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