Protect Your Fertility – 5 Major Factors

When a couple receives an infertility diagnosis, this is commonly the point many of us are informed about the reproductive process and our chances to conceive. This shows us that we as humans, do not fully understand our bodies and how they really function. Sadly, we often spend our lives as young adults trying to avoid pregnancy so by the time we are ready, we are surprised to find out our bodies might have missed our prime fertility years. Chasing careers, finding a good partner, and feeling emotionally ready, often leaves us with a reduced ovarian reserve, stress, and not an optimal fertile environment.

Around the world, over 50 million couples in the reproductive age group of 15 to 44 struggle with infertility. This is a surprising 10 percent of women globally. Therefore a major health concern, infertility ranks as a major issue for women and couples. Let us review the top four factors to focus on regarding infertility: Sexually transmitted infections/ Stress, Weight, Age, Tobacco. Each factor has a strongly negative effect on both female and male infertility.

Sexually Transmitted Infections (STIs)

The quiet killers of fertility are STIs usually resulting from gonorrhea or chlamydia. Many infections from these bacteria have no symptoms but can do much damage to your fallopian tubes and surrounding abdominal organs. Symptoms are usually mild and include vaginal discharge with odor and burning during urination. If untreated, these infections can result in abdominal and pelvic pain with fever as well as possible hospitalization from PID (pelvic inflammatory disease). With PID, this can lead to a blocked swollen end of the fallopian tube filled with fluid; Further risk is the surrounding organs becoming covered in scar tissue and tubal factor infertility (TFI). Each case of PID greatly worsens the likelihood of TFI.

If not practicing safer sex, especially barrier contraception, you may be placing yourself at risk for TFI and/or an ectopic pregnancy (a pregnancy outside the uterus and often in the fallopian tube). The latter problem occurs in 2 percent of all pregnancies bur increases to 8 percent after a previous PID infection. The incidence of TFI increases exponentially with repeated infections to the fallopian tubes. Vigilant screening and timely treatment may reduce the damage to reproductive potential.

Stress

How often have you shared your problem with infertility and been told, "Just relax…it will happen?" Not only have regular folks offered this advice but unfortunately, so have doctors. That stated, stress does affect fertility. A recent study regarding the stress hormone called salivary alpha-amylase (SAA) in women trying to conceive (TTC) for one year. It found this: (1) 29 percent of women who had the higher levels of SAA took a longer time to conceive; and (2) women with the highest SAA levels had a 12 percent less likely chance to conceive each month. Infertility can cause stress and there is some research showing that stress, specifically depression, may decrease fertility. Please understand that infertility is challenging. You may find peace of mind in speaking with a counselor who has knowledge in this area.

Weight

For women, being overweight or even underweight is the cause for 12 percent of all infertility cases. For men, fertility is also negatively affected by obesity.

A common hormonal abnormality often associated with a higher body mass index (BMI) is Polycystic Ovary Syndrome (PCOS), which can lead to an ovulation disorder.

In men, obesity causes decreased testosterone and sperm counts by increased estrogen production in the fat cells. The higher levels of feedback onto the brain's pituitary gland and reduces follicle stimulating hormone (FSH), a hormone required for sperm production.

It is also possible to be too thin. An exceptionally low BMI can affect ovulation and many times occurs with the quite common (but not well-known) Female Athlete Triad of amenorrhea, bone loss, and eating disorder. According to the American Society for Reproductive Medicine (ASRM), an optimal BMI is vital to your successful reproduction.

But even if you lose weight and conceive with an elevated BMI, you remain at risk for greater pregnancy problems for you and baby-including miscarriage, gestational diabetes and high blood pressure, stillbirth, preterm delivery, preeclampsia, C-section delivery, shoulder dystocia complicating a vaginal delivery, fetal distress, early baby's death, and small-for-gestational-age (as well as large-for-gestational-age) infants.

Age

The average age of first-time mothers continues to advance globally. In the United States, this age began rapidly advancing in the 1970s. Women delay childbearing usually due to the lack of a partner but also for career reasons. To be sure, the problem of ovarian aging, that is, diminished ovarian reserve (DOR), is increasing. The main impact on pregnancy rate is oocyte (egg) quality and quantity. As a result, fertilization is negatively affected, implantation is reduced, and miscarriage is increased.

So you can understand DOR, it’s important to understand the two components-the quality of eggs and quantity of eggs. The term quality as it relates to the egg is a nebulous description because there are no clear-cut criteria. While embryologists love to view an embryo that appears perfect in shape (morphology), this evaluation alone has a limited correlation with pregnancy. Rather, chromosomal analysis of the embryo preimplantation is considered the best measure of quality and is the best prediction of embryo implantation. Quality of eggs is based on your birthday-the more birthdays, the poorer the quality. Actually, egg quality begins to decline after you pass age 30. Quantity, on the other hand, is determined indirectly by the result of a hormone blood test and a pelvic ultrasound.

Ovarian aging is currently best measured by considering three things: your chronologic age; your antral follicle count (AFC), small ovarian cysts with immature eggs that can be measured with a pelvic ultrasound; and your levels of Anti-Müllerian hormone (AMH), which can be assessed with a blood test. Natural fertility begins to decline on average above age of 30 for a woman. An AFC less than eleven reflects DOR, and less than six is severe DOR. Low AMH levels, defined as below 1 nanogram per milliliter of blood, have been shown to reduce the number of eggs retrieved with IVF and may predict pregnancy outcome. AMH levels below 0.4 ng/mL are severe.

The use of a screening test for DOR in a random population at low risk for infertility will result in a larger number of false-positive results (i.e., saying a woman has DOR when in fact she has a normal ovarian reserve).

Very low AMH levels (less than or equal to 0.4) affect the outcome of IVF cycles as a woman ages. To explain, in 2016 the Journal Fertility & Sterility reported data using the Society for Assisted Reproductive Technology (SART) statistics. The women had a mean age of 39.4 years and were treated with IVF. Due to a poor ovarian response to stimulating medication, 54 percent of women were cancelled prior to egg retrieval. In those who underwent an egg-retrieval attempt, no eggs were obtained in 5.4 percent of patients and no embryo transfer occurred in 25.1 percent of cycles. The live birth rate per embryo transfer was 20.5 percent (9.5 percent per cycle start and 16.3 percent per retrieval) occurring in women with a mean age of 36.8 years.

In a nutshell, random screening of AMH levels in women not diagnosed with infertility and less than 35 years age may result in unnecessary alarm. While it is possible the results of AMH screening may encourage you to electively freeze your eggs, counseling is recommended on the realistic implications of the number of eggs you will obtain if you have a low AMH level. There is no current evidence that AMH levels should be used to exclude patients from undergoing IVF.

According to the ASRM, the review of medical studies on ovarian reserve tests have limited value due to a small number of patients, different types of study design and analysis, and a lack of valid tools to measure outcomes.

Bottom Line: Your best chance for a pregnancy is attempting to conceive before your 30th birthday.

For so many years, all fertility physicians believed men can father a child indefinitely. More recently, however, males over the age of 40 have been shown to have an increased risk of infertility and miscarriage, as well as offspring with a higher of birth defect, schizophrenia, and autism. While this data is preliminary, certainly further studies are vital due to the current trend of delaying parenting in both men and women.

Given all this, it is important that fertility doctors breech the topic more frequently with male patients and encouraging, but not requiring, them to freeze their sperm if they are childless or infertile and approaching 40.

Tobacco

Many millions of people around the world smoke cigarettes and use tobacco in other forms, which is responsible for 13 percent of infertility cases. These habits (even half a pack per day) results in a 40 to 60 percent decrease of fertility. Cigarette smoking, including second-hand smoke, speeds up the loss of eggs and results in higher rates of miscarriages, ectopic pregnancies, menopause beginning sooner, and possible genetic damage to eggs and sperm. When compared to nonsmokers, female smokers have a reduced number of eggs; a lower ovarian response to fertility medication; and a lower number of eggs retrieved and fertilized in IVF. Furthermore, the pregnancy rate in IVF treatment cycles is diminished in smokers by 34 percent!

For males, smoking reduces sperm counts by 22 percent on average and will get worse with increased cigarette smoking. Even if sperm counts remain in the normal range, smoking reduces sperm potency.

There is good news that if you stop smoking, within one year, you may be able to return to normal fertility.

In other words: If you do not smoke, certainly do not begin. If you or your partner smoke, the smoking should stop to improve your fertility. Just imagine what would you rather hold, a cigarette or a baby?