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Fertility Europe United in Europe – helping the storks to fly
Treatment of Subfertility
Martin ImhofFertility Europe, ESHRE, Stockholm July 4, 2011
Regular Fertility
• conception = 25-30% per female month
healthy couples conceive
• 50% after 3 month • 75% after 6 month• 90% after 12 month
• medium 4 month to conceive
Definition of Subfertility
• reduction of male and female fertility
• no pregnancy after a period of 12 months of sexual intercourse
• every 5th couple has problems in reproduction
• every 10th couple needs medical treatment
Subfertility
Age first Delivery
Age and Fertility
-- % abortion-- % fertility
Time delay
Wish to start family
Causal treatment
up to 7 years
Fertility Check
day 1 day 30
First Consultation
Blood check Semen analysis
8-10 days
SonographyHysteroscopy
Fallopian TubesInfection screening
SummaryNext steps
1-3 days
Female Treatment
• Track ovulation • Hormonale therapy• Therapy of infections • Ovarian stimulation• Laparoscopy • .....• Less than 3-5% need IVF
Swan et. al. – National Institute of environmental health sciences
•Review of 101 published studies•Data collected 52 years (1938-1996)
Average annual decrease of
U.S. minus 1.5%/year
Europa minus 3.1%/year
Semen Quality
Male Subfertility
Guidelines on food fortifcation with micronutrientsby Lindsay Allen et al. World Health Organization andFood and Agriculture Organization of the United Nations2006
Male factor subfertility: possible causes and the Impact of nutritional factorsWong WY et al., Fertil Steril 2000 73:435-442
Profertil Study with 120 men, Ø 35,9 a (23-58) Intake 2x1 Capsule daily for 3 Month
L-Carnitin 440 mgL-Arginine 250mgVitamin E 120 mgSelenium 60 μgGlutathione 80 mgFolic-acid 800 μgCoenzyme Q10 15 mgZinc 40 mg
Improvement of Male Fertility
Concentration in Mio/ml
53,19 mio
29,46 mio
20 mio
10 mio
50 mio
60 mio
40 mio30 mio
+ 80,54%
Prog. Motility Ejaculate in ml
3,61 ml
2,91 ml
1ml
0 ml
4 ml
5 ml
3 ml
2ml
+ 24,05%
19,27%
8,95%
5 %
0 %
20 %
15 %
10 %
+115,3%
Sperm QualityImproves with Micronutritients
natural conception
insemination
In vitro fertilisation (IVF)
Intracytoplasmatic sperm injection (ICSI)
Better Sperm - Less Intervention
Martial Fertility
First line• Age• Lost time
Second line • Medical condition
Fertility Treatment
Question of supporting not replacing nature
IVF treatments:treatment of majar medical
conditionsnot a reaction to lost time
Thank You for Your Attention
Reasons of Infertility
unknown
male
hormones
endometriosis
abortion
fallopian tubes
myoma
cervix
others
The Road to Conception