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Infertility: initial advice; change in health

Mr Anil Gudi, Mr Amit Shah and Prof Roy homburg

About 15-16% of couples fail to conceive after one year of unprotected regular intercourse. After two years, with no treatment, about half of these will still not have conceived. Most couples will turn for help after one year. That means that one in seven couples will look for advice after one year. Earlier investigation and treatment should be initiated where there is a history of obvious fertility impeding factors such as irregular periods, previous operations in the lower abdomen, pelvic infection, undescended testis, sexual dysfunction or if the female partner is aged 35 years or over. Advancing female age is probably the single most important factor influencing fertility potential. From the age of about 35 years onwards, there is a steady downward trend in fertility capacity and this is probably a reflection of the declining number of eggs remaining and biological aging.

Many couples attempting to conceive are unaware that regular intercourse around the time of ovulation is a basic requirement. Trite as they may sound, a simple explanation regarding the approximate time of presumed ovulation for the woman with regular cycles may prove very helpful. If the couple are advised to have intercourse a minimum of once every two days around this time, pregnancies can be achieved in not a few cases without further investigation or treatment.

Excessive regular alcohol consumption by the male partner may affect not only sexual performance but also semen quality. Smoking is clearly not good for general health and couples attempting to conceive should be encouraged to stop smoking. There is evidence to show that women who smoke heavily may have a reduced fertility potential and that the semen quality of men who smoke may be reduced.

Many medications, whether prescribed, over-the-counter or recreational drugs, may interfere with male and female infertility. Due note must be taken of such medication and appropriate measures taken. Some of the most common examples include some sedatives that increase prolactin discharge, so-called complementary medications containing oestrogens, and salazopyrines that may have drastic effects on semen quality.

Both extremes of body weight may have a significant effect on fertility potential. Obese women have a significant disadvantage in fertility potential, take longer to conceive, require more drugs for ovarian stimulation and are at a greater risk of miscarriage than those of normal weight. Participation in a programme involving instruction in diet, weight loss and exercise before the initiation of any further treatment can be very rewarding. Obese men are also more likely to have reduced fertility and should similarly be encouraged to lose weight. Underweight women who have irregular or absent periods should be encouraged to increase their weight as, often, this alone may restore regular ovulation.

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