So what is the problem? Michael Savvas Assisted Conception Unit King’s College Hospital

Chance of conception Natural Woman < 40 years More than 80% of couples will conceive within 1 year Of remaining 20% half will conceive in second year 2 year cumulative pregnancy 90%.

Chance of conception Pregnancy Rate (%) Age

When to investigate After one year of unprotected SI Earlier referral where: The woman is > 36 years There is a known clinical cause There is a history of predisposing factors

Assessment A specific enquiry about lifestyle and sexual history should be made. NICE 2013

Lifestyle Frequency and timing of SI Alcohol Smoking Caffeine Body weight Exercise Diet Psychological stress

Frequency and timing Timing not helpful SI 2-3 times a week Most pregnancies result from SI occurring in window 5 days before and day of ovulation

Alcohol Women who are pregnant or trying to conceive should consume <1-2 units per week Excess alcohol (more than 3-4 units per day) is detrimental to sperm

Smoking Reduced fertility in women Effect on pregnancy Effect on male fertility unclear but does effect semen quality

Caffeine In combination with alcohol can effect semen quality

Obesity BMI >30 assoc with reduced fertility in men and women Women with BMI<19 Amenorrhoea, infertility and pregnancy complications Diet and exercise can improve fertility

Recreational Drugs Marijuana and Cocaine Can effect ovulation and tubal function Can effect Semen quality Anabolic steroids Can effect semen quality

Stress Effects male and female fertility Fertility treatment stressful

Vitamins and Anti-oxidants Selenium Vitamin C, E Zinc Selenium Folate Shown to improve sperm motility

Conclusion Healthy lifestyle improves Natural fertility Treatment outcomes