fertility – Winnie Wagtail

So you’ve had a baby! Contraception is probably the last thing on your mind but, it’s an important conversation to have with a healthcare provider (Midwife, Obstetrician, GP, Family Planning Services) to discuss what will best suit you- and there’s quite the array!

If you are breastfeeding, postpartum contraception options include:

Lactational Amenorrhoea Method (LAM) – When you’re exclusively breastfeeding bub, the hormonal process can effect menstruation, halting ovulation (voila contraception!). The World Health Organisation accepts this as an effective method of contraception, and is considered 98% effective (the same efficacy as the pill) when used according to the guidelines. These guidelines should be discussed with a healthcare provider (this is very important…don’t want any surprises!)

Three criteria can be used to predict the return of your fertility.

Have you had a menstrual bleed? (for the purposes of LAM this is defined as any bleeding, on any two consecutive days, that occurs 2 months after the birth)
Are you giving regular supplementary foods or foods or fluids to your baby in addition to breastfeeding?
Is your infant older than 6 months of age?

If you answer no to all the above three questions, then you potentially meet the requirements for the LAM.

Progesterone only Pill (POP) – Progesterone only pills are considered safe whilst breastfeeding. POP works by thickening the cervical mucosa making it harder for sperm to penetrate. The important thing to note with the mini pill is that it needs to be taken at the same time each day (so set that alarm clock!)…because if you miss it (by 3 or more hours, that window is considered a missed pill, and extra contraceptive precaution will be needed).

Implanon® – is a progesterone implant, which may be suitable from 6 weeks. A conversation for your 6 week check up, perhaps?

Depo-Provera®/ Depo-Ralovera® – Progesterone intramuscular injection. Commence anytime from 6 weeks postpartum.

Mirena® – is an IUD. Dependent on hospital policy/doctor’s policy, the IUD may be able to be inserted within 48 hours postpartum. If this is not possible, it should be left until 4 weeks after childbirth. Its effective within 7 days, lasts 5 years and is a localised progesterone. If at any point you don’t want it anymore, it can be taken out…no 5 year lock in contract!

Note: women who have had a caesarean section should not have a IUD inserted prior to 6 weeks postpartum due to the increased risk of perforation.3

Side note: I have one of these bad boys, and they’re fab! 5 years contraception…tick…peace of mind.

Condoms – Can be used immediately.

Diaphragms – make sure size and fit is correct, and it is advised to wait 6 weeks.

Combined oral contraceptive Pill (COCP) – Not recommended to be used for the first 4-6 weeks. If breastfeeding is established, and no other methods are deemed suitable, this is an option to discuss with your GP etc. The reason COCP is not recommended for the first 4-6 weeks, is because the combination of hormones can reek havoc with breastmilk supply establishing.

Non-breastfeeding mamas you really are spoilt for choice! All contraceptive methods are suitable. On average, for non-breastfeeding mamas, first ovulation cycle returns 45 days postpartum.

References:

KEMH Policy and Guideline

POP info

LAM method

After you’ve had a baby

There are many fertility myths flying around as fact out there! When it comes down to it though, every woman is different and will find certain things work better for her and her partner than others. But so this article isn’t a total cop out; we’ve done some research on the “Top 5 Fertility Factors” according to The Fertility Site of Australia YourFertility and medical journals (references below)..

1. Age

There isn’t a nice way to put it, the older you are…statistically, the trickier it makes things. This is considered the single most important factor in conception.

Conceiving naturally (without the help of say, IVF) statistics say:

From age 32, the odds of conceiving naturally begin to decrease gradually (but significantly).
From age 35, natural conception decline speeds up
By age 40, fertility has been reduced by half (at 30, the chance of conceiving each month is approximately 20%. At 40 it’s approximately 5%)

Not to make it all about the female biological clock…and you do hear time and time again, “oh he can have kids whenever, women have the biological clock…”… it may seem that men do to. Research has found that:

The average time to pregnancy for men 25 and under is a little over 4.5 months. Men at 40 it’s around 2 years (if the woman is under 25).
For men over 45 years, there’s a five-fold increase in time to pregnancy.
For couples travelling down the IVF route, if the male partner is 41 or over, then your chance of not falling pregnant is 5 times higher than men younger than them.
The volume of a man’s semen and their motility- their ability to move towards the egg, decreases continually between the ages of 20 and 80.
Miscarriage is twice as high for women that are with partners over 45 (and they themselves are under 25).

2. Weight

Parents to be, both sides of the parenting partnership, to better your odds at fertility, you should be within a healthy weight range.

Diet and exercise, not only for personal health gain, but in shaping healthy lifestyle habits to share with your to-be-bubs is worth taking incredibly seriously! Check out the following links to help you assess where you sit health wise, and access to some good tips re food choices.

Conversely, being underweight makes falling pregnant tricky too!

Check out your BMI here: Better Health Channel

3. Smoking

We all know smoking is bad, so it shouldn’t come as a surprise that it’s not crash hot for fertility, either! Smokers may be at twice the risk of infertility than non-smokers and are 1.5 times more likely to take more than a year to conceive. Partners that smoke may also contribute to infertility.

Something I hadn’t considered was passive smoking and the effect is has on fertility. Research shows that actively smoking is only marginally worse than passive smoking, when it comes to fertility. Female passive smokers are more likely to take over a year to fall pregnant than women from non-smoking houses.

QuitPacks are fabulous, and midwives are trained in helping mama’s and their family members make short term and long term goals to either cut back, or kick the habit altogether!

Keep in mind, smoking does affect your baby, in more ways than one. See here for more information.

4. Alcohol

In a nutshell, heavy drinking will reduce your chances of falling pregnant. Of course, once pregnant, because we are unable to gauge a safe amount of alcohol, to reduce chances of Fetal Alcohol Syndrome, it is recommended that women do not drink throughout pregnancy. Please speak further to your midwife or obstetrician if you have further questions regarding alcohol in pregnancy.

Need help to reduce or stop drinking? Visit the Australian Drug Information Network for a list of national and state services in Australia.

Unsure what’s classified as “a standard drink”? Visit DrinkWise Australia.

5. Timing

Rather than trying to reword this, I’m doing the sneaky, and borrowing all words from ‘The Women’s guide to Fertility and Timing’, from YourFertility. See below:

Pregnancy is technically 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 (5 days) and the lifespan of the ovum (24 hours).

If a woman has sex six or more days before she ovulates, the chance she will get pregnant is virtually zero. If she has sex five days before she ovulates, her probability of pregnancy is about 10%. The probability of pregnancy rises steadily until the two days before and including the day of ovulation.

At the end of the ‘fertile window’, the probability of pregnancy declines rapidly and by 12-24 hours after she ovulates, a woman is no longer able to get pregnant during that cycle.

For those women who are not aware of their ‘fertile window’ or when they ovulate, sexual intercourse is recommended every 2 to 3 days to help optimise their chance of conceiving.

***A couple of extra things – I get asked a stack of questions about certain foods, in particular Soy. There seems to be conflicting conclusions drawn on the relationship between soy and infertility in studies found online. I personally have an opinion, however want some cold hard evidence to back it up. I’m in and out of hospitals this week, so I will keep you posted after some discussions with colleagues.

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