Understanding fertility

Planning to have a baby

Planning ahead

If you are thinking about having a baby in future, there are some things you can do to improve your chances. Preconception is the period leading up to getting pregnant. This is a great time for both men and women to focus on ways to improve their health, and increase the chance of pregnancy and having a healthy baby.

The earlier you start the conversations about having a baby, the better. Here are some things you and your partner (if any) should start thinking about now:

  • the number of children you would like to have
  • the age at which you would like to have your first and last child
  • improving your health before you try
  • booking a preconception health check with your GP.

Your Fertility has practical ideas for how you can improve your preconception health including checklists for men and women.

Improving fertility

Age is the most important factor affecting a woman’s chance of conceiving.  Female fertility starts to decline around age 30 and after age 35 the monthly chance of conceiving decreases more rapidly. Age can also affect a man’s fertility and the chance of having a healthy baby.

Certain lifestyle factors for both men and women also affect the ability to conceive, the health of the pregnancy, and the health of the future baby. A healthy weight, a nutritious diet and regular exercise can significantly boost fertility, as can quitting smoking, stopping drug use and curbing heavy drinking.

When you are ready to try for a baby, it is important to know when conception is most likely to happen. In an average cycle of 28 days, ovulation happens on day 14. However, cycle length varies between women, and it is important to note that ovulation occurs earlier in women with shorter cycles and later in women with longer cycles. However, pregnancy is only possible during the five days before ovulation through to the day of ovulation. These six days are the ‘fertile window’ in a woman’s cycle, and reflect the lifespan of sperm (five days) and the lifespan of the egg (24 hours). Your Fertility’s ovulation calculator can help you work out the fertile window.

Medical conditions and fertility

PCOS

Polycystic ovary syndrome (PCOS) is a common hormonal condition affecting up to one in five women of childbearing age. The condition affects two hormones, insulin and testosterone (male-like hormones), which may be produced in higher levels and can impact on fertility. Women with PCOS are prone to irregular menstrual cycles due to absent or infrequent ovulation.

While the majority of women with PCOS become pregnant without fertility treatment, they often take longer to fall pregnant and are more likely to need treatment (ovulation induction or IVF) than women without PCOS. Despite this, studies show little difference between the number of children born to women with PCOS than to those without.

Conception may sometimes occur as a result of lifestyle modification or after receiving medication to assist with ovulation (ovulation induction) and advice regarding the timing of sex. The most successful way to treat PCOS is by making healthy lifestyle changes. Eating a healthy diet and exercising regularly is the best way to reduce symptoms and increase fertility.

If you have difficulty conceiving, your GP may refer you to a specialist clinician. Monash Centre for Health Research and Implementation (MCHRI) has a list of questions that may be helpful.

You can find more information and resources about PCOS at Your FertilityJean Hailes for Women’s Health and MCHRI.

Endometriosis

Endometriosis is a condition in which endometrium, the tissue that normally lines the womb (uterus), grows outside the uterus. Endometriosis may cause fibrous scar tissue to form on the uterus. It can also affect the ovaries, fallopian tubes and the bowel. Endometriosis may cause very painful periods and reduce fertility or cause infertility.

You can find out more about endometriosis at Jean Hailes for Women’s Health and the Better Health Channel.

Personal quotes

"My partner suggested that we wait until the beginning of the following year when we had more time and space in our lives because we’d heard that the IVF journey can be very full-on. So I decided I’d throw everything I had at conceiving naturally… The first thing I wanted to do was get really healthy and fit and to lose some weight". Ricci-Jane

References

du Fosse, NA, van der Hoorn, MP, van Lith, JMM, le Cessie, S, Lashley, E (2020) Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Human Reproduction Update

Harris, A, Tsaltas, J (2017) Endometriosis and Infertility: A Systematic Review. Journal of Endometriosis and Pelvic Pain Disorders 9, 139-149.

Horta, F, Vollenhoven, B, Healey, M, Busija, L, Catt, S, Temple-Smith, P (2019) Male ageing is negatively associated with the chance of live birth in IVF/ICSI cycles for idiopathic infertility. Human Reproduction

Kim, CH, Chon, SJ, Lee, SH (2020) Effects of lifestyle modification in polycystic ovary syndrome compared to metformin only or metformin addition: A systematic review and meta-analysis. Scientific Reports 10, 7802.

Lan, L, Harrison, CL, Misso, M, Hill, B, Teede, HJ, Mol, BW, Moran, LJ (2017) Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women. Human Reproduction 32, 1925-1940.

Oostingh, EC, Hall, J, Koster, MPH, Grace, B, Jauniaux, E, Steegers-Theunissen, RPM (2018) The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies. Reproductive BioMedicine Online

Pfeifer, S, Butts, S, Fossum, G, Gracia, C, La Barbera, A, Mersereau, J, Odem, R, Paulson, R, Penzias, A, Pisarska, M, Rebar, R, Reindollar, R, Rosen, M, Sandlow, J, Vernon, M (2017) Optimizing natural fertility: a committee opinion. Fertility and Sterility 107, 52-58.

Stephenson, J, Heslehurst, N, Hall, J, Schoenaker, DAJM, Hutchinson, J, Cade, JE, Poston, L, Barrett, G, Crozier, SR, Barker, M, Kumaran, K, Yajnik, CS, Baird, J, Mishra, GD (2018) Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet 391, 1830-1841.

Frequently Asked Questions

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When does my fertility start to decrease?

For women, fertility starts to decline around age 30 and from age 35 the decline speeds up. Men’s fertility starts to decline from age 40. Regardless of if you are conceiving naturally or using fertility treatment, women younger than 35 and men younger than 40 have a better chance of having a child than those who are older.

We’ve been trying to get pregnant for a while. When should we get help?

If you have been trying to conceive for a year or more without success, it is time to see a doctor. For women aged 35 years or older, speak to your GP after trying for six months or more.

I have PCOS, can I still have a baby?

Women with PCOS often take longer to fall pregnant and are more likely to need treatment than women without PCOS. Despite this, studies show little difference between the number of children born to women with PCOS than to those without.

You can find out more about PCOS and fertility here.

I have endometriosis, can I still have a baby?

About 30 per cent of women diagnosed with endometriosis have trouble getting pregnant. However, most women with endometriosis become pregnant without the need for treatment. You can find out more about endometriosis and fertility here.

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