her specialist said. After a six-month program of weight reduction including exercise, she reached a healthy weight, conceived naturally and had a baby.
Overweight and obesity can sabotage fertility in both sexes – regardless of whether you're trying to conceive naturally or through IVF. In men it's linked to poorer sperm quality, while women who are overweight or obese have less chance of getting pregnant overall and twice the risk of miscarriage compared to women with a healthy weight according to Your Fertility, a website developed by the Victorian Assisted Reproductive Treatment Authority.
"IVF studies have linked a BMI higher than 25 to lower live birth rates and higher rates of miscarriage. One problem is that obesity can create a state of oxidative stress in the body which can damage cells," Dr Kuhn explains.
Too many drinks?
Then there's the effect of surprisingly small amounts of alcohol.
A study of couples trying to conceive through IVF, found that women who had four or more drinks each week had a 16 per cent lower chance of having a live birth compared to women who drank less while in couples where both partners had four or more drinks weekly, the live birth rate was 21 per cent lower compared to those who drank less.
"Four drinks a week isn't a lot and it's a common scenario for couples to have a few drinks on a Friday or Saturday night but I think the potential effect of alcohol on conception is underestimated," Dr Kuhn says.
What about other lifestyle factors?
We all know that cigarettes and pregnancy are a bad combination but even being exposed to other people's smoke can affect a woman's fertility according to Your Fertility – and in male smokers can damage the DNA of sperm in the three months before conception.
"Studies have found that smoking has a profoundly negative impact on IVF outcomes especially in cases of unexplained infertility, and may be the cause of the problem," says Dr Kuhn.
Too much caffeine can also reduce the success rates of IVF, he adds. A Danish study found that five or more cups daily reduced the success rate of IVF by half.
Endocrine disrupting chemicals
There's also growing unease about the impact of endocrine disrupting chemicals (EDCs) on fertility. A number of studies now show that people who have difficulty conceiving have higher levels of some of these chemicals in their bodies says Dr Mark Green from the University of Melbourne's School of BioSciences. While it's difficult to avoid them, he recommends reducing exposure to common EDCs like BPA (Bisphenol A), phthalates and parabens by avoiding food packaged in plastic, cans lined with plastic and drinks in soft plastic bottles – and not microwaving food in plastic containers. Use china or glass dishes instead and cover them with a paper towel or plate.
Getting older (except in Hollywood)
Although age isn't something we can control, it's a big factor in female infertility – although that's easy to forget when so many female celebrities now produce babies well into their 40s – including Laura Linney and Janet Jackson who both had children at 49.
But without being transparent about the use of IVF or even surrogacy it's sending an unrealistic message about female fertility, Dr Kuhn says.
"It's possible to get pregnant naturally at 49 but the chances are very remote."
IVF Success. An evidence-based guide to getting pregnant and why you're not pregnant now by Dr Raphael Kuhn is published by ISO Media, rrp $29.99 (paperback); $9.99 (eBook). Kindle version, $7.83.