If you can't get pregnant, IVF is usually the next port of call - but there are alternatives, as Paula Goodyer discovers.
It was 2005, and after nine months of IVF treatment and a positive pregnancy test, 36-year-old Jill King was having a routine ultrasound to check that all was well. But when she turned to the screen, expecting to see a heartbeat, there was just an empty embryonic sac. In a cruel biological hoax, the sac minus its embryo - called a blighted ovum - was causing positive signs of pregnancy. There were more disappointments to come. By the time she discontinued IVF two years later, King had produced 50 embryos, but no babies, at a cost of about $50,000.
"People talk about the grief of miscarriage, and I've experienced that, but to me each embryo was also a potential baby lost," she recalls. "Whenever I had an embryo transfer [where the embryo is passed through the cervix into the uterus], I'd be calculating when its birthday might be."
Finally, she approached Jane Lyttleton, a traditional Chinese medicine (TCM) practitioner in Sydney who specialises in treating infertility. After three months of using Chinese herbs and acupuncture, King conceived naturally and gave birth to a daughter last year. "My message to other couples is be open-minded about alternative treatments," says King. "I know that for many people, IVF is the answer - but when both partners have been tested for all the typical causes and your infertility is still classed as 'unexplained', then Western medicine may not be the best approach. How can it successfully treat a problem it can't diagnose?"
Lyttleton is the first to admit that TCM is no cure-all for infertility, but it can help to normalise hormone levels, thus making ovulation more regular. It also improves the lining of the uterus and helps to prevent endometriosis and polycystic ovary syndrome (common causes of fertility problems in women). Sluggish or abnormally shaped sperm can benefit from Chinese medicine, too. "But it can't help with blocked Fallopian tubes - even if tubes are scarred rather than fully blocked," cautions Lyttleton. "I'd encourage a woman to try IVF in those circumstances."
Some cases of unexplained fertility may have a cause that is overlooked if IVF is used as a first, rather than a last, resort, says Dr Anne Clark, medical director of Fertility First, a clinic in Sydney's Hurstville.
Being overweight, smoking or drinking too much - even a lack of vitamin D or iodine - can sabotage conception or increase the risk of miscarriage, points out Clark. While the clinic offers IVF treatment, 25 to 30 per cent of couples conceive without it after correcting certain lifestyle factors.
"Women are hammered for being overweight or for smoking, but we know that with men, nine kilograms of extra weight can lower fertility by altering hormone levels," she says. "We also know that fragmentation of DNA in male sperm is a common cause of miscarriage, and that factors such as smoking, alcohol and possibly caffeine may be contributing."
Her study in 2008 of 800 men who were attending Fertility First found 58 per cent had sperm damage, but that lifestyle changes and vitamin supplements could help prevent this. "Unlike eggs, which are as old as the woman herself, sperm is freshly made every three months," says Clark. "Because of this, you can often reverse the problem quickly."
This was the case for Matthew Lake, a 34-year-old landscaper whose partner, Amanda, had had three miscarriages by the time she was 29. Test results showed she had no obvious problem, but Matthew had fragmented DNA in 33 per cent of his sperm.
At Clark's suggestion, he reduced his weekly beer consumption from 24 to seven, stopped drinking Coke and took a daily multivitamin. He also took supplements of coenzyme Q10 and vitamins E and C, antioxidants that, according to some research, help reduce sperm damage.
"After six months, the number of fragmented sperm had dropped to nine per cent - a month later I was pregnant," says Amanda. "I don't think people realise the problem can often be with the male partner, and that the solution can be simple."
In Clark's experience, men are often only asked to provide a sperm sample, and if that is problematic, the couple are directed to IVF rather than addressing a man's underlying health problems. The pressure of ageing impels couples towards IVF, too, she says.
Francesca Naish, from the Jocelyn Centre for Natural Fertility Management in Sydney, agrees. "People are in a hurry to conceive, but they need to take about three months to clean up first."
The "cleaning up" regimen recommended by the centre, which employs medical practitioners, naturopaths and an acupuncturist, entails both partners eating whole food - preferably organic - taking herbs and vitamin and mineral supplements, and reducing exposure to environmental toxins.
"Take the example of a hairdresser or a motor mechanic," says Naish. "She's exposed to bleaches and solvents, and he's working with solvents, heavy metals and paints. This doesn't mean hairdressers and mechanics can't make babies together, but if their fertility is already compromised, these exposures can make conception - especially of a healthy baby - harder." Other workers who come into contact with pesticides, such as farmers, may experience problems, too, explains Naish, as can people who spend a lot of time flying (sperm and eggs can be affected by radiation at high altitude). Some studies have linked heavy mobile phone use to reduced sperm count and sperm health. In isolation, these factors may mean nothing, but an accumulation of them, plus increasing age, can make a difference.
Although there's evidence that the miscarriage rate is higher with IVF, says Naish, "this isn't necessarily to do with IVF technology, which is fantastic. Miscarriages can occur because other problems aren't being sorted out first," she says. "IVF helps sperm and egg to meet and then gets the fertilised egg to the uterus, but it doesn't solve underlying problems that can impede a pregnancy."
Anne Clark acknowledges that with IVF offering a monthly pregnancy rate that is two to three times higher than nature, it will always appeal to couples in the stressed-out 21st century. When she recommends waiting until the lifestyle changes kick in, some couples feel pretty thrown to begin with. "But achieving a pregnancy can be a bit like painting a wall," she says. "It's all in the preparation."
East meets West
Acupuncture and IVF might come from opposite sides of the medical fence, but there's growing interest in combining them. Some studies show an improvement in pregnancy rates if acupuncture is used at embryo transfer, says Jane Lyttleton, a traditional Chinese medicine practitioner who works in partnership with IVF clinics. "We need more research to understand how it works," she says. "It may be that acupuncture increases blood flow to the lining of the uterus, creating a better environment for the embryo to grow. It may lower levels of stress hormones or, by having a calming effect on a woman's immune system, it may reduce the chances of her body rejecting the pregnancy."