LIFE STYLE MODIFICATION IN INFERTILITY MANAGEMENT
The number of infertile people in the world may be as high as 15%, particularly in industrialized nations. Lifestyle factors can be modified to enhance overall well-being as they are ultimately under one’s own control. They play a key role in determining reproductive health and can positively or negatively influence fertility.
My motto In life is : Live every day to the fullest — in moderation.”
The goal of this review is to demonstrate the potential effects of multiple lifestyles on reproductive health for both men and women. The review focuses primarily on modifiable lifestyles including the age when starting a family, nutrition, weight management, exercise, psychological stress, cigarette smoking, recreational drugs use,medications, alcohol use, caffeine consumption, environmental and occupation exposure, clothing choices, hot water, and lubricants.
The reproductive timeline
Age of a man or woman is as important as other factors that can affect fertility. Due to pursuit of education and other factors, many couples are choosing to delay childbearing.Fertility peaks and then decreases over time in both men and women, thus the reproductive timeline may be one aspect to consider when determining the ideal time to start a family. As men age, testosterone levels begin to decrease and hypogonadism results. Semen parameters also begin a steady decline as early as age 35; semen volume and motility both decrease and morphology may become increasingly abnormal. After the age of 40, men can have significantly more DNA damage in their sperm, as well as decline in both motility (40%) and viability (below 50%) (n = 504,p < 0.001).
The reproductive timeline for women is complex. A woman is born with all the oocytes she will ever have, and only 400–500 are actually ovulated. As the number of oocytes decline, a woman’s menstrual cycle shortens and infertility increases.When under the age of 30, a woman’s chances of conceiving may be as high 71%; when over 36, it may only be 41%.
Maintaining a balanced diet and a healthy weight can make a difference in chances of conceiving nd maintainence of pregnancy. Epidemiological data suggest that obesity accounts for 6% of primary infertility. Overweight and obesity are associated with lower implantation and live-birth rates, and are at increased risk for cycle cancellation. Women with a very low body mass index (BMI) also are more likely to experience infertility and have a lower likelihood of success with IVF than women whose BMI falls in the normal range.
In men, obesity is also associated with infertility — sperm count and motility have been shown to be lower in obese men. Weight loss has been shown to improve semen parameters. Erectile dysfunction is more common in obese men.
Aerobic exercise has a positive effect on improving ovarian morphology, both ovarian volume and number of follicles, in women with polycystic ovarysyndrome (PCOS).
Exercise has a similar effect on men—one hour of exercise three times weekly seems to be associated with a higher count, motility, and normal appearing sperm than sperm from men who do not exercise and those who engaged in more frequent/vigorous exercise.
Caffeine in general does not show a significant negative impact on time to pregnancy in normal women; however, some research indicates that caffeine intake of more than 50 mg/day is linked to lower pregnancy rates in IVF patients. A study of over 600 women reviewed the effect of coffee and tea on IVF. Increased caffeine serum levels adversely affected the number of eggs; coffee consumption was correlated with the number of miscarriages and high tea consumption resulted in a decline in the number of good embryos.
Extreme alcohol intake has been associated with decreased fertility. What is less clear is the amount of alcohol it takes to negatively impact reproductive function. A review of the literature suggested that four drinks per week is associated with a decreased likelihood of successful IVF in women. It is universally suggested that alcohol should be avoided when undergoing IVF.Female alcohol consumption is associated with fewer oocytes obtained, lower pregnancy rates, and a 2.21 times increased risk of miscarriage. Heavy alcohol consumption in men is associated with decreased sperm count, motility,testicular atrophy decreased libido and decreased percent of normal appearing sperm.
There is strong evidence that nicotine negatively effects fertility. Smoking in men negatively impacts sperm quantity and quality and is associated with reduced success with IVF and intra-cytoplasmic sperm injection (ICSI).Men who smoke tend to have a decrease in total sperm count, density, motility, normal morphology, semen volume, and fertilizing capacity.
Cigarette smoking is associated with infertility, pregnancy loss, and IVF failure. Cigarette smoke contains many harmful components that can adversely affect fertility, including maturation of follicles, embryo transport,endometrial receptivity, endometrial angiogenesis, uterine blood flow, and uterine myometrium.
Studies on the impact of recreational drugs on female fertility are few. Women who use marijuana appear to be more likely to experience infertility. In men, marijuana has been found to increase ejaculation problems and impotence as well as reduce sperm count and motility. Most negative effects from recreational drugs have been shown to be reversed by discontinuing their use
Environmental and occupational exposures
Many potential threats to reproductive health are encountered in every-day life through biological (viruses), physical (radiation), and toxic (chemicals) sources.
Air pollution is the release of pollutants such as sulfur dioxides, carbon monoxide, nitrogen dioxide, particulate matter, and ozone into the atmosphere from motor vehicle exhaust, industrial emissions, the burning of coal and wood, and other sources. Men who are exposed to higher levels of air pollution were more likely to experience abnormal sperm morphology,decreased motility, and an increased chance of DNA fragmentation (n = 48 or 408 respectively).
Negative reproductive side effects of air pollution on women can include preterm delivery, miscarriage, stillbirth, spontaneous abortion, and fetal loss. Many times when fetal loss occurred, there were malformations within the fetal reproductive tract.
The incredible convenience of the cell phone has dramatically increased its usage in the last decade. However,it does not come without negative effects. There havebeen an increasing number of studies demonstrating negative effects of the radiofrequency electromagnetic waves (RFEMW) utilized by cell phones on fertility. Cell phone usage has been linked with decreases in progressive motility of sperm, decreases in sperm viability, increases in ROS, increases in abnormal sperm morphology, and decreases in sperm counts.
While amount of research demonstrating negative effects of cell phone usage and fertility grows, there can be no clear conclusion as no standard for analyzing cell phone effects is available and many studies have limitations. Another aspect to consider is the effect of text-messaging on the body, as it is becoming more prevalent in respect to making phone calls.While technology quickly advances, research lags behind, providing the opportunity for unforeseen damage to occur.
While contraceptives are often associated with preventing pregnancy, several studies have demonstrated that both condom usage and oral contraceptives can preserve fertility in women. In 2010, Revonta et al. concluded that infertile women used less oral contraception; women who considered themselves infertile might be less inclined to use contraceptive. In one study,condom users had shorter time to conception compared to oral contraceptive users; oral contraceptive users in turn had shorter time to conception than those women not using any contraceptives.
Many fertility authorities rely on the data provided from research of the effects of temperature on sperm function and then apply the idea to hot baths, jacuzzis, or saunas. Tight-fitting clothing (especially underwear), prolonged bicycle riding, hot tubs and hot baths, or holding a laptop computer on your lap rather than on a pillow or desktop, can increase scrotal temperature
Many studies have been conducted hoping to find an answer to the question of what type of clothing is best for fertility. The view that elevation of scrotal temperature negatively impacts spermatogenesis and sperm parameters is universally acknowledged. But the question of whether tight-fitting underwear actually has an effect on scrotal temperature and therefore semen quality has long been debated. . Increases in scrotal temperatures could be due to an increase in temperature of about 3.5°C of the air between the clothing and the skin in comparison the ambient air.
Many sexually active couples choose to utilize vaginal lubricants to treat vaginal dryness and pain during intercourse. While attempting to conceive, nearly 75% of participating couples reported to an internet study that they used lubricants to ease the female partner’s vaginal dryness, and 26% had claimed that they almost always used a lubricant.
A few studies have shown that a higher intake of folic acid (the synthetic form of folate, which occurs naturally in foods like oranges) may improve ovulation. It’s important that all women of reproductive age take between 400 and 800 mcg each day. And men who get higher doses of folate make healthier sperm, potentially reducing the chances of miscarriage or genetic problems in their babies.
The fertility treatment process presents a roller coaster of emotions. Some couples with multiple problems will overcome great odds, while other, seemingly fertile, couples fail to conceive. The emotional burden on the couple is considerable, and some planning is helpful. While there are associations between psychological effects and infertility, it is hard to establish a cause-effect relationship. Couples attempting to conceive may try relaxing and reducing exposure to stressors in an effort to increase fertility.
The present literature review encompasses multiple lifestyle factors and places infertility in context for the couple by focusing on both males and females.The growing interest and amount of research in this field have made it evident that lifestyle factors have a significant impact on fertility.It is important to understand the ways in which lifestyle behaviors may benefit or harm fertility in order to minimize complications and to maximize fertility outcomes.
Clearly, there is a need for early education on the value of health promotion and prevention in relation to the management of infertility.
Physicians and nurses need to take a more active role in educating patients on the impact of lifestyle factors on fertility and fertility treatment outcome.