Fertility

Everything you need to know about fertility testing

What's involved, where to go and who pays.

By Karyn Henger

Infertility is a growing issue for New Zealand couples because we are leaving it later to start our families. With this trend unlikely to swing back the other way fertility specialist Dr Mary Birdsall from Fertility Associates foresees a growing number of Kiwi women seeking to freeze their eggs.

"We already have an increasing number of women coming and talking to us about egg freezing and international trends suggest this will only continue, but the challenge around egg freezing is it's expensive and it’s not a guarantee."

In New Zealand we can pay around $10,000 to have eggs, sperm or embryos frozen and stored for up to 10 years.

Freezing our eggs shouldn't be seen as a be-all solution though, Dr Birdsall stresses. She suggests women plan ahead and find out when their fertility span is likely to expire.

"All women have their own reproductive time span and that’s often fairly genetically driven - about 70 per cent of your egg numbers are driven by your mum's genes - so have a conversation with your mother about when her menopause was so that you have a reasonable explanation about what your time span looks like.

"Most women stop having babies about 10 years before they hit menopause. The average age of menopause is 51 and the average age that you have your last baby, if you never use contraception and have normal fertility is 41, so if you have a mother who hit menopause in her mid-forties that means you need to have completed your family by your mid-thirties."

She also urges women to allow themselves enough time to complete their family.

"So many people are struggling to make baby number two. If you start trying to have a family at age 38 and, say, you want to have two children and you have an average number of eggs and normal fertility, you could take six to nine months to get pregnant, then you have the baby and you breastfeed your baby. By the time you’re ready to start trying for baby number two you might be 41 or 42 and your time might have run out."

Another way of getting a gauge on your fertility is to take an AMH test, or anti-mullerian hormone test. An AMH test is a relatively new fertility test that has become widely used in New Zealand and abroad in the past five or six years.

"It's a really accurate way of determining how long a woman has left to have babies, and when her menopause might be," Dr Birdsall says. The test can be done by your GP or a fertility specialist and costs around $86 in the North Island and is free for those living in the South Island.

How to know when you might need further testing

If you've been trying for a baby for over a year, or you're older than 35 and have been trying for at least six months, it's recommended you have your fertility tested. To kick things off, visit your GP, who will test your blood and your partner's sperm, and depending on those results you may then be referred to a fertility specialist.

As well as measuring your ovarian reserves a fertility specialist can arrange tests to determine whether you're ovulating and assess your general health - including measuring your full blood count and detecting whether you have hepatitis B or C, HIV, syphilis or diabetes, whether you're immune to rubella and chicken pox and whether your thyroid gland is functioning perfectly.

They may conduct an internal or transvaginal ultrasound to check the health of your uterus and ovaries. And from there you may be recommended to undergo a HSG (Hystosalpingogram) test - a procedure where dye is flushed through your ovaries and fallopian tubes to ensure there are no blockages or tubal damages.

If other problems are suspected such as endometriosis, adhesions (scar tissue), ovarian or endometrial cysts etc, you may need a laparoscopy, which is a surgical procedure in which cysts, adhesions and fibroids can be removed.

Unexplained fertility

Despite all of the information fertility tests can uncover, they can still sometimes lead to no explanation as to the reason for your infertility. This is known as unexplained infertility and it can be incredibly frustrating for a couple. Unexplained fertility can also rule you out for public funding for treatment unless you've been trying for a baby for five years or more and are still under 40.

Will you be eligible for publicly funded testing and treatment?

Fertility treatment can costs thousands of dollars but if you meet certain criteria you may be eligible for public funding.

The criteria for public funding for fertility testing varies from region to region. In most regions a couple needs to have been trying for a baby for at least one year. In Auckland the female must be under 40 years and have a BMI (body mass index) of 19-32 yet in the Bay of Plenty, Waikato and Taranaki the BMI criteria does not apply - and in Wellington you need to have been trying for 18 months rather than a year if you are 35 or younger.

However, if you already know you have something "really wrong" like severe endometriosis, or you may have cancer and are about to have treatment that is going to damage your fertility, you don't have to wait a year.

To complicate things further, being eligible for a publicly funded consultation doesn't necessarily mean you will be eligible for publicly funded treatment. Additional criteria applies.

"It's a fairly rigorous process and to get publicly funded IVF treatment you need to have demonstrated that you have very significant fertility issues. But it's been well researched because it means that the couples that don't qualify, provided they are under 40, still have a reasonable chance of conceiving without help," Dr Birdsall explains.

Insurance companies do not cover fertility treatment - apart from the NZ Police insurance scheme. "And I think that's a huge disappointment of insurance companies, and we talk regularly with the country's biggest medical insurer to ask why people are discriminated against, particularly where they would take out a policy prior to knowing they had fertility issues," says Dr Birdsall. "I think that is wrong and if you could quote me on that that would be fabulous."