About 14% of couples in industrialized countries
report infertility problems. There is suspicion that
the incidence of infertility is increasing. Since
there are many things that can affect fertility that
we have control over -- lifestyle choices of smoking,
drinking alcohol or caffeine, food ingestion and weight,
sexual practices and so forth -- it is important to
examine how much effect these things can have on future
fertility. Many women are unaware as to how important
these lifestyle choices can be with regard to future
attempts to conceive.
An article by Silva PD, Cool JL, Olson KL: Impact
of lifestyle choices on female infertility. J Reprod
Med 1999;44:288-296, helps us to put some of these
lifestyle habits in perspective as to how they affect
fertility. These authors did an extensive review of
the literature to determine how much different life
choices affect a woman's ability to later conceive.
Does being overweight affect fertility and
if so, how?
Obesity has a strong association with infertility
and menstrual irregularities. While some of the ovulation
problems and menstrual changes are explainable by
women with Polycystic Ovarian Syndrome (PCOS) who
are also obese, women who do not have PCOS but are
overweight also have the same problems. Group treatment
programs that assist obese women with diet and exercise
plans have shown return of fertility in many patients.
Weight loss of 15 lbs (6.5 kg) has been shown to restore
ovulation. It is thought that the improvement in insulin
resistance has more to do with restoring ovulation
than the actual amount of weight or weight loss itself.
For most studies, 20% over ideal weight is considered
obese. Officially, a BMI (body mass index) of 25-30
is considered overweight and a BMI of over 30 is considered
obese.
Can weighing too little lower my chances
of getting pregnant?
Low weight and weight loss is also associated with
ovulatory dysfunction and thus infertility. Even a
moderate weight loss of 10-15% under ideal body weight
can result in menstrual irregularity. It does not
need to be the weight alteration of 30% or more as
seen in women with anorexia nervosa or bulimia. Weight
gain programs in these underweight women have been
shown to restore ovulation and pregnancy in up to
73% of women who were able to achieve 95% of their
ideal body weight. For many studies affecting eating
disorders, a BMI (body mass index) of 17.5 - 20 is
underweight and under 17.5 (90 lbs at 5 feet 0 inches)
is considered very underweight.
I want to put off having children until our careers
provide more opportunity. Will delaying childbearing
affect my ability to get pregnant?
It is quite common for women to pursue educational
and career opportunities and put off childbearing
into the late 30's and early 40's. Aging, however,
brings with it many effects that will decrease fertility.
Depletion over time of ovarian follicles affects
menstrual regularity.
Endometriosis has more time to produce scarring of
the ovary and tubes so they cannot move freely or
it can even replace ovarian follicular tissue if ovarian
endometriosis persists and grows.
Leiomyomata (fibroids) can slowly grow and start causing
endometrial bleeding that disrupts implantation sites
or distorts the endometrial cavity which affects carrying
a pregnancy in the very early stages.
Abdominal adhesions from other intraabdominal surgery,
or ruptured ovarian cysts can also affect tubal motility
needed to sweep the ovary and gather an ovulated follicle
(egg).
Does smoking affect my ability to conceive?
Almost all studies show that smoking decreases fertility.
Smoking causes decreased estrogens with breakthrough
bleeding and shortened luteal phases. Smokers have
an earlier than normal (by about 1.5-3 years) menopause
which suggests that there is some toxic affect of
smoking on the follicles directly. Chemically, nicotine
has been shown to concentrate in cervical mucous and
metabolites have been found in follicular fluid and
been associated with delayed follicular growth and
maturation. Finally, there is some affect on tubal
motility because smoking is associated with an increased
incidence of ectopic pregnancy as well as an increased
spontaneous abortion rate.
I know alcohol is not good during pregnancy,
but what about its use while trying to conceive?
The total effect of alcohol on fertility is not as
well established as with cigarettes and other substance
abuse. In one survey, women with high alcohol use
reported more menstrual problems and gynecologic surgery.
It has been shown to alter estrogen and progesterone
levels as well as cause anovulation. Most chronic
alcoholics become amenorrheic. While the effects of
alcohol on fertility are real, it is not clear how
much must be consumed to affect fertility, or conversely,
how much consumption is safe. In pregnancy, we know
that an average of 2 drinks per day or more, or binge
drinking of 5 or more drinks at a time can produce
fetal alcohol syndrome birth defects. As far as fertility,
one study found that there was a 60% increase (risk
ratio 1.6) in ovulation difficulties with the consumption
of more than 100 grams of alcohol a week (about one
drink a day). There was no increase with less than
100 grams consumption a week.
Some people say caffeine is bad for trying
to conceive but I cannot believe two or three cups
of coffee a day could really affect conception --
can it?
Not all reports, but many, show that increased caffeine
consumption affects the ability to become pregnant
and carry the pregnancy. Caffeine clearance from the
body is decreased during the luteal phase. Animal
and human data suggest an increased rate of spontaneous
abortions with increased caffeine use and most human
studies show a decreased fetal growth during pregnancy
with increased caffeine intake. How much is too much?
Consumption of 3 or more cups of coffee per day (greater
than 300 mg caffeine) leads to fertility problems
in 4 studies.
Does catching a sexually transmitted disease
(STD) always cause infertility?
Tubal factor infertility accounts for about 15% of
infertility and pelvic inflammatory disease from gonorrhea
or chlamydia infections produce most of this. As many
as 40% of untreated chlamydia cervical infections
ascend into the tubes and pelvis causing PID (pelvic
inflammatory disease). If a woman has PID, she has
a 20% chance of being infertile. The biggest problem
with the affect of PID on fertility is that it is
most often contracted at a time when very little thought
is being given to the future ability to become pregnant.
Birth control pills and other hormonal methods of
contraception do not protect against STDs. Only the
barrier methods and especially the use of condoms
and spermicidal foam decrease the chances of acquiring
an STD.
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