Infertility

Infertility is defined as the inability for a couple to get pregnant after 1 year of trying. In females it can also be defined as the inability to bring a pregnancy to a live birth. Approximately, one in six couples in New Zealand experience infertility and one in eight couples require some form of medical assistance to achieve a pregnancy. In approximately 35% of cases the infertility is due to a problem by one partner, and it is equal between the male and female in about 25%.

There are several different causes for infertility. For men there may be problems with the quality or amount of sperm produced. This can be caused by an anatomical problem, an endocrine disorder or caused by a genetic defect. For women there are considerably more problems causing infertility. It may be a problem in ovulation which can be caused by polycystic ovarian syndrome, amenorrhea (the absence of the menstrual period- which in itself has several different causes) and problems with the flow of the egg through the reproductive areas, specifically the fallopian tube.

Symptoms

Infertility may cause no physical symptoms. It can, however, generate feelings of emotional stress and frustration, which can lead to strife within a relationship and physical problems related to stress.

Diagnosis and Pharmaceutical Interventions

For men the history is obtained and physical examination is performed to search for causes of infertility. Mumps, inflammation of the testes, cryptorchidism (a condition in which one or both testes fail to descend normally), testicular injury, exposure to industrial or environmental toxins, excessive heat exposure, acute illness or prolonged fever within the previous 3 months, recreational drug use, alcohol intake, and exposure to diethylstilbestrol or anabolic steroids should be excluded. Physical examination should focus on anatomic abnormalities–i.e. decreased testicular volume, an inflamed prostate gland, hypospadias (where the penile opening is located on the wrong side), or a varicose veins in the testicule. The main diagnostic technique is semen analysis to evaluating male infertility. It should be performed after 2 to 3 days of sexual abstinence. This analyses the appearance, volume, viscosity, the sperm count, sperm motility and shape.

Specialized tests of sperm function and quality are available at major infertility centers and may be appropriate before any assisted reproduction techniques are considered.

For women, monitoring ovulation is one of the first places to start. This can be measured via an endometrial biopsy that measures the development of the uterine tissues in response to reproductive hormones. A delay of more then 2 days may suggest a luteal phase deficiency, in which the production or action of progesterone in the luteal or last half of the menstrual cycle is inadequate. For this diagnosis to be established, delay should occur in two menstrual cycles. A condition that contributes to infertility is polycystic ovarian syndrome (PCOS), where the female reproductive hormones between the brain and the ovary are imbalanced. Tests for this include looking at levels of the hormones prolactin and follicle stimulating hormone, insulin and thyroid stimulating hormone.

Looking at the patency of the Fallopian tubes through imaging techniques such as an ultrasound or xray of the area may also be a consideration in diagnosis of fertility for women. It may be related to other conditions such as pelvic inflammatory disease, the improper use of an intrauterine device, ruptured appendix, a lower abdominal surgery or ectopic pregnancy.

Home evaluation can also be used for women to assess normal ovulation. Daily measurements of basal body temperature have been used successfully to monitor ovulation. A nadir in temperature suggests impending ovulation; an increase of greater than 0.5° C characterizes the postovulatory period.

There are medications to stimulate ovulation in women. Clomiphere citrate (phenate or clomid) is an ovulation inducer; it is an antagonist to estrogen. Some adverse reactions to it include hot flashes, abdominal pain, breast pain, nausea and headaches. It should not be used by anyone with a history of liver disease, and ovarian cysts. If used for more than 12 cycles, it is thought to contribute to ovarian cancer.

Many people believe that certain vitamins should not be taken during pregnancy. Vitamin A is one example. It is only when the vitamin A is in the form of retinol (in other words, the fat soluble, animal form of vitamin A) that there is a problem. It has been found that retinol can cause birth defects if taken in excess of 10,000 IU a day. Beta-carotene, which is one of the vegetable forms of vitamin A, does not carry any risks.

Lifestyle and Dietary Modifications

The optimal temperature of the testes for sperm production is slightly lower than body temperature, which is why the testes hang away from the body in the scrotum. Men with low sperm counts are frequently advised to minimize lifestyle factors that may overheat the testes, such as wearing tight (e.g., “bikini-style”) underwear or frequently using spas and hot baths.

There are several substances that may change fertility for both the male and females. Coffee intake is associated with reduced rate of conception. This effect can emerge at about three or four cups per day. It is recommended that those wishing to conceive discontinue all caffeine.

Smoking reduces fertility even in the children of smokers. The more women smoke, the less likely they are to conceive. In fact, it has been shown that women whose mothers smoked during their pregnancy are less likely to conceive compared with those whose mothers were nonsmokers. Smoking is also associated with low sperm count. Quitting smoking may enhance fertility.

Even moderate drinking of alcoholic beverages by women is linked to an increased risk of infertility in some research. Alcohol intake should be modest, at most, in women attempting to achieve pregnancy.

Medications can interfere with fertility, for example sulphasalazine, a drug used to treat inflammatory bowel disease can drastically reduce fertility in males. Other medications that may contribute to infertility are anabolic steroids, methotrexate, some nonsteriodal anti-inflammatories and chemotherapeutic agents for treating cancer.

Common pesticides can reduce sperm count. Lower sperm counts and obvious damage to the quality of the sperm producing part of the testicles (called the seminiferous tubule) were found in test animals exposed to the pesticide chlordane. Other sperm abnormalities are associated with the use of chemical fertilizers. These compounds act as xenoestogens, which interfere with the normal activity of reproductive hormones. They also come from plastics. It is recommended to use organically grown foods.

Consumption of food contaminated with polychlorinated biphenyls (PCBs) may reduce the ability of women to conceive. Foods commonly high in PCB’s are Great Lakes fish and farmed fish. Women who ate more than one fish meal per month of fish known to be contaminated with PCBs had reduced fecundity (meaning that it took longer for them to become pregnant) compared to women who ate less contaminated fish.

Being both overweight and underweight can impair fertility. Obesity is associated with PCOS, along with diabetes type II. Exercise, combined with calorie restriction, has led to improvement in cycles in women with PCOS. Women who are underweight have an increased risk of infertility due to low levels of reproductive hormones and lack of the menstrual cycle.

Nutritional Factors Shown to be Beneficial

Multivitamin- Mineral supplement

It has been shown that that taking a multivitamin-mineral supplement may increase female fertility. Women who use a supplement containing folic acid beginning three months before becoming pregnant and continuing through the first three months of pregnancy, have a significantly lower risk of having babies with neural tube defects (e.g., spina bifida) and other congenital defects.
Dose: as instructed on bottle

Vitamin C

Supplementation with this vitamin may help with problems due to a hormonal abnormality known as luteal phase defect. It may increase pregnancy rates by 25%. Vitamin C also enhances sperm quality, protecting sperm and the DNA within it from damage.
Dose: 750 -1000 mg a day

Vitamin E

It has been shown that Vitamin E deficiency in animals leads to infertility. It has been suggested that the antioxidant activity of vitamin E make the sperm more fertile.
Dose: 400-800 IU a day

L-Arginine

The head of the sperm contains an exceptional amount of this nutrient, which is essential for sperm production. Supplementation with L-arginine has been shown to improve fertilization rates in women with a previous history of failed attempts at in vitro (test tube) fertilization.
Dose: Females: up to 5 grams a day, males 500 -1000 mg a day

Calcium

Calcium is a key regulator of human sperm function, as the concentration of calcium in semen determines sperm motility (the ability of sperm to move spontaneously).
Dose: 1000 mg a day

Coenzyme Q10 (CoQ10)

CoQ10 is a nutrient used by the body in the production of energy. While its exact role in the formation of sperm is unknown, there is evidence that as little as 10 mg per day (over a two-week period) will increase sperm count and motility.
Dose: 10- 30 mg a day

Vitex (Vitex agnus-castus)

This herb is occasionally used as an herbal treatment for infertility—particularly in cases with established luteal phase defect (shortened second half of the menstrual cycle) and high levels of the hormone, prolactin. It helps to balance the hormones when disturbed in PCOS.
Dose: 40 drops of a liquid extract of vitex each morning with water. Approximately 35–40 mg of encapsulated powdered vitex (one capsule taken in the morning) provides a similar amount. Vitex should be discontinued once a woman becomes pregnant.

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