Latest / The Home of Fertility with Liz Walton & Helen Zee / Female Infertility Basics From Testing To Treatment with City Fertility Dr Anne Poliness

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Female Infertility Basics From Testing To Treatment with City Fertility Dr Anne Poliness · The Home of Fertility with Liz Walton & Helen Zee

• 0:05
  SPEAKER_00: Welcome back to the Home of Fertility.
• 0:09
  SPEAKER_00: Today's episode is part of the City Fertility Education Series on the Home of Fertility.
• 0:17
  SPEAKER_00: And this is created in partnership with City Fertility.
• 0:21
  SPEAKER_00: Together, we are bringing you a series of conversations designed to answer some of the biggest questions people have about their fertility, about IVF, family building, and of course reproductive health.
• 0:35
  SPEAKER_00: So whether you are beginning to explore your options, whether you're already navigating fertility treatment, our hope is that these conversations leave you feeling more informed, more empowered, and knowing you are not alone.
• 0:53
  SPEAKER_00: So now let's welcome today's guest.
• 1:03
  SPEAKER_00: So good morning, good afternoon, good evening, wherever you are in this world, gorgeous, beautiful people.
• 1:10
  SPEAKER_00: I am welcome you.
• 1:12
  SPEAKER_00: And today I am very excited.
• 1:14
  SPEAKER_00: I'm talking to a wonderful doctor, Dr.
• 1:17
  SPEAKER_00: Anne Polinus.
• 1:19
  SPEAKER_00: Is that the correct way of saying it?
• 1:20
  SPEAKER_00: And also welcome.
• 1:22
  SPEAKER_01: Yes, thank you.
• 1:23
  SPEAKER_01: And thanks for the warm welcome.
• 1:25
  SPEAKER_00: Ah, yeah.
• 1:25
  SPEAKER_00: Well, I'm really excited.
• 1:27
  SPEAKER_00: We're talking about a really important subject.
• 1:30
  SPEAKER_00: It's a subject that, you know, was my path at one stage in life, which is female fertility issues, female infertility issues, depending on how um it is the best way to word it, you know.
• 1:44
  SPEAKER_00: So um I'm gonna first of all start off with um the bio of Dr.
• 1:50
  SPEAKER_00: Anne Pollyness.
• 1:51
  SPEAKER_00: And we're gonna do this because I've managed to get Dr.
• 1:54
  SPEAKER_00: Anne Pollyness in between clients.
• 1:57
  SPEAKER_00: So um I'm just very grateful.
• 2:00
  SPEAKER_00: So Dr.
• 2:01
  SPEAKER_00: Anne Pollyness, she's look, she's a highly regarded fertility specialist over the last 15 years, experienced in reproductive medicine.
• 2:09
  SPEAKER_00: So during her first IVF cycle, which was May 2008, um, based in East Melbourne, she's known for her warm, inclusive approach, her expertise in managing very complex fertility um concerns, including endometrius polycystic ovarian syndrome, which is PCOS but now PMOS, isn't it?
• 2:29
  SPEAKER_00: Um, and has completed her medical degree in 93, obtained her fellowship in gynecology in 2002, holds a doctorate of medicine in endometriosis and a master's in reproductive medicine from the University of Melbourne.
• 2:44
  SPEAKER_00: Her training has taken her across Australia and the UK, my home country, including advanced laparoscopic surgical training and specialist research into endometriosis.
• 2:57
  SPEAKER_00: Oh wow, you are amazing, Dr.
• 2:59
  SPEAKER_00: Anne Polinus.
• 3:01
  SPEAKER_00: So today, Dr.
• 3:02
  SPEAKER_00: Anne is uh Victoria's Medical Director of the City Fertility and Rainbow Fertility.
• 3:06
  SPEAKER_00: Yay! She offers a full range of fertility treatments, including IVF, IUI, ICSE, that's what I had, ovulation induction, and donor conception options.
• 3:17
  SPEAKER_00: Fabulous.
• 3:18
  SPEAKER_00: Anne is deeply committed to supporting individuals and couples from all the diverse backgrounds, including single parents, LGB, GTQI families, and both in-person as well as telehealth consultants.
• 3:32
  SPEAKER_00: So wow, what a woman, amazing woman you are.
• 3:38
  unknown: Thank you.
• 3:39
  SPEAKER_00: Thanks for talking me up.
• 3:42
  SPEAKER_00: I don't think I'm talking you up.
• 3:43
  SPEAKER_00: It's just the truth.
• 3:44
  SPEAKER_00: You know, that must it's you know, it's takes a long time to become an expert, and you know, the work you do is so needed.
• 3:52
  SPEAKER_00: So thank you.
• 3:53
  SPEAKER_00: So when we talk on this topic of infertility and the you know that what's going on for our female bodies, I should say, it in fact it affects so many of us, you know, millions of individuals.
• 4:05
  SPEAKER_00: If we talk about one in five couples, um, so it's often far more common than people realize, obviously.
• 4:13
  SPEAKER_00: So female infertility is influenced by, oh gosh, a range of factors.
• 4:17
  SPEAKER_00: You know, there's age.
• 4:18
  SPEAKER_00: I know I was older, I was 35, there's ovulation disorders, again, as we said before, endometriosis, PMOS, all sorts of reproductive health conditions, and then there's the lifestyle factors.
• 4:30
  SPEAKER_00: You know, a big thing that have been coming up for me is looking at plastic.
• 4:33
  SPEAKER_00: So, what I'm what we're going to talk about in this episode and unpacked are some of those most common causes for female infertility.
• 4:41
  SPEAKER_00: When we seek help, what do we expect from fertility assessment and you know the treatment options that are available today?
• 4:49
  SPEAKER_00: So, lovely Dr.
• 4:50
  SPEAKER_00: Anne Polyness, how let's start off at the beginning.
• 4:54
  SPEAKER_00: How is infertility defined?
• 4:57
  SPEAKER_01: Um, thanks for the question, Liz.
• 4:59
  SPEAKER_01: And please call me Ann.
• 5:00
  SPEAKER_01: Um I think I think um uh yeah, so uh traditionally it's been defined over the number of cycles someone's been trying to conceive uh naturally uh in a heterosexual couple.
• 5:12
  SPEAKER_01: And so traditionally it's been um more than 12 months uh for someone under age 35, or over six months for somebody um 35 or older.
• 5:24
  SPEAKER_01: But this is this has been kind of a yardstick for um people with you know natural cycles that are regular, no pain, no history of fertility issues.
• 5:35
  SPEAKER_01: So there's all these kind of other um factors that might mean that you don't have to wait 12 months if you're trying and you've got painful periods or irregular cycles, absolutely seek help earlier than um that definition, because um that's what we would would think was important that you're given more assessment earlier.
• 5:56
  SPEAKER_00: Yeah, yeah.
• 5:57
  SPEAKER_00: And so when should someone seek that fertility advice or testing?
• 6:00
  SPEAKER_00: You know, is it that if you're under 35, you know, really after after 12 months, it's that's when I should do it, or over 35 more in your six months?
• 6:11
  SPEAKER_01: Um, I'm more of a planner than that.
• 6:13
  SPEAKER_01: So I'd say that I would suggest people see their GP family doctor for pre-pregnancy assessment, which is checking that you're immune to viruses that's you know you can be immunized for to avoid pregnancy, which is rebella and chickenpox, um, uh make sure uh, you know, your vitamin D is good, your iron's good.
• 6:33
  SPEAKER_01: So a general health wellness assessment.
• 6:36
  SPEAKER_01: Um, and then so planning that um before uh getting pregnant or at some stage at the beginning of the journey so that um you can kind of have a you know information and a plan and confidence moving forwards.
• 6:51
  SPEAKER_01: And uh so if someone's not immune to chickenpox or a bella getting that vaccination prior to pregnant, prior to trying.
• 6:58
  SPEAKER_01: Um, and so you're ready to go, as it was.
• 7:01
  SPEAKER_00: Yeah.
• 7:02
  SPEAKER_00: Okay, awesome.
• 7:03
  SPEAKER_00: I wish I'd known this.
• 7:05
  SPEAKER_00: So um one of the most common fertility tests, you know, that we hear for women, and it gets bounded a lot, I think, is AMH.
• 7:13
  SPEAKER_00: Um, so can you, you know, dumb it down for for someone like me as well.
• 7:19
  SPEAKER_00: What is AMH and what does that tell us?
• 7:22
  SPEAKER_00: And so within that, what are the limitations?
• 7:26
  SPEAKER_01: Yes.
• 7:26
  SPEAKER_01: So AMH, which are the letters AMH stand for anti-mularian hormone.
• 7:32
  SPEAKER_01: So it's a hormone produced by the ovaries and in particular the follicles that are developing in the ovaries.
• 7:39
  SPEAKER_01: And it's a predictive tool for overall ovary reserve or egg reserve, how many eggs there are in the pool.
• 7:48
  SPEAKER_01: Um, it's also helpful in regarding assessing response to IVF stimulation or egg-freeze stimulation.
• 7:56
  SPEAKER_01: Uh, but its limitations are it only gives you a number like quantity, it doesn't predict quality.
• 8:04
  SPEAKER_01: Um, so that it can't be used um as a you know, as a quality tool to say the eggs are um of good health or not.
• 8:12
  SPEAKER_00: And it's on a blood test.
• 8:14
  SPEAKER_00: Uh-huh.
• 8:14
  SPEAKER_00: Yes.
• 8:15
  SPEAKER_00: Oh, that's so interesting.
• 8:16
  SPEAKER_00: Thank you for creating that clarity.
• 8:19
  SPEAKER_00: So, how does age impact fertility?
• 8:24
  SPEAKER_00: And uh, what should women understand about their area ovarian reserve versus, as you said, tier egg quality?
• 8:33
  SPEAKER_00: Yeah.
• 8:34
  SPEAKER_01: So um age has unfortunately a negative impact on egg quality.
• 8:40
  SPEAKER_01: Um, and uh this can be uh chromosomal or genetic, like the actual makeup of the egg, or it could be metabolic, how much energy or normality the egg has.
• 8:53
  SPEAKER_01: And we know that even in young, much younger women, say somebody age 20, an abnormal egg can come along, you know, but it's just the number or proportion of eggs um that are abnormal increases over time, to the point where if someone's um, you know, over 38, then it it more than 50% of the eggs are not actually normal.
• 9:14
  SPEAKER_01: So they may well still be ovulating every month and an egg's coming out, but it's just the chance of pregnancy is not there or significantly reduced due to egg quality.
• 9:24
  SPEAKER_01: Um, sorry, what was the second part of the question?
• 9:26
  SPEAKER_00: Oh no, absolutely, I know I'm asking you all these questions, so totally fine.
• 9:31
  SPEAKER_00: So um, yeah, so what should we understand?
• 9:34
  SPEAKER_00: Oh yeah, that was there.
• 9:35
  SPEAKER_00: What should we understand about ovarian reserve versus sort of the egg quality?
• 9:40
  SPEAKER_00: So I from what I can see as we get older, that quality can change in different reasons for different reasons.
• 9:46
  SPEAKER_01: Yes, yep.
• 9:47
  SPEAKER_01: So um, so yeah, so you you help it's helpful to kind of have some kind of assessment done in regarding quantity, like pelvic ultrasound and egg count, AMH, for anyone who's wanting to conceive or trying to conceive, but it doesn't predict quality.
• 10:03
  SPEAKER_01: And the only way of knowing if someone is going to get pregnant is to try, frankly.
• 10:07
  SPEAKER_01: So, and it's thought that um by giving things time that um uh if the patient feels comfortable with, you know, uh the time frame, that hopefully a good egg will come along.
• 10:19
  SPEAKER_01: Even if the majority of eggs aren't normal, then hopefully a good egg will come along, say, in that first six months.
• 10:25
  SPEAKER_00: This episode is part of the City Fertility Education series on the home of fertility in partnership with City Fertility.
• 10:34
  SPEAKER_00: If you've been trying to conceive and it just isn't happening as you expected, one of the hardest questions simply can be when should I ask for help?
• 10:45
  SPEAKER_00: Understanding what may be affecting your fertility does not necessarily mean jumping straight into IVF.
• 10:52
  SPEAKER_00: It can begin with a conversation, understanding your medical history, appropriate fertility testing, and looking at the different factors that may be influencing your ability to conceive.
• 11:04
  SPEAKER_00: City Fertility supports people from those very first questions through to more advanced fertility treatment when needed with care tailored to the individual.
• 11:16
  SPEAKER_00: If you're wondering whether it might be time to speak with the fertility specialists, you can learn more at cityfertility.com.au.
• 11:25
  SPEAKER_00: Now let's get back to this amazing conversation.
• 11:28
  SPEAKER_00: Thank you.
• 11:31
  SPEAKER_00: Absolutely okay, yeah.
• 11:32
  SPEAKER_00: And so what tends to be the most common causes for female infertility in your knowledge?
• 11:38
  SPEAKER_01: So um uh organically um it's in um times on pi, it was it was a structural thing such as endometriosis, so um issues with um uh ovarian function, tubal function, um, or implantation, or cycles being irregular or not ovulating, the eggs not releasing, such as with PMOS, uh polyendocrine metabolic um syndrome, which is the um modern name of PCOS.
• 12:10
  SPEAKER_01: Um so they were they were structural things like that.
• 12:12
  SPEAKER_01: So the female uh on the female side, on the male side, abnormal semen function.
• 12:17
  SPEAKER_01: And as time's gone by, in more recent times, there's certainly an age factor as well that um even if someone doesn't have any endometriosis, they're ovulating regularly, the sperm's fine, there's still this other issue of the egg quality or reduced egg function that means pregnancy is less likely.
• 12:37
  SPEAKER_00: Yes, no, absolutely, you know, and it keeping our health is probably one of the most important factors for fertility, isn't it?
• 12:45
  SPEAKER_01: Um, yeah, so there are some things that um uh usually there's no, it's not like uh there's anything that people feel should feel guilty about.
• 12:52
  SPEAKER_01: I mean, obviously there's nothing most people can find or change their egg quality or their egg health.
• 12:58
  SPEAKER_01: I mean, uh there are some some things though that that if someone is currently smoking that would uh reduce their egg quality or egg health in its own right.
• 13:07
  SPEAKER_01: But other things, um, you know, um diets, there's nothing to say you need to change your diet or a better diet is necessarily going to improve your egg health.
• 13:17
  SPEAKER_01: Um so yeah, it's really about trying to, you know, in a um non-judgmental way, of course, you know, moving forward and using the tools we have and the information we have to help patients get pregnant.
• 13:29
  SPEAKER_00: Yeah, absolutely.
• 13:30
  SPEAKER_00: And you know, I suppose with that, you know, the healthier our lifestyle can be, then that's definitely got to be a bonus, hasn't it?
• 13:37
  SPEAKER_01: Um yes, although you'd say, well, even some things where someone might say, look, I'm doing exercise every day or running a marathon next week, um, that could negatively impact on fertility in the extreme cases.
• 13:49
  SPEAKER_01: But generally we do say a more active exercise, uh exercise, a more active lifestyle is better, unless it's in that that group that are, you know, um marathon runners and uh yeah, long distance runners perhaps that might reduce fertility.
• 14:02
  SPEAKER_01: Yeah.
• 14:02
  SPEAKER_01: Absolutely.
• 14:03
  SPEAKER_00: Yeah, because that's you know, they could be quite full on for the body as it is.
• 14:06
  SPEAKER_00: But although I do, you know, I'm in awe of those kind of people, absolutely.
• 14:10
  SPEAKER_00: So, what fertility tests um and investigations would you typically recommend when someone is struggling to conceive?
• 14:21
  SPEAKER_01: So initial testing would involve on the female side pelvic ultrasound, so looking at the structure, uterus, tubes, and ovaries, and hormone profile, which it would include the AMH or egg test.
• 14:37
  SPEAKER_01: On the male side, it's a sperm sample, it's a semen analysis.
• 14:41
  SPEAKER_01: And if nothing shows up on those results, um uh then discussing further investigations, which may involve a tubal function test.
• 14:53
  SPEAKER_01: I personally don't order that at the beginning because it is painful uh for a woman to go through that, having floored pushed through the tubes.
• 15:01
  SPEAKER_01: Yep, very painful.
• 15:02
  SPEAKER_01: It is somewhat costly.
• 15:03
  SPEAKER_01: And also um yeah, you kind of think we'll do the non-invasive things first, see if something shows up, and then maybe you don't need that painful tube test.
• 15:11
  SPEAKER_00: Yeah, yeah, yeah, yeah.
• 15:13
  SPEAKER_00: No, highly agree, highly agree.
• 15:15
  SPEAKER_00: Um, it was yeah, it's quite a shock that one for me.
• 15:17
  SPEAKER_00: But that was years ago now.
• 15:19
  SPEAKER_00: So I don't think it's got less painful.
• 15:24
  SPEAKER_00: So um thank you.
• 15:26
  SPEAKER_00: Yeah, now what treatment options are available depending on that underlying cause?
• 15:34
  SPEAKER_01: So um, if someone's got very irregular cycles that implies they're not ovulating regularly, we usually are talking about uh the simplest um less least invasive um option, which is ovulation induction, and that's usually tablets to start with.
• 15:50
  SPEAKER_01: Um if someone's ovulating themselves, you think, well, there's no point in spending months and months talking about ovulation tablets if it's not going to improve their chance, you know, if that gets covered, if you like.
• 16:00
  SPEAKER_01: If someone's um got very painful periods or ultrasound evidence that there's endometriosis, and um then we're usually talking about the pros and cons of doing you know a laparoscopy, a keyhole surgery to treat endometriosis in patients who are uh you know uh looking at um uh conceiving naturally longer or wanting to conceive naturally uh in the future.
• 16:26
  SPEAKER_01: If um patients uh if we don't find anything or suggest there's any of those structural changes and they're ovulating well, we usually are talking about fertility treatments such as insemination or IVF that will increase the chance of pregnancy over natural chance.
• 16:45
  SPEAKER_00: Right.
• 16:46
  SPEAKER_01: So it depends, it's individualized depending on what the circumstances are, what obviously patients' wishes are, you know, and uh it's a dialogue and you know, uh discussion of what would be best for them.
• 17:00
  SPEAKER_00: Absolutely.
• 17:00
  SPEAKER_00: You know, everybody is different and every journey is different, so it's creating what's right for them a hundred percent.
• 17:08
  SPEAKER_00: And so then what advice would you give someone, you know, especially right now if they're listening, and this would be just so beautiful, who is just beginning their fertility journey?
• 17:20
  SPEAKER_01: I think that um I would suggest um, you know, seeing the GP if they haven't done a pre-pregnancy assessment already, just to go at least have a chat with where they're at and what their um what their um you know um for their uh status is in regarding whether they're immune to rebellar and chicken pox, um, starting folic acid supplements and the importance of that to reduce the chance of spinobifida, um, checking general health like vitamin D and iron, you know, making sure the cycles are regular or are there any can specific concerns about the periods that need to be investigated early?
• 18:01
  SPEAKER_01: Um, because I would say that, yeah, I would think that people want to know more more early, you know, if there is an issue, I think people want to know that earlier or should be able to find that out earlier rather than waiting a set number of months before they're allowed to do any investigations.
• 18:20
  SPEAKER_00: Yes, absolutely.
• 18:21
  SPEAKER_00: And I think the more I understand is is really start, you know, start before you're ready to start.
• 18:26
  SPEAKER_00: Let's getting, let's get the whole body in the best health and also understand what's going on for the that particular body at the time.
• 18:35
  SPEAKER_00: Yes, yes, agreed.
• 18:38
  SPEAKER_00: Good summary, thank you.
• 18:40
  SPEAKER_00: You're so welcome.
• 18:41
  SPEAKER_00: So let's have a look at key takeaways here.
• 18:44
  SPEAKER_00: So, female, you know, the female infertility, what's going on for us females when we're having issues with infertility, it can have so many different causes.
• 18:55
  SPEAKER_00: Um, but having that early assessment, understanding our health is so important, including understanding, you know, what what age we are, what's our ovarian reserve, our underlying reproductive health conditions.
• 19:09
  SPEAKER_00: So all of this can help identify really what's the most appropriate path forward and you know the best outcomes to the best things to do to improve our outcomes.
• 19:20
  SPEAKER_00: Would that be correct?
• 19:21
  SPEAKER_01: That's right.
• 19:22
  SPEAKER_01: And to assist, absolutely, and to assist patients feeling empowered in being part of the decision making in the journey.
• 19:28
  SPEAKER_00: Yeah.
• 19:29
  SPEAKER_01: Awesome.
• 19:30
  SPEAKER_00: And as we now, I know you've got to get back to your beautiful next client, and I don't want to stop that.
• 19:36
  SPEAKER_00: Um, as we finish, what would be your top tip or something to leave our listener with today?
• 19:43
  SPEAKER_00: Um, that would be the most helpful thing they can do.
• 19:48
  SPEAKER_01: I think that everyone should feel empowered in being able to seek help early if that was their choice.
• 19:55
  SPEAKER_01: And whether that's through their GP or through a fertility specialist, um, we're very happy to see people even before they start trying or in their early stages of um their fertility journey, just to give them um the information they may be seeking.
• 20:11
  SPEAKER_01: Um, answer the question, no questions too small, answer questions they have.
• 20:16
  SPEAKER_01: Always happy to give people more information if that's what they're seeking.
• 20:20
  SPEAKER_00: Yeah.
• 20:20
  SPEAKER_00: Well, I think that's beautiful.
• 20:23
  SPEAKER_00: Thank you, thank you, thank you, Anne, so much for having this chat with me today and bringing like the first step of the journey of what of what needs to happen when we're trying to understand.
• 20:35
  SPEAKER_00: So thank you for your time today, and may you have a wonderful rest of the day.
• 20:39
  SPEAKER_01: Thank you so much for your time, Liz.
• 20:41
  SPEAKER_01: It's been a pleasure talking to you today.
• 20:43
  SPEAKER_01: And you also have a wonderful day.
• 20:45
  SPEAKER_01: I will, I will.
• 20:47
  SPEAKER_00: So, with that, beautiful listeners, I am going to bid thee a good um good day.
• 20:53
  SPEAKER_00: And remember, it's good to check all your general health knowing if it's time to start your baby journey.
• 21:00
  SPEAKER_00: So you just take care.
• 21:02
  SPEAKER_00: Lots of love.
• 21:05
  SPEAKER_00: Thank you for joining me for another episode of the City Fertility Education series, which is on the home of fertility.
• 21:14
  SPEAKER_00: This is created in partnership with City Fertility.
• 21:19
  SPEAKER_00: I do hope today's conversation has given you something extremely useful to take away.
• 21:25
  SPEAKER_00: Perhaps it's a better understanding of your fertility, maybe it's a new question, or simply more confidence in knowing what your options might be.
• 21:35
  SPEAKER_00: Because sometimes one conversation can be the thread that leads you to the information, support, or next step that's right for you.
• 21:45
  SPEAKER_00: If you'd like to learn more about City Fertility and the services that they offer, please visit cityfertility.com.au.
• 21:55
  SPEAKER_00: And if today's episode could help someone you know, please share it with them and follow the home of fertility wherever you listen on your podcasts.
• 22:06
  SPEAKER_00: I'm Liz Walton.
• 22:08
  SPEAKER_00: Thank you so much for listening, and I'll see you back here for our next conversation.