The ultimate guide to fertility

Infertility, which affects approximately 15% of couples worldwide, is defined as the inability to conceive after one year of regular unprotected intercourse (or six months if the woman is over the age of 35). In this extensive guide, leading GP Dr Sidra Hasan covers the common causes of infertility and different methods to improve fertility.

 

 

Common causes of infertility

Causes of infertility can be due to biological issues of both the mother and even the father.

In women, infertility can be attributed to hormonal imbalances, structural issues, or complications that come with ageing.

Hormonal imbalances can cause irregular ovulation, which means that the egg cannot reliably mature and be deposited into the uterus, therefore causing difficulty with fertilising an egg. This can be due to:

• Thyroid dysfunction, which can oestrogen and progesterone levels to be imbalanced to the point of interfering with ovulation.
• PCOS (Polycystic ovary syndrome), which can cause cysts to grow on the fallopian tubes and obstruct the egg implantation, or cause the womb lining (endometrium) to thicken, which is hostile for the egg.
• Elevated prolactin levels, which is the hormone that produces breastmilk and suppresses ovulation for postpartum mothers.
• Luteal phase defects, where the ovaries don’t produce enough progesterone which prepares the endometrium for an egg

Structural in which the fallopian tubes are blocked may physically prevent an egg from entering and implanting in the womb, such as:

• Endometriosis, where endometrium tissue grows outside of the womb and can grow over the fallopian openings.
• Fibroids and cysts that grow over the fallopian tubes and obstruct them.
• Adhesions, which is scarring that forms between the pelvic organs.

Cervical abnormalities like ectropion, polyps, and Nabothian cysts can also prevent sperm from entering the womb properly.

As they age, women’s periods will decrease and eventually stop altogether. During this time, they will have decreased egg quality, reduced ovarian reserves, chromosomal abnormality, and implantation issues. Once a woman reaches menopause, she is no longer physically capable of conceiving.

 Men can also experience infertility. They may have poor sperm health in the form of a low count, poor motility (speed), deformed sperm, or fragmented DNA, which can all prevent successful conception. They may have structural issues too, like:

• Varicocele, which is when the veins of the testicle are enlarged and blood pools in the testicles, deteriorating sperm.
• Blocked ducts, which prevent sperm from entering the womb.
• Prostate problems, like an enlarged prostate, which can also obstruct sperm or cause erectile dysfunction.
• Infections, in which invasive and pathogenic cells can also kill sperm.

If struggling with conception for unknown reasons, it is recommended to undergo fertility testing such as blood work to look at the hormone levels, sperm analyses, structural evaluations like ultrasounds, and genetic testing to see if any chromosomal or genetic abnormalities or undiscovered sexually transmitted infections could be preventing pregnancy.

 

Can fertility be improved?

Hopeful mothers and fathers can make adjustments to their diets and lifestyles and seek medical therapies to improve their chances of successful conception.

 

Diet

For diet, fertility can be enhanced with nutrient and mineral-rich foods like:

• Organic fruits and vegetables
• Grass-fed meats
• Wild-caught fish
• Whole grains
• Legumes
• Nuts and seeds

Foods that can be harmful to fertility include:

• Processed foods
• Excess caffeine
• Alcohol
• Trans fats
• Added sugars
• Artificial additives

There are key nutrients that prospective parents can focus on, and they can easily get their daily fill in the form of supplements, such as:

• Folate – 400mcg of folic acid daily can with neural tube development and is involved with the reduction of homocysteine which has been linked to miscarriage
• Iron
• Zinc – zinc deficiency has been linked to miscarriage
• Vitamin D
• Omega-3 fatty acids – daily doses can improve blood flow and manage sexual hormones
• Antioxidants
• CoQ10 – helps with healthy egg and sperm production
• Selenium – beneficial for sperm health, increasing sperm count and improving morphology and motility

 

Lifestyle

They say parents’ lives are forever changed when they have children, but that change ideally starts before conception.

Be sure to manage stress, as stress and anxiety can affect the mechanisms which allow for normal ovulation and make it longer to get pregnant. This can be achieved with activities such as:

• Meditation
• Yoga
• Deep breathing exercises
• Regular exercise
• Adequate sleep
• Nature walks
• Mindfulness practices

Pregnancy is physically draining and if fitness, stamina, and strength are not up to par, then the body may not feel prepared to conceive. It is recommended that all patients maintain a healthy level of physical activity with activities such as:

• Walking
• Swimming
• Dancing
• Light strength training

However, it is important to maintain balance and avoid excessive or heavy exercise, as this will circle back into stress on the body.

Being aware of the environment around you is also something to consider for a healthy pregnancy:

• Reduce toxin exposure
• Use natural cleaning products
• Choose organic when possible
• Stay adequate hydrated, and filter drinking water
• Avoid plastic containers
• Use natural personal care products

 

Traditional medicine approaches

Medicinal approaches, both modern and traditional, may be explored when trying to increase fertility. Traditional medicine methods from all around the world have been practised for thousands of years. Though you may not find them in the regular hospital, most are undangerous and may even have scientific merit.

Patients can consider natural and homoeopathic supplements. For women: vitex (chasteberry), evening primrose oil, maca root, red raspberry leaf, royal jelly, and probiotics. For men: L-arginine, L-carnitine, ashwagandha, saw palmetto, panax ginseng.

Acupuncture, a 2000-year-old practice from China, has proven benefits in improving blood flow, regulating hormones, and reducing stress, which can lead to enhanced implantation, better egg quality, and reduced endometrial inflammation.

Herbal medicines, which are nontoxic and safe for consumption, can be utilised. There are many different kinds from all over the world, such as Chinese formulas, Ayurvedic remedies, Western herbalism, and adaptogenic herbs.

 

Fertility tracking and support

To track fertility and plan around the optimal time for conception, fertility tracking apps are widely available. However, it is also important to be familiar with your own body and increase natural awareness. This can be achieved by keeping note of the basal body temperature (the lowest temperature when at rest) daily, monitoring the luteal cycle and ovulation patterns and keeping notes on the texture and quality of discharge (which can indicate when it is easiest for the sperm to reach the womb).

Once you're familiar with tracking your cycle, you can predict your optimal conception windows, meaning you can identify the days when you are supposed to be most fertile and can plan your intercourse around it. Ovulation tends to occur 14 days before the menstruation starts, so planning intercourse for the days 10 to 15 of a typical 28-day cycle can be beneficial.

Sexual health expertise and resources can advise on the best positions, lubrication options, and frequency guidelines to increase the chances of getting pregnant.

Struggles with infertility can be emotionally taxing. Be sure to stay in open, honest dialogue with your partner about this journey and make decisions together about your options and health. If one person feels too burdened, then stress will increase which will be counterintuitive to your goals.

Find community with counselling and support groups. Many other couples and people around the world have been in similar positions, so talking with them about what worked and didn’t work for them may be enlightening.

 

Conclusion

If you are under the age of 35 and have been trying and failing to conceive for over a year, or are over 35 and have been trying for over six months, it may be time to seek professional consultation and treatment regarding your fertility and further options. If you have experienced recurrent miscarriages, or have a diagnosis that could be interfering with conception, then seek medical counsel as soon as possible.

Managing infertility naturally requires a comprehensive approach that addresses physical, emotional, and environmental factors. Success often comes from combining multiple strategies and maintaining patience and consistency. While natural approaches can be effective, it's important to work with healthcare providers and know when to seek additional medical support.

Remember that every person's fertility journey is unique, and what works for one may not work for another. The key is to develop a personalised plan that addresses specific causes while promoting overall health and well-being.

 

If you are struggling to conceive, you can consult with Dr Hasan via her Top Doctors profile.