Child bearing ends 10 years before the menopause, this is consistent regardless of age of menopause approximately 10% of women will have a decreased ovarian function in their early to mid 30’s AgeRate of egg abnormalities < 35 years10% 40 years30% 43 years40% >45 years100% Age and fertility
Age and fertility: the current problem In Canada, the percentage of first time mothers who are > 30 years of age increased from 11% in 1987 to 26% in 2005. In that same time period, there was a significant increase in first time mothers >35 years of age, from 4% in 1987 to 11% in 2005 and a corresponding decrease in the group of women who were <25 years
Timing it right 1.Fertile window 2.Frequency of SI 3.Predicting ovulation 4..
Fertile window The 6 day interval that ends on the day of ovulation. Length of the fertile period may vary among women.
Frequency of intercourse FrequencyProbability of pregnancy per month Daily37% Alternate days33% Once a week15%
Frequent intercourse (every 1 to 2 days) during the fertile window yields the highest pregnancy rates but even 2 to 3 times per week are almost as good. Frequency of intercourse
Predicting ovulation Challenging using any available method. Time of peak fertility can vary considerably even among women with regular cycles. Women who monitor cycles and track changes (mucus, libido, pain or mood) are able to predict ovulation only 50% of the time. No substantial evidence that monitoring (using any method) helps increase probability of pregnancy Cervical mucus peaks within 2 to 3 days of ovulation
Ovulation detection kits Reasonably accurately detects urinary LH surge Ovulation may occur anytime within the two days thereafter. May be helpful in couples having infrequent SI due to choice or circumstances.
Coital practice Coital position and orgasm has no relationship to fertility.
The effect of alcohol on fertility is not clear. It has been estimated that alcohol consumption of more than 2 drinks a day may be associated with a 60% increased risk of infertility. American Society of Reproductive Medicine (ASRM- 2013): higher levels of alcohol consumption (>2 drinks/day) are probably best avoided when attempting pregnancy. NICE: 2 units of alcohol once or twice per week, men: 3-4 units/day. Alcohol and fertility
The literature strongly supports an association between cigarette smoking and infertility. Adverse effect of smoking is dose dependent.
Smoking causes: 1. a more rapid reduction in the number of follicles in the ovary and may cause chromosomal and DNA damage to the eggs. 2.shorter cycle length (≤ 24 days) and this has been associated with possible reduced chances of pregnancy. 3.earlier age of menopause, occurring one to four years earlier in smokers. 4.require twice the number of IVF attempts to conceive than non-smokers. 5.If pregnancy occurred, smoking was associated with increased risk of spontaneous miscarriage and ectopic pregnancies. Smoking and fertility
The adverse effects of passive smoking has also now been established and there is now good evidence that non-smokers with excessive exposure to tobacco smoke may have reproductive consequences as great as those observed in smokers. Smoking and fertility
High levels of caffeine consumption associated with infertility. ‘High’ levels defined: more than 5 cups of coffee a day or its equivalent; 500mg. During pregnancy, caffeine consumption of more than 200- 300mg/day may be associated with an increased risk of miscarriage. However, there does not appear to be an increased risk of congenital anomalies. The American Society of Reproductive Medicine (ASRM- 2008) overall, moderate consumption of caffeine (defined as one to two cups of coffee per day or its equivalent) before or during pregnancy has no apparent adverse effects on fertility or pregnancy outcomes.