We may have been trying for just a month or more than a year, but the feeling of anxiety and frustration can be the same for different people. The World Health Organization recommends that a couple begin their medical investigation after one year of regular and unprotected sexual intercourse without pregnancy. “Regular” does not imply intercourse just around the fertile days, but sexual intercourse every 2 to 3 days after the end of menstruation and before the start of the next, as it significantly improves the pregnancy rates and relieves the couple’s stress from “programmed sexual contact”.
Lifestyle and daily habits can significantly affect the fertility of both men and women and belong to factors that are transient, that is, we can improve them. We know that smoking and alcohol consumption negatively affects ovarian function and oocyte quality, while having an equally negative effect on sperm parameters and sperm DNA quality by inducing oxidative stress. Smoking reduction or even better quitting it altogether and reducing alcohol consumption on a daily basis but also occasionally in larger quantities, can significantly help couples to have a better chance in their attempt for pregnancy.
Obesity in women (BMI>30kg/m2) promotes irregularities in the endocrine function and menstrual cycle, reducing the chances of conception. It has been shown that with proper diet and a loss of 10% of the total body weight, the ovarian response and the overall reproductive function are significantly improved. Overweight men are more likely to develop sperm disorders or even azoospermia, while obese men are twice likely to have sperm disorders and inability to produce sperm than men with a healthy weight. The combination of weight loss with mild exercise results in better chances for conception than just weight loss.
Underweight women with a very low body mass index (<19 kg/m2), may also experience menstrual irregularities or even amenorrhea and should follow a balanced diet with adequate caloric intake to increase their body weight and improve fertility. In the process of weight regulation but even if body mass index is within a healthy range, the consumption of foods with antioxidant properties such as green leafy vegetables and fruits is recommended, in addition to a balanced diet.
Other factors that can affect fertility are certain medications for which we should always consult our Doctor, the use of unapproved or recreational drugs, the active or passive temperature increase in the male genital area (inflammation, fever, hot baths, sauna, prolonged daily driving, cycling, tight underwear), long-term exposure to harmful factors (chemicals, radiation) and a range of health conditions, making it absolutely important to consult the appropriate Doctor when changes in our body and daily function occur. Although there are differing scientific opinions, stress may act as a deterrent to the process of conception, most likely through changes in the normal hormonal balance and its impact in the overall bodily function.
If following lifestyle changes pregnancy does not occur, if a year of systematic effort has passed, if there are age-related reasons to suspect lower reproductive dynamics, but also when we want to assess our reproductive health in a preventive manner, we must always consult a Doctor specialized in fertility and reproductive medicine. The couple should be informed about the approaches used in fertility investigation, about what constitutes a proper reproductive effort but also about possible interventions and treatments that will help the family to expand. The couple should provide details on their medical history, possible factors that may affect their fertility, but also converse simple and complex questions and confide possible fears and expectations. Every couple and every person is different, so the medical approach is not always the same. The initial fertility screening often means a series of simple or specialized tests, depending on the medical history and indications that usually includes:
- Male fertility investigation begins with analysis of sperm parameters (semen analysis / spermiogram). This is one of the most important examinations of the couple because a detailed investigation reflects the reproductive health of the man, while many parameters constitute a unique result that determines the medical management of the couple. Equally important is sperm quality, by examining the integrity of the genetic material carried by the sperm and in particular the percentage of DNA fragmentation, as it has been found to significantly affect the chance of conception, the early embryo quality and the possibility of miscarriage during the first trimester of pregnancy.
- Laboratory tests for female fertility investigation comprises a group of tests, based on mainly hormonal measurements, but often -and depending on the indications and medical history-, may include hematological, biochemical and immunological tests, or even molecular investigations where appropriate. In women, the assessment of fertility and reproductive health is multifactorial, as due to their number and location in the body we cannot directly examine the oocytes for diagnostic purposes and importantly the female body is the place that hosts and nurtures the developing embryo and we must ensure the best possible conditions by having available the most modern diagnostic tools that scientific development has offered us.
- Imaging examinations of the female partner to check the physiology and function of the reproductive system, which often includes gynecological ultrasound, tubal patency assessment with either specialized ultrasound or hysterosalpingography, and assessment of the endometrial cavity by hysteroscopy.
Based on the data from numerous demographic studies, a significant percentage of the global population will seek medical advice for childbearing problems, undergo a series of fertility tests, receive medical or invasive treatment, or will even undergo assisted reproduction. But we should not think that a delay in conception, a diagnosis of infertility in a man or a woman, or treatment referral indicates a one-way route that leads to either IVF or the fear of ending up childless. Your Doctor and Reproductive Scientists are and should be your team and this team should be characterized by mutual appreciation, respect, trust and cooperation from all sides.
Some individuals will solve their problem more immediately, some will need different tests, some will undergo IVF, some will have more or less difficulty, but everybody should lay on a common ground: every couple is important, every couple is different, every couple needs personalized approach and advice, desire for family is sacred and should bring joy and hope to all of us.
