Enhancing Natural Fertility

1. Enhancing Natural Fertility Ahmad Hammoud MD, MPH Utah Center For Reproductive Medicine University of Utah

2. Important points • The effect of age on natural fertility • Other factor that can affect natural fertility • Enhancing natural fertility • Naturally enhancing fertility treatments

4. Protect your eggs • 1–2 million oocytes at birth • 300,000–500,000 at puberty • 25,000 at age 37 years • 1,000 at age 51 years

5. IVF success rates and age

6. Factors that reduce the number of eggs • Age • Smoking • Toxins such as dry cleaning products • Genetic conditions • Chemotherapy • Radiation • Infections • Multiple surgeries on the ovaries

7. Additional factors that can affect fertility • Weight • Diet • Exercise • Pollution

8. Weight and fertility • Obesity in women • Irregular ovulation • Increased risk of miscarriage • Increased risk of preterm birth • Underweight women • Loose menstrual cycle and ovulation • Are at an increased risk for pregnancy complication such as intra-uterine growth restriction

9. Weight and fertility • In men, increased weight results in lower sperm count

10. Diet and fertility • Alcohol (more than 2 drinks per day ) can reduce fertility by 60% • Caffeine (more than 250 mg =3 cups per day) can reduce fertility by 45% • Illicit drugs can reduce fertility by 70% • Avoid high intake of seafood: can increase blood mercury levels

11. Diet and fertility • Harvard study: • Increased risk of ovulation problems in women with high intake of : • Saturated fat compared to mono unsaturated • Rapidly digested carbs compared to slow digested carbs • Animal protein compared to plant protein • High protein compared to low protein • Low amount of whole milk products

12. Exercise and fertility • Natural pregnancy • Excessive exercise can affect the menstrual cycle: • Luteal phase defect • Arrest of menstrual cycle • IVF • 30% reduction in pregnancy rate in IVF patients if cardiovascular exercise exceeds 4 hours per week

13. Pollution and fertility

14. Pollution and fertility Ahmad Hammoud MD

15. Natural solutions

16. Fertile window of the month Fertile window 1 14 28 First day of flow Ovulation

17. Timing • For couple who have infrequent intercourse because of work schedule or other reasons: • Use LH predictor kit: when positive have intercourse the same day and the following day • For couple that are capable of more: • Frequent intercourse is better than ovulation predictor kits

18. Myths • Abstinence is better • Some sex positions are better • Certain times of the days are better • I need to stay flat or the hip should be tilted upward after the intimate relation to save the sperm

19. Lubricants • Some lubricants can damage the quality of the sperm • KY Jelly • Astroglide • Touch • Olive oil • Better lubricant if needed • Canola Oil • Pre-Seed

20. Life style interventions • Weight loss or weight gain if necessary • Stop smoking • Reduce alcohol or stop completely • Reduce caffeine to less than 3 cups/day • Avoid heavy exposure to chemicals, toxins, and solvents • Reduce exercise to less than 4 hours per week while attempting pregnancy

21. Weight loss

22. Vitamins and supplements • All women should be on folic acid 400 mg daily • For men several antioxidants have been suggested to help sperm such as • Vitamin C • Vitamin D • N-Acetylcysteine • CoQ10 • For women, a new study suggest that CoQ10 can fight the effect of aging on the quality of eggs

23. Diet • A balanced diet rich in antioxidants • New study showed that women undergoing IVF have a higher rate of pregnancy with Mediterranean diet: • Vegetable oil • Legumes • Fish • Vegetables • Low snacks

24. Take home message • If you are less than 30, no other infertility factors , you can try naturally for a year • If you are more than 35, no pregnancy after 6 months, get checked : clock is ticking • You can still try enhancing your fertility naturally while undergoing treatments such as insemination or IVF • Discuss with your doctor your plan for natural treatment because some treatments can be counter productive

25. Ahmad Hammoud MD, MPH Utah Center For Reproductive Medicine University of Utah