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

2. 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%.

3. Chance of conception Pregnancy Rate (%) Age

4. 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

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

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

7. 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

8. 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

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

10. Caffeine In combination with alcohol can effect semen quality

11. 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

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

13. Stress Effects male and female fertility Fertility treatment stressful

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

15. Conclusion Healthy lifestyle improves Natural fertility Treatment outcomes