Routine Screening, what is it and when should it be performed for fertility assessment?
Currently there is no schedule for such testing, the reality is, if routine screening was conducted early, different choices could be made, with potential treatment and/or intervention.
Most clients find out they have fertility issues after having tried to conceive naturally for some time, however if given the knowledge earlier, they would have made different plans with their lives and family planning.
Why are we not encouraging this screening schedule to happen earlier?
Recent conversations I have been having with clients have revolved around life choices and how differently they would have been made, if they had been aware of fertility problems sooner, early diagnosis would have changed everything.
So what is currently available and should fertility screening be placed on the routine screening schedule. We advocate, regular pap smear tests (this is despite the new vaccine) and skin cancer checks, so why not fertility checks?
In a recent social media post I outlined the findings of a study of university students in the Journal of Human Fertility, they surveyed this group online and their answers to questions about fertility were a little concerning to say the least. These future generation of young women and men were unaware when female fertility declined and even that men’s fertility declined with age. 55% of these students just did not get this crucial fact correct. Clearly we need more education around these facts and routine screening will go a very long way in terms of outcomes for these students later in life.
The link to this article is below for you to read in its entirety. https://www.tandfonline.com/doi/full/10.1080/14647273.2018.1482569
What tests then should be offered to men and when?
I believe a Semen Analysis, Blood Test for STI’s and Hormone Levels and Physical Examination should be conducted as the bare minimum. If these tests were conducted every 3 years from the age of 25 years of age, men would have ample opportunity to address potential problems much earlier and take preventative action.
Showing men how to conduct their own self-examination, will empower them to be able to identify varicoceles, unusual bumps and swelling and ultimately give them a greater control over their fertility.
After the bare minimum tests of Semen Analysis, Hormones, STI’s and Physical have been performed, any abnormalities can be followed up by ultrasounds, to show testicular abnormalities, genetic testing and specialist appointments for further investigations.
Knowledge is power. Men knowing they are likely to need IVF/ICSI in the future, can potentially modify their health, diet and life style factors and look at ways to save for their upcoming treatment cycles, which will be expensive. Careers can be put on hold to create families earlier.
Being the healthiest version of yourself from a younger age will enhance fertility chances later on when they meet the right partner and want to start their families.
We know that diet and lifestyle factors are damaging to health in general and those clients who are screened earlier can make different choices around smoking, drinking alcohol, drug taking and eating healthier foods and exercise. Pivotal decisions can be taken into consideration and habits formed to ensure good health.
So many people stop exercising when they leave school and organised sporting activities.
Screening tests every 3 years at the ages of 25, 28, 31, 34, 37 and 40 will give women and men the chance to check the fertility health earlier on and make different choices.
On this note I believe that men should freeze sperm samples at this earlier age of 25 years, when they are their most fertile, a few samples frozen, just in case!
I once worked with a Scientist who froze sperm samples when he was younger, in case when he was older he discovered he was unable to conceive naturally. Thankfully he went on to have 2 natural conceptions with his wife who was also a Scientist at the same clinic. I must ask him if he ever discarded those samples, as he no longer works at the clinic!
Women I believe should also have routine screening checks every 3 years from the age of 25 years also.
This would entail Hormone levels, STI’s, Physical and AMH levels.
The AMH – Anti Mullerian Hormone – test is an indicator of the ovarian reserve. Hormone levels would be analysed to check for depletion or elevations and ensure other markers are not present and warrant further investigation. STI check is extremely important as we know that some infections are silent (without noticeable symptoms) and cause significant damage to the female’s reproductive tract.
Physical examination of the pelvis and history of periods and the related symptoms again can pick up on potential problems that require follow up investigation.
Ultrasounds, blood testing for genetic screening, referral to a gynaecologists for further investigations will all be recommended if the initial tests show a cause for concern.
An awareness campaign regarding the low percentage of conception per cycle and the subsequent decline with age should be marketed to University Students in particular and I believe a National Campaign to encourage a positive change.
Women should be encouraged to know their cycle and symptoms, what is regular or irregular. Keeping a record of their periods with a health app is gaining popularity now, however this will not help the 38 year old who has not met their life partner.
Knowing you have fertility concerns earlier in life will allow for different decisions and life choices, healthier habits will be formed earlier to preserve and maintain optimal health. Careers may be placed on hold to start families earlier, women can start saving for their fertility treatment nest egg, if it is required.
Again here I believe that we should be encouraging women to freeze their oocytes at a younger age. Although a great deal more intrusive than men freezing a sperm sample, freezing their eggs at a younger age will give women a back-up plan in case they do not find the right partner until later in life. Or decide to have a family on their own, no matter what the lifestyle choice, I believe that every woman deserves to have options and some control over their fertility.
The argument could be put forward about the cost of such a National Health Initiative, I would counter by saying that fertility treatment later in life will cost significantly more, furthermore if healthier lifestyle choices were made at a younger age, the ripple effect would be less cost on the Health care system ultimately. Healthier people, will mean less visits to the Doctors. Fertility clinics will still be treating patients and have the younger generation banking sperm and oocytes for their future fertility treatment.
After all we have insurance for our cars, homes, businesses and life, so why not for our fertility? Freezing oocytes and sperm for later in life is a type of fertility insurance, back up or plan b option.
How can we shift this paradigm?
Ultimately I think Routine Screening and earlier intervention will have significant health benefits and I strongly believe that we need to get this awareness and education campaign happening sooner rather than later.
If you would like any further information or would like to send me any questions please contact me through the website –
www.ivfcoachingclinic.com.au or my Facebook page
https://www.facebook.com/ivfcoachingclinic/ or you can follow me on Instagram
@sophiabaseotto or @ivfcoachingclinic
Kind Regards, Sophia