For optimum fertility, men and women should have a balanced diet, normal body mass index (20-25) and a regular but moderate exercise regimen. High frequency or intensity of exercise can reduce fertility in both sexes. Regular smoking or use of recreational drugs reduce sperm concentration, motility and affect its DNA. Alcohol intake in women may prolong time to pregnancy. Excessive alcohol intake can also cause significant damage to the child during pregnancy and it is best avoided or limited to 1-2 units per week. Similarly amongst men, regular and excessive alcohol intake can cause a variety of sperm function disorders and should be limited or avoided.
Medical evidence supports folic acid supplementation in women for a reduction in the risk of spina bifida. Scientific evidence for benefit is lacking with regards to other dietary supplements. Obesity, alcohol, tobacco smoke, and environmental pollutants induce chemicals in the body called reactive oxygen species (ROS) and these are widely responsible for cell damage. Antioxidants (vitamins C and E) and antioxidant cofactors (selenium, zinc, and copper) are capable of disposing, scavenging, or suppressing the formation of ROS. However prospective scientifically designed studies are needed to adequately evaluate the relationship between oxidative stress, dietary supplements and fertility. Use of anabolic steroids, cannabis, heroin, and other recreational drugs is absolutely prohibited.
In a regular 28 day menstrual cycle, the fertile period for most women is between the 10th to 14th day. Urine dipstick tests are readily available at the chemist shops and can be used for identification of the ovulation/fertile time.
Overall, around 70% of couples will have conceived by 6 months, 85% by 12 months and 95% will be pregnant after 2 years of trying. NICE 2004 stated that “people who are concerned about their fertility should be informed that about 84% of couples in the general population will conceive within 1 year if they do not use contraception and have regular sexual intercourse. Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate 92%).” However women’s fertility starts to decline before their 30th birthday and the effects of age accelerate in late 30’s. Investigations are generally begun at 12-18 months but it is recommended that they be brought forward in couples with predisposing risk factors.
Amongst women, apart from age, history of menstrual disorders, pelvic surgery, past history of an ectopic pregnancy, sexually transmitted infection, chemo/radiotherapy, chronic systemic illness, family history of premature menopause, endometriosis and polycystic ovaries are some examples. Amongst men, history of undescended testis, inflammation of the epididymis or testis, sexually transmitted infection, diabetes, family history of male infertility, sexual dysfunction, chemo/radiotherapy etc would be indications for an early investigation.