What can a patient do to improve her/his fertility? What should you avoid?
Fertility Risk Factors
Infertility is a disease affecting the reproductive
systems of men and women that can lead to an inability to have
children. It is a disease which affects many people - recent
estimates are that about 6-7 million people in the United States are
affected by infertility. In contrast to many unavoidable diseases,
there are steps that people can take to optimize their current and
future fertility.
Factors which can significantly influence fertility include the
following:
Age: A woman’s age
has a strong impact on her ability to conceive.
Stress:There is
some evidence that stress and depression may impact the hormones
that regulate reproduction.
Smoking: In addition to its other health risks,
smoking can prematurely age the ovaries in women and reduce
sperm production in men.
Alcohol: Fertility problems can be encountered
with even relatively modest amounts of alcohol intake in
both men and women.
Unprotected intercourse: Sexually transmitted
infections can cause fertility problems for both men and
women.
Weight and Exercise:Women whose weight is either above average (10-15% above
normal) or below average (10-15% below normal) may encounter
hormonal abnormalities affecting reproduction.
Environmental factors: Certain chemicals, radiation, and
high temperatures may impact fertility in both men and women.
Many women are delaying childbearing. It is estimated that
approximately 20% of women are waiting until after the age of 35 to
start a family. This can be due to many factors, including the
availability of effective birth control options, the desire to
succeed professionally prior to beginning a family, and the fact
that women are marrying at an older age. There are many stories in
the media which can suggest that fertility treatments can help to
overcome this delay in childbearing successfully. However,
successful fertility treatments depend upon a reasonable amount of
ovarian function -- which may or may not be available for women who
choose to wait to begin a family.
It is important to remember that the decrease in fertility with age
becomes more pronounced after the age of 35. Even with the advances
of modern medicine and the fact that many women are healthier and
taking better care of themselves, this does not offset the natural
decline in fertility with age. This is because women are born with
all the eggs they will ever have and are unable to make any new
ones. Even before puberty occurs, they have lost all but
approximately 500,000 eggs. Though a woman ovulates (releases)
approximately 300 eggs during her reproductive life, many more are
lost through the natural aging process of atresia. The eggs that are
remaining in the later 30s and early 40s are older eggs and have a
higher chance of having developed genetic mistakes. This can lead to
a decreased risk of pregnancy and an increased risk of miscarriage
if pregnancy does occur.
An option for women whose ovarian function has significantly
deteriorated is donor egg IVF. The chances of a successful pregnancy
can be very high using an egg from a donor in her 20s or early 30s,
and the miscarriage rate is very low. The high success with egg
donation confirms that the egg quality is a significant barrier to
pregnancy in older women.
Though we know that fertility naturally declines as women get older
-- when and how quickly the decline occurs varies significantly. It
is important to seek help with appropriate testing and treatment to
maximize the chances for successful pregnancy.
A common complaint for patients presenting with infertility is
stress -- which is often multifactorial in nature. The emotional
challenges of infertility can be compounded by other personal,
professional, and familial issues. If this stress becomes chronic,
it can lead to depression, changes in sleep habits, weight
gain/loss, and susceptibility to illness.
Many patients wonder if stress is causing infertility. There is no
definitive proof that stress causes infertility, unless a woman is
experiencing irregular or absent menstrual cycles as a result of
stress.
It is well known that infertility can compound and exacerbate
stress. It can be difficult for a couple to realize that the road to
parenthood is not happening for them, in spite of having many family
members or friends who appear to have no difficulty. It can be very
isolating for a patient to feel as if there is something wrong with
her body. Though patients are more open than in the past about
infertility struggles, it is not uncommon for a woman to feel as if
she is alone in her infertility experience.
Infertility tests and treatments can be physically, emotionally, and
financially taxing. Infertility can lead to such stress that a
couple grows apart, further increasing stress levels. During
fertility treatment, it can be difficult for many patients and
partners to miss work or other activities for multiple doctors’
appointments.
Though stress may not directly lead to infertility, it certainly
does not feel good and it can make the process of treating
infertility much more challenging. It is important to find ways to
reduce stress. This is accomplished in different ways for different
people, but reaching out to others can be a helpful start. It is
critical to maintain communication within the couple. Some couples
find it helpful to seek counseling advice to address and discuss
their thoughts and feelings. Other patients may find support groups
in person or online helpful.
Physically, it is helpful to learn stress reduction techniques, such
as meditation, yoga, or acupuncture. Reducing caffeine intake can be
helpful for improving fertility, reducing miscarriage, and lowering
stress. Regular exercise can optimize physical and mental health.
It is also important to communicate with your doctor so that you are
well-educated about treatment options and predicted success rates as
well as the financial and time responsibilities inherent in these
options. It is helpful to have your partner aware of these issues as
well so that you can support each other through the emotional
highs/lows of infertility.
Infertility is a reproductive disorder which can have many causes.
Some causes are not easily -- or even able -- to be changed.
However, lifestyle changes can have a profound impact on your
fertility and pregnancy health.
It is clear that tobacco abuse, weight issues, alcohol, and caffeine
use can all impact fertility, pregnancy, and fetal outcomes. It is
ideal to address these factors before pregnancy takes place.
Tobacco use: The chemicals in cigarette smoke can cause the
ovaries to age faster, leading to a higher change of infertility,
miscarriage, and menopause at an early age. Much of this impact
appears to be irreversible. Cigarette smoking can also increase the
chance of pregnancy complications, including preterm labor and
delivery, underweight newborn, placental problems, and ectopic
pregnancy. There can also be adverse effects on the health of
children who grow up around smoking parents.
Alcohol: Alcohol consumption has been shown, in general, to have a
detrimental impact on female and male fertility. Higher levels of
consumption (more than 2 alcoholic drinks a day) are best avoided
when attempting pregnancy. In women, a more conservative amount is
generally accepted. Once ovulation occurs and a possible pregnancy
is germinating, there is no safe level of alcohol exposure. There
are a variety of birth defects related to alcohol intake during
pregnancy; these can range from mild growth retardation and
neurobehavioral effects to the full fetal alcohol syndrome.
Unprotected intercourse: Chlamydia and gonorrhea are sexually
transmitted infections which can have a profound impact on
fertility. Untreated, approximately 40% of women will go on to
develop pelvic inflammatory disease (PID). A critical issue is that
many women with chlamydia or gonorrhea may have no recognizable
symptoms. The same can be true of the male partner. It is important
for women and men who desire future fertility to take steps toward
reducing infection exposure during intercourse. This can be
accomplished by limiting sexual partners and/or using condoms.
Caffeine: Caffeine exposure has been linked to both infertility
and miscarriage. One study has shown a 50% increase in infertility
in those who consume excessive (500mg or more) caffeine intake
daily. An even smaller amount (more than 200-300 mg) daily may still
increase the risk of miscarriage. It is reasonable to minimize
caffeine prior to and during pregnancy to optimize reproductive
outcome.
Other: Though there is limited research, illicit drug use can have
a detrimental impact on both fertility and pregnancy outcome.
It is important from a fertility and pregnancy standpoint to
maintain a healthy weight. A normal body mass index (BMI)* is 20 to
25. This level is associated with good health and is desirable for
both women and men.
Women who are overweight (who have a BMI over 27) may have greater
problems with ovulation. A reduction in weight can increase the
chance of ovulation and, therefore, the chance of pregnancy. Even small
changes in weight (i.e. 5 or 10 pounds) can accomplish this in some
women. Even though there are medications which can overcome
ovulation problems for many women, it is ideal to accomplish this
through lifestyle changes, if possible. Ovulation medications can
cause a higher chance of twins or more, and these pregnancies can be
more risky than a singleton pregnancy.
Weight loss is most successful when both changes in diet and
exercise are accomplished. It is important to not over exercise,
however. Women who exercise more than 60 minutes per day can also
experience problems with ovulation.
Women who are underweight (BMI of less than 20) may benefit from
weight gain. An increase in weight may improve both the chance of
ovulation and the likelihood of pregnancy. Again, changes in diet
and exercise may be needed to optimize success.
A few studies have suggested a link between excess exercise and
infertility. Some studies suggest that more than seven hours per
week of aerobic exercise can be associated with ovulation problems.
There appears to be evidence that excess exercise can also cause a
decrease in fertility in people who have regular, monthly menstrual
cycles. In a study on women undergoing in vitro fertilization, four
or more hours per week of strenuous exercise was associated with a
lower pregnancy rate.
Alternatively, inadequate levels of exercise, in association with
being overweight, may be a common cause of ovulation problems. A
reduction in weight, through diet/exercise modification, can cause
ovulation to resume in many patients. Even small amounts of weight
loss (i.e. 5-10 pounds) can be helpful in restoring ovulation in
some patients.
What is an optimum amount of exercise for someone who is trying to
optimize fertility? In a woman with a normal body weight, no more
than 7 hours/week of aerobic exercise is recommended. A patient who
is overweight should consider mild or moderate exercise with an
appropriate diet to maximize fertility. If a patient is underweight
or exercises excessively (i.e. more than 7 hours of aerobic exercise
weekly), she should strongly consider modifying her exercise and
diet regimen.
Overall, mild to moderate exercise can maintain good health, reduce
stress, and help you to prepare for a safe and healthy pregnancy.
Other potential reproductive hazards include: work-related or
household chemical exposure, toxoplasmosis risk from changing cat
litter boxes or eating under-cooked meat, mercury from fish
consumption, and lead used in arts and crafts. There is no good
evidence that exposure to common sources of electromagnetic field
radiation, such as computer monitors, electric blankets, heated
water beds, and microwave ovens, is harmful.
