so what is the problem? michael savvas assisted conception unit king’s college hospital
TRANSCRIPT
So what is the problem?
Michael Savvas
Assisted Conception Unit
King’s College Hospital
Chance of conception Natural
Woman < 40 years
•More than 80% of couples will conceive within 1 year
•Of remaining 20% half will conceive in second year
•2 year cumulative pregnancy 90%.
Chance of conception
Pregnancy Rate (%)
Age
When to investigate
• After one year of unprotected SI
• Earlier referral where:
The woman is > 36 years
There is a known clinical cause
There is a history of predisposing factors
Assessment
• A specific enquiry about lifestyle and sexual history should be made.
NICE 2013
Lifestyle
• Frequency and timing of SI• Alcohol• Smoking• Caffeine• Body weight• Exercise• Diet• Psychological stress
Frequency and timing
• Timing not helpful
• SI 2-3 times a week
• Most pregnancies result from SI occurring in window 5 days before and day of ovulation
Alcohol
• Women who are pregnant or trying to conceive should consume <1-2 units per week
• Excess alcohol (more than 3-4 units per day) is detrimental to sperm
Smoking
• Reduced fertility in women
• Effect on pregnancy
• Effect on male fertility unclear but does effect semen quality
Caffeine
• In combination with alcohol can effect semen quality
Obesity
• BMI >30 assoc with reduced fertility in men and women
• Women with BMI<19 Amenorrhoea, infertility and pregnancy complications
Diet and exercise can improve fertility
Recreational Drugs
Marijuana and Cocaine
• Can effect ovulation and tubal function
• Can effect Semen quality
Anabolic steroids
• Can effect semen quality
Stress
• Effects male and female fertility
• Fertility treatment stressful
Vitamins and Anti-oxidants
• Selenium
• Vitamin C , E
• Zinc
• Selenium
• Folate
Shown to improve sperm motility
Conclusion
Healthy lifestyle improves
•Natural fertility
•Treatment outcomes