What is Fertility?
Fertility refers to the biological ability of an individual or couple to conceive and carry a pregnancy to term. It encompasses a complex interplay of various factors in both the male and female reproductive systems. So the key aspects of fertility are:
- The ability to conceive: This involves egg fertilization by sperm, which requires healthy reproductive systems and functional gamete production (eggs and sperm).
- Carrying a pregnancy to term: This involves successful implantation, development of the fetus in the uterus, and ultimately, live birth.
- Timeframe: The definitions typically consider a timeframe of 12 months of regular intercourse for a couple to achieve pregnancy naturally.
It’s important to note that fertility can decline with age in both men and women, and various medical conditions and lifestyle factors can impact it. Consulting a healthcare professional for personalised guidance on assessing and potentially improving fertility is always recommended.
Factors Affecting Fertility:
Williams Obstetrics (25th Edition, 2023) by Cunningham et al states:
“Fertility is impacted by a complex interplay of factors, including age, ovarian function, uterine health, cervical health, and overall health in women, and sperm quality, testicular function, and hormonal balance in men.”
Factors Affecting Fertility in Women
- Age: Fertility naturally declines with age, especially in women over 35. Egg quality and quantity decrease.
- Ovulatory function: Regular ovulation is crucial for conception. Underlying health issues like Polycystic Ovary Syndrome (PCOS) can disrupt ovulation.
- Uterine health: Uterine fibroids or polyps can affect implantation.
- Cervical health: Blockages or infections in the cervix can hinder sperm from reaching the egg.
- Overall health: Chronic health conditions like diabetes or thyroid issues can impact fertility.
- Lifestyle: Smoking, alcohol, and excessive weight can negatively affect egg quality and overall reproductive health .
- Reproductive History: Prior pregnancies, miscarriages, or sexually transmitted infections (STIs) can influence future fertility.
Factors Affecting Fertility in Men
- Sperm count and quality: Low sperm count, motility (movement), or abnormal morphology (shape) can affect fertility.
- Varicocele: Enlarged veins in the scrotum can impact sperm production.
- Hormonal imbalances: Testosterone deficiency can affect sperm production.
- Lifestyle factors: Smoking, alcohol, and drug use can decrease sperm quality.
Assessing Fertility
Several inputs can provide insight into your fertility health:
- Age: This is a readily available indicator.
- Coital frequency of 2 or more times weekly is considered good for natural conception.
- Menstrual cycle: Tracking your cycle length and regularity can suggest ovulation patterns.
- A transvaginal ultrasound can help us understand the reproductive organs, namely the uterus and ovaries and the relationship between them. By instilling saline solution into the uterus, we can assess the fallopian tubes as well ( SSG).
- Semen analysis carried out in an accredited lab with trained manpower gives a fair assessment of the male partner’s reproductive potential.
- General and metabolic assessment is crucial to ensure a healthy pregnancy.
Consulting a Doctor:
If you’re concerned about your fertility, it’s advisable to consult a doctor or fertility specialist. They can perform a comprehensive evaluation, including:
- Medical history review: Discussing past medical conditions, surgeries, and medications.
- Physical examination: Assessing overall health and reproductive system function.
- Blood tests: Hormone levels, ovarian reserve (AMH test), and other relevant tests.
- Imaging tests: Ultrasound scans to evaluate the uterus and ovaries.
- Semen analysis: For men, this assesses sperm count, motility, and morphology.
Fertility Assessment Guidelines
While there’s no single universal guideline for assessing current fertility, several international organizations and professional societies provide recommendations and best practices. Here’s an overview from various sources:
1. World Health Organization (WHO):
- Focus: The WHO focuses on promoting reproductive health and reducing maternal mortality.
- Recommendations: While not offering specific assessment guidelines, the WHO emphasizes the importance of seeking professional medical advice if you’re concerned about your fertility. They also advocate for comprehensive sexual and reproductive health services, including fertility counseling and treatment options.
2. The American Society for Reproductive Medicine (ASRM):
- Focus: The ASRM is a leading professional organization dedicated to advancing reproductive medicine.
- Recommendations: The ASRM offers a comprehensive guide for fertility evaluation, outlining various tests and procedures based on individual circumstances. These may include:
- History and physical examination: Discussing medical history, medications, and lifestyle habits.
- Ovulation evaluation: Tracking ovulation and hormone testing.
- Semen analysis: Evaluating sperm count, motility, and morphology.
- Imaging studies: Utilizing ultrasounds or X-rays to assess the uterus and fallopian tubes.
- Note: The ASRM emphasizes the importance of consulting a board-certified reproductive endocrinologist (REI) for a personalized evaluation and treatment plan.
3. The International Federation of Fertility Societies (IFFS):
- Focus: The IFFS is a global network of fertility societies promoting collaboration and knowledge exchange.
- Recommendations: The IFFS echoes the importance of seeking professional help from an REI for fertility assessments. They emphasize:
- Individualized approach: Recognizing that every case is unique and requires a tailored evaluation.
- Multidisciplinary team: Collaboration between REIs, nurses, counselors, and other specialists to provide holistic care.
