Whether you are trying for a baby now, or thinking about your long term fertility there are a few things that you can address and change if necessary. Almost everyone will relate to some or other items on the following list, and it is never a case of blaming yourself for fertility problems. The real situation is always far more complex and there can be very many factors involved when trying to get pregnant. What follows are seven very common areas that you can consider to improve or preserve your fertility. They all have scientific evidence to support their inclusion. You can give yourself the best chance of pregnancy by identifying which ones might be relevant to you.
1. Maternal age
It is very common for women to delay starting a family until their mid-thirties or later and this often leads to difficulties in conceiving. Viewed from a biological perspective of a woman’s fertility combined with her general health and psychological maturity, the best time to have a baby is probably her early twenties.
There can certainly be many advantages in the older mother, but the problem is that fertility does decline with increasing age, and the reason for that is that a woman enters her reproductive life with a fixed quantity of eggs available. No more are created during her lifetime and once the supply begins to run low the number and quality of eggs is reduced and the chances of pregnancy lessens. In general, this reduction in fertility begins to become noticeable by the mid-thirties and over the age of around thirty-five fertility declines much more quickly. Around 30% of couples where the women is over thirty-five experience some fertility problems, a rate which doubles in the over forties.
One option is to have eggs frozen while young for use later in life. This procedure, called egg vitrification, is a relatively recent development and has shown to be successful. It may be that in the future we will see women in their late thirties simply defrosting eggs that they froze in their mid-twenties. It is natural for us to be unconcerned about our fertility until we wish to begin a family, and if a woman is already thirty-five by that time, her egg freezing options might already be reduced. The same is true for IVF and other fertility treatments; success rates begin to decline over thirty-five and are extremely low in the early forties. Of course many older women do conceive naturally.
2. Healthy weight
It is not just being overweight that can reduce fertility, being excessively underweight can also cause problems. That is not to say that all women who are not their ideal weight will experience fertility problems. But weight can have an effect on the fertility of some women and it is certainly a good idea to consider weight if you are experiencing fertility problems or wish to preserve your fertility for as long as possible.
Basal Metabolic Index (BMI) gives an approximation of ideal weight and can be calculated by taking your weight in kilograms and dividing it by the square of your height in metres. There are lots of on-line automatic calculators that will do the job easily just using height and weight in various units. The BMI is useful because it allows us to compare different people and establish normal ranges and associations with health problems. The normal range for BMI is 18.5 – 25, and 25 – 30 is considered overweight. A woman with a BMI of over 30 is regarded as mildly obese and should seek medical advice for an evaluation of her hormonal status with regard to ovulation, and to exclude other problems such as diabetes, thyroid disease, insulin resistance or polycystic ovaries.
At the other end of the scale, having a low BMI of 18.5 or less can lead to irregular periods, loss of ovulation and hormonal problems. Severe low weight with a BMI of less than 17.5 could be the result of an eating disorder, or excessive exercise. Women with a very low BMI should talk to their doctor about exercise, nutrition or hormone levels.
3. Cigarette smoking
Scientific studies comparing smokers to non-smokers almost always show a higher prevalence of infertility and a longer time trying before becoming pregnant women who smoke. Some components of cigarette smoke have been identified as potentially interfering with oestrogen production, and may reduce the egg quality itself. It appears that smoking accelerates the decline in fertility associated with age, and may advance the menopause by several years.
The situation is similar when it comes to IVF, where smokers tend to do less well than non-smokers. On the whole they are likely to require higher doses of gonadotropins, collect fewer good quality eggs and require more attempts than similar women who do not smoke. There is also an increased risk of ectopic pregnancy or spontaneous miscarriage in smokers. The effects of smoking are more generally apparent in older women. Aside from fertility itself the pregnancy associated issues relating to smoking are well known and include lower birth weight and higher risk of premature birth.
All these effects are related to the number of cigarettes smoked and the duration of smoking. There is good evidence that stopping smoking prior to trying for a baby or undergoing fertility treatment does partly reverse some of these effects, so there is always benefit to be had by quitting.
4. Drinking alcohol
There appears to be a link between drinking and reduced fertility, though the exact mechanisms for this are not fully understood. The Department of Health advise that… “pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk”.
Units of alcohol are based on the amount of alcohol in a drink so that a litre of a drink has the same number of units as the percentage of alcohol it contains. Put another way, a litre of 14% alcohol wine contains 14 units, and a litre of beer at 5% alcohol contains 5 units. This means that an average glass of wine will typically contain between 2.5 and 4 units, while a pint of beer has around 2.5 units.
As little as 6 units per week have been shown to have a significant negative impact on conception rates, especially in older women. There are also a few conflicting studies and some show little effect of very light alcohol consumption. There is complete agreement when it comes to heavy drinking and the greater the intake the larger the effects. Of course the best advice is to give up drinking completely when trying for a baby or having fertility treatment. But in any case it is worth thinking about cutting down and drinking within sensible limits.
The situation regarding drinking in pregnancy is very clear. Alcohol can pass through the placenta to the baby and the unborn child cannot process alcohol very well so it stays in their body for longer than the mothers. There is a known risk of developmental problems in children born to mothers who drink excessively during pregnancy, including learning or behavioural difficulties, low birth weight and heart defects. In severe cases these problems are known as foetal alcohol syndrome.
5. Sexually transmitted infections
Chlamydia and gonorrhoea are the two most common sexually transmitted infections that can seriously affect fertility. If these conditions go untreated then they can lead to pelvic inflammatory disease (PID) in 10 – 15% of cases which in turn can cause scarring of the uterus or fallopian tubes. Chlamydia can also infect the fallopian tube causing inflammation, scarring and in some cases blockage. The problem is made even worse because these infections sometimes cause no symptoms. Therefore, it is worthwhile getting an STI screen or at least a screen for these two common infections, which can be done with a simple blood test.
6. Seeking expert diagnosis
If a couple have been having unprotected sex for a year or more they should consult a doctor in order to exclude other possible causes. Women over 35 may wish to reduce this time to 6 months. Most fertility problems affecting women can be overcome, but first they have to be diagnosed. A typical fertility assessment would include a full medical history and examination, probably including ultrasound of the ovaries and uterus. Routine blood tests for hormone profile and for STI’s are generally performed. Sometimes further investigations are warranted, for example the patency of fallopian can be assessed by passing a dye through them, or the inside of the womb can be visualised by passing a fine flexible fibre optic cable through the cervix. These further tests would only be carried out on the recommendation of a fertility specialist for a specific reason.
We live in an increasingly stressful world, overcrowding, busy lifestyles, the daily commute, relationships and work can all be sources of stress at some time in our lives. High stress levels can affect the hypothalamus which exerts control over production of hormones which cause ovulation, and in some cases can cause delayed ovulation. Too much stress can also affect sexual relationships and diet. Although some stress is normal and stress or anxiety alone are not likely to be the main cause of infertility, it can become another factor. Trying for a baby can itself be stressful and this can seem like a vicious circle. Stress is not simply in the mind, it can have very real effects on the body and behaviour, and because we learn to live stressful lives the problem can go unrecognised.
Every person is different, so there is no universal approach to the problem. Many people find that yoga or meditation is helpful. Some find it useful to talk about their worries to a fertility counsellor who is highly trained in recognising stress and may suggest techniques for helping with the problem. Acupuncture or other complimentary therapies can be of great value in dealing with stress, or just making a bit more time for yourself or prioritising your own needs a bit more might help. Whatever works is the right approach. It is worth seeking advice about stress from your doctor if you think this might be an issue.
Science Director Concept Fertility Clinic www.conceptfertility.com