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Human reproduction and fertility can be affected by several factors including the following:
Maternal age is the most important factor affecting infertility. Fertility in women generally begins to decline after the age of 29, with significant acceleration of the decline after the age of 37. The age-related decline in fertility in women is known to be the result of declining egg quality and egg number. Age can significantly influence chance of pregnancy because women are born with a finite number of eggs and as a woman ages there is a continuous decline in the number and the quality of the remaining eggs. During the intrauterine life at twenty weeks of gestation a female fetus has about six to seven million eggs. The total number of remaining eggs is significantly reduced and amounts to about one million at birth and about 200,000 to 450,000 at puberty. Existing data is suggestive of significant acceleration of reduction of oocytes between the ages of 37 and 38. Under normal conditions, complete loss of eggs in a woman results in menopause at about age 51. In one percent of women complete loss of eggs can result in premature menopause or premature ovarian failure at an age younger than forty. In addition, with aging there is a greater chance of abnormal chromosomes in the remaining eggs. The resulting chromosomal imbalance in the eggs of an aging woman can prevent normal fertilization and/or affect early embryonic development resulting in very high rates of first trimester pregnancy losses and increased rate of chromosomal anomalies in the babies born to older women.
Several studies have shown that advancing age in men is associated with decreased gonadal function resulting in decreased testosterone production around the age of forty. In addition to decreased serum free testosterone, semen parameters including semen volume, sperm motility, and normal morphology of the sperm also decrease. These changes, as suggested by several studies, are associated with reduced fertility in men that starts in late thirties and early forties. Available evidence indicates that pregnancy rates as well as time to conception are affected as male age increases. Pregnancy rates decrease as a man ages and time to conception increases. The age related reduction in fertility in men, however, contributes relatively little to age related decline in fertility. It is well known that while fertility in women drops precipitously in their late thirties and early forties, men can maintain their fertility into their sixties or even more advanced ages and a good number of pregnancies are fathered by men over the age of fifty. The oldest father on record is ninety-four years of age. As mentioned above, advancing age in women is associated with chromosomal changes in oocytes which can be a significant cause of most pregnancy losses. Age related chromosomal changes in sperm is not as clear as in oocytes, however some studies indicate an increased risk of sex chromosome changes with advanced paternal age.
EU US White Leather Sandals White 38 Simple Menorquinas M Off Classic M 8 B Avarcas Spaniard Lifestyle habits including diet, smoking, caffeine and alcohol intake
Tobacco smoke contains several hundred substances including nicotine, carbon monoxide, and mutagen (including radioactive polonine, benzopyrine, naphthalene, and methyl-naphthalene). Several studies have shown strong evidence that smoking negatively impacts all facets of fertility including follicular development and ovulation, oocyte retrieval from the ovaries, transport of oocytes in the Fallopian tube, and fertilization and early embryo development. Some studies have also revealed that smoking in a pregnant woman can also jeopardize future fertility of her fetus (male or female). There is also evidence that smoking can induce DNA damage in sperm and adversely affect IVF outcome. The data with male smokers is less compelling although tobacco use may decrease semen volume by nearly fifty percent. Three recent studies have reported that men exposed to smoking in utero (maternal smoking during pregnancy) had decreased sperm concentration (twenty percent reduction compared to men not exposed at all). Marijuana and cocaine have been reported to interfere with production of sperm, decreased sperm count, decreased sperm motility, and increased number of sperm with abnormal morphology. High doses of cocaine may also cause erectile dysfunction. As a result, smoking cessation should always be an integral part of infertility treatment. M Sandals White Leather Off EU Avarcas White B Spaniard 8 M 38 Classic Menorquinas Simple US Today there is compelling evidence that smoking can have a negative influence on IVF outcome.
The adverse effects of alcohol on pregnancy are clearly established, however the ill effects of alcohol on fertility has not been very clearly studied. Few studies have reached the conclusion that alcohol in a dose-dependent fashion can reduce the chance of conception. In some studies, female alcohol consumption has been associated with a decrease in oocyte retrieval and rates of pregnancy and increased risk for miscarriage. Few studies have suggested that drinking in men, about one drink per day, may be associated with increased risk of spontaneous abortion in their partners. At this point, however, the findings of adverse effects of alcohol on fertility, particularly in men, and the evidence for an association between alcohol and IVF outcome is inadequate and not clearly known yet.
Several studies have reported an association between caffeine use and increased risk of pregnancy loss. Caffeine intake in men, however, has not been known to have any effects on sperm parameters, IVF end points, or neonatal characters. The evidence for an association between IVF outcome and caffeine intake is inadequate at present due to the scarcity of studies, however few studies have suggested caffeine intake in a woman resulting in decreased fertility.
COITAL FREQUENCY and TIMING OF INTERCOURSE
It is known that activated sperm can last for up to eighty hours in the female reproductive tract. Proper timing of intercourse around the time of ovulation can significantly affect establishment of pregnancy. Wilcox HR reported that highest chance for pregnancy is when intercourse occurs in the six-day window that ends with the day of ovulation. The greatest chance for pregnancy is when intercourse occurred beginning two days prior to ovulation. It should be noted, however, that pregnancies can also occur when a single act of intercourse takes place up to five days before ovulation. Several studies have reported that no pregnancies were achieved if intercourse only takes place after ovulation has occurred. Greatest chance of pregnancy as far as frequency of intercourse is concerned was when intercourse occurred two or three times during the six-day window mentioned above. Increased frequency (four to six times) of intercourse during the fertile period was associated with lower pregnancy rates. It should be emphasized that coitus is usually a spontaneous expression of love between two partners. As a result, if the lovemaking act is placed on too rigid and specific timed schedule, it can result in significant sexual dysfunction, performance anxiety, and finally a worsening of the problem at hand. Consequently, and in the absence of male factor infertility, there is no clear medical justification for advising the avoidance of coitus at any time. To facilitate patient decision making in this regard, it can be suggested to the patient that they make love at least twice a week from the day that menstrual bleeding ceases.
Diet and Nutrition
M EU White Off Spaniard Menorquinas Sandals Simple B Avarcas 38 White US Leather 8 Classic M There is no known particular diet per se that can significantly impact fertility. Increased caloric intake or inadequate diet, however, resulting in extremes of body weight can affect ovarian function and as a result, predispose women to infertility. Low body mass index (BMI) less than 19 or body fat less than 22 percent can result in hypothalamic dysfunction presenting as menstrual irregularities or ovulation dysfunction. On the other hand, women with increased body weight with BMI more than 25 (and certainly with BMI more than 30) may have polycystic ovarian syndrome which can result in ovulation dysfunction. Aside from ovulation dysfunction, there is significant evidence suggesting that increased body weight itself may result in reduction of fertility. In women with advanced body weight treated with IVF, a statistically significant drop in implantation and as a result, pregnancy rates have been reported.
Several studies in wild life, laboratory animals and epidemiologic studies with humans suggest that many environmental chemicals and heavy metals may have a toxic effect on reproductive system and may contribute to infertility in men and women. Many of these chemicals are present in everyday life household products and may exert their adverse effects even at a very low concentration. It is of significant interest to note that humans are at the top of the food chain and as a result have accumulated many of these toxic chemicals. The adverse effects of these environmental contaminates on the reproductive system and reproductive processes depends on the dose, duration and timing of exposure (in utero, during childhood, adolescents or in adulthood). As a result, during initial history taking the potential exposure to solvents, personal care products, cosmetics, pesticides, or heavy metal phthalates, where patients live or used to live, any medications taken during his or her mother’s pregnancy, or whether their parents had exposure to plastics, lead or pesticides, should be evaluated and necessary education counseling given as indicated. For example in cases of decreased ovarian reserve, premature ovarian failure, PCOS and many anatomic abnormalities in the reproductive system in women and abnormal semen analysis in men, miscarriages, testicular cancer, endometriosis or uterine fibroids the possibility of the environmental insults as a contributory factor should always be considered. The overall contributors of environmental exposure to infertility is unknown, however wild life animal studies and epidemiologic data in humans support and are highly suggestive of a link between the above mentioned environmental contaminates and miscarriages, endometriosis, ovarian dysfunction and sperm abnormalities. At this point, however and in the absence of a large scale database and concrete information about environmental contaminates effects on human fertility and reproductive health, patients with infertility should minimize their exposure to these potentially toxic substances.
“ Helping patients build a family is my passion. I am completely invested in your treatment and will apply my full knowledge and abilities to achieve your goals.” Dr. Guerami