Lifestyle and infertility. Laura dracea, MD, PhD Gynera Fertility Center Bucharest, Romania.
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We hope you enjoyed your coffee.Don’t worry! Up to 5 cups of coffee/day have No demonstrable adverse effects on your health.Higdon J, Frei B. Coffee and Health: a review of recent human research. Crit Rev Food SciNutr 2006; 46
our choices or our patients’ choices
could make a difference?
Infertility factors identified What about the other 20% ?
in 80 % of the cases
Different results of the treatment Why ?
in patients with same causes
Adjuvant medication Why not adjuvant lifestyle ?
Patients underestimate the What about professionals ?
influence of certain factors
Aren’t we missing something?
Infertility Increases With Age
Age Group (years) Percent Infertile of remaining childless
20 - 24 7 6
25 - 29 9 9
30 - 34 15 15
35 - 39 22 30
40 - 44 29 64
Success rates of ART treatment by maternal age
The most recent United States IVF-monitoring U.S. 2007
(CDC online publication)
Average pregnancy rate per cycle:
Woman age < 3535-3738-4041-4243-44
Fresh cycles 40 % 31 % 21 % 12 % 5 %
U.S. Department of Health and Human Services, Centers for Disease Control (CDC) at /www.cdc.gov/ART/ART2007
Review of data from the various IVF centers in the USA 2007 CDC Report
Smoking vs Nonsmoking women
Relative risk of infertility increased 60% Clark et al., 1998
Increased miscarriage risk Natural conception Augood et al., 1998
Assisted conception Winter et al., 2002
Increased risk for ectopic pregnancy Saraiya et al., 1998 Conception delay over 1 year Augood et al., 1998
Hull et al., 2000
Require nearly twice the number of IVF cycles to conceive Feithinger et al., 1997
Each year of smoking - 9% increased risk of unsuccessful ART Klonoff-Cohen et al.,2001
Decreased IVF pregnancy rate for passive smokers as well Neal et al., 2005
Menopause occurs one to four years earlier Mattison et al., 1989
Baron et al., 1990
Higher gonadotropin dose requirements MacMahon et al., 1982
More diploid oocytes in the ovary Zenzes et al., 1995
Lower sperm count in male progeny Storgaard et al., 2003
Increased risk of trisomy 21 offspring Yang et al., 1999
Increased transmission of modiﬁed DNA to embryo Zenzes et al., 1999
Much of the risk may be reversed within a year of cessation Hughes et al., 2000
Smoking as a risk factor for men
Most recent systematic review and meta-analysis
Li et al., FertilSteril 2011
57 cross-sectional studies
29,914 participants from 26 countries/regions
Sperm parameter Pooled mean difference Test for overall effect
IV 95 % CI p value
Sperm volume -0.25 (-0.32,-0.18) < .00001
Sperm density -7.07 (-10.03,-4.10) < .00001
Total sperm count -32.20 (-43.28,-21.11) < .00001
Sperm motility -1.85 (-3.27,-0.43) .01
Sperm normal morphology -4.92 (-6.90,-2.94) < .00001
Sperm abnormal morphology 0.72 (0.15,1.29) .01
30%–47% of overweight women have irregular menses Castillo-Martinez et al., 2003
Obesity decreases fecundity, even in ovulatory women Gesink Law et al., 2007
Ovulation and pregnancy rates improve after weight loss Clark et al., 1995
Obesity decreases IVF pregnancy rate Nichols et al., 2003
Obesity increases requirement for gonadotropins Fedorcsac et al., 2004
The risk for spontaneous abortion increases in overweight Wang et al., 2002
The risks for preeclampsia, gestational diabetes increase Dokras et al., 2006
The effect of BMI on sperm parameters is uncertain Li et al., 2011
Moderate alcohol consumption
Detrimental effects on fetal development American Academy of Pediatrics, 2001
o evidence to indicate that adversely affects fertility Parrazini et al., 1999
Higher alcohol consumption (> 2 drinks/day)
Decreases fecundity Williams et al., 2009
Can reduce semen volume Li et al., 2011
High levels of caffeine consumption (> 5 cups/day)
Decrease fertility Bolumar et al., 1997
Increase the risk for miscarriage Signorello et al., 2004
Mild consumption of up to 200 mg caffeine per day
( 2 cups)
Not associated with any apparent adverse effect on reproduction
Have been shown to have a negative effect on fertility:
Toxins and solvents used in the dry cleaning and printing industries
Pesticide exposure for agricultural workers
The most common reason for discontinuation of fertility treatment
Inversely related to pregnancy and life birth rate in IVF
No convincing evidence demonstrates a direct adverse effect on fertility
More often an effect than a cause for infertility:
Prolonged infertility Too many treatment cycles
High psychological impact
Unprotected intercourse via Sexual transmitted diseases
Cause hormonal dysregulation in women
Reduce testosterone level, sperm motility and capacitation
Anabolic androgenic steroids Suppression of hypotalamo-gonadal axis
Methadone Depress spermatogenesis
NSAI Impairment of follicle rupture and tubal function
Calcium channel blockers Fertilization failure
Anderson K et al. Lifestyle factors in people seeking infertility treatment - A review. Aust N Z J ObstetGynecol 2010
Roth et al., 2001
Tool: Provide convincing evidence !
Do not defer childbearing!
Do not defer fertility treatment!
Do not defer IVF treatment for women over 38!
How relevant is this choice?
Percent of infertile women < 15 % 29 %
Risk of spontaneous abortion 15 % 30 %
Risk of genetic defects in newborn 1/192 1/42
Average success rate of IVF 30-40 % < 12 %
How relevant is this choice?
Loose weight to:
Dilemma: Delaying treatment to allow loss of weight
Stop drinking alcohol during pregnancy!
No safe level of consumption to avoid detrimental effect on fetal development
Avoid high consumption (>2 drinks/day) when attempting pregnancy!
No evidence to indicate that moderate consumption adversely affects fertility
Quit drinking coffee?
Just do not exaggerate!
Do not blame the psychological stress for everything.
This is not supported by evidence.
Older, fatter, stressed, tobacco intoxicated and infertile
but having a career and affording assisted reproduction?
Apparently, the lifestyle factor that has the most detrimental effect on fertility potential seems to be the social trend of having a career before a family
We need to make people aware of the consequences !
They could deal with both goals in a much more efficient way.