Optimizing Natural Fertility
John A. Schnorr, MD Coastal Fertility Associates
Approximately one out of seven couples in the United States experiences infertility. The diagnosis of infertility is defined as the inability of a couple less than 35 years of age to be able to conceive within a one year period of unprotected intercourse. For women above 35 years of age, the time period is shortened to six months to help encourage couples to seek care sooner other than later, as increasing female age can further negatively impact fertility.
The definition of infertility is based upon the fact that approximately 80% of couples typically conceive within the first six months of attempting pregnancy. Monthly pregnancy rates are the greatest actually within the first three months of a person’s attempt to conceive. For women less than 30 years of age, typical monthly pregnancy rates are 20 to 25% per month. If a couple has been trying for over a year to conceive without success, pregnancy rates are estimated to be less than a 3 to 5% chance of pregnancy per month.
The most common cause of infertility in America today is increasing female age. As women age, the number and quality of eggs in the ovaries declines. This is the reason for the trend of decreasing pregnancy rates, increased miscarriage rates and increased birth defect rates as women advance in age. Fortunately the uterus does not age with time. In regards to sperm, there is a very subtle decline in the quantity and quality of sperm for men as they age with minimal impact on pregnancy rates or birth defect rates.
I am frequently asked how frequently somebody should have intercourse to attempt conception? Sperm lives in the reproductive track for 3 to 5 days and is capable of resulting in a pregnancy as far out as 7 days from intercourse. Men with normal sperm counts tend to have relatively stable sperm counts with intercourse as frequently as daily. If emotions take over daily intercourse will not hurt pregnancy rates, however, the general recommendations are intercourse every 2 to 3 days during the “fertile window”.
The “fertile window” is described as the time period, which has the maximum fertility for women. Intercourse after a woman ovulates typically results in a very low chance of pregnancy and therefore it is optimum they have intercourse several days prior to ovulation. The fertile window is typically between day 10 and 20 of a woman’s menstrual cycle assuming they have cycles on average every 28 days. The recommendation would be intercourse every other to every third day between days 10 to 20 of the menstrual cycle.
While it would make sense that the optimum way to conceive would be through monitoring ovulation, it turns out that ovulation predictor kits are not 100% accurate. Several of the kits have high false positive and false negative rates, meaning that the kit will tell you that you are not ovulating when in fact you are ovulating. This occasionally results in couples not having intercourse when they should be due to errors in the test results. Accordingly, maximum pregnancy rates occur through regular intercourse without monitoring for ovulation as described above. If monitoring is required due to travel or other challenges, the recommendation would be to use ovulation predictor kits between day 10 and day 20 in the cycle using the second morning urine, so the urine is not overly concentrated when testing. If you have a positive LH surge, intercourse should be that night and the following night.
Coital positioning does not seem to alter fertility rates. There are several studies, however, showing that vaginal lubricants can decrease fertility. Water-based lubricants such as KY brand jelly can inhibit sperm motility. Studies show that canola oil and mineral oil do not appear to decrease sperm motility if used with small concentrations.
Diet and lifestyle have a profound impact on fertility. Fertility rates are decreased in women who are either very thin or obese. The ideal body mass index for fertility is between 20 and 30 kg/m2. There is little evidence that dietary variations such as vegetarian diets, low-fat diets, vitamin-rich diets, antioxidants or herbal remedies improve fertility or affect infant gender.
Tobacco use has a substantial adverse effect on overall fertility. Several large studies show that women smoking have a two-fold increase risk of having infertility, and have an earlier onset of menopause. The most important thing a smoker could do is to discontinue tobacco use to help improve the overall pregnancy rates and to lower miscarriage rates. Tobacco use can also hurt sperm concentration and sperm motility being a big cause of male factor infertility.
Consistent with the theme of moderation in all things, alcohol consumption has also been shown to decrease fertility rates and increase miscarriage rates. Several studies show one to two-fold increase risk of infertility by drinking one glass of alcohol per day. The recommendation is four or less glasses of alcohol per week. Similar data exists for caffeine consumption with the overall recommendation of two or less cups of caffeine per day.
There are adverse effects of recreational drugs including marijuana. Marijuana now in several studies have been found to decrease sperm motility and decrease ovulatory rates in women. A review of the medical literature shows that sauna bathing does not decrease female fertility and is safe while trying to conceive and in an uncomplicated pregnancy. Similar recommendations are available for men.
In summary, long term success rates are over 90% for couple seeking treatment for infertility and most conceive with simpler forms of infertility treatment. The time to conception increases with age. The greatest challenge is decreasing egg number and egg quality. For those reasons women over 35 years of age should seek consultation with a reproductive specialist if you are not able to conceive within six months of trying or within one year if you are under 35 years of age.
If you would like to find out more information contact Coastal Fertility Specialists.
This information is purely informational. Talk to your health care provider for specific medical advice.
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