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Opposed to what happens to men (who, after puberty, can produce sperm continuously throughout life), women are born with a limited number of ovarian follicles (some of which, after puberty, will develop to oocytes), that will be lost during the period that goes from birth to menopause: at birth there are 1-2 million follicles, 75% of which will be lost until puberty (the age at which there will be only about 300,000) and the rest until menopause (by age 50).
The peak of a woman's fertility is reached between the ages of 20 and 30, with a sharp decline after the age of 35 and very significant after the age of 40.
Therefore, the decision (for medical, professional or personal reasons) to postpone motherhood is always associated with a lower probability of getting pregnant in the future.
Companies like Apple, Facebook and Google have decided to offer their female employees the possibility of cryopreserve their oocytes, so that they can plan the start of their families without the constraint of the “biological clock” ticks.
If it is true that there were several criticisms to this initiative, which could suggest that the professional activity is more important than the creation of a family, it is also the case that there are other reasons (than professional) that may lead to the delay of motherhood (financial, medical or, simply, the absence of the “right partner”).
Whatever the reason, oocytes cryopreservation (particularly if done before the age of 35) can be a way of preserving your reproductive potential until the age when you decide to have children. The subsequent use of these oocytes will, of course, require a Medically Assisted Procreation technique. It should be noted that, in Portugal, the age limit for a woman to recourse to Medically Assisted Procreation techniques is 50 years.
The relationship between overweight and obesity and infertility (both male and female) is now well documented. There are numerous studies that demonstrate, unequivocally, that overweight and obesity in men are associated with lower levels of testosterone and poorer sperm quality, with a significant reduction in the number and quality of spermatozoa.
In women, overweight and obesity are associated with several hormonal imbalances that translate into ovarian dysfunction (higher incidence of cycles without ovulation), worse oocyte quality, less uterine receptivity to embryo implantation and a higher number of complications during pregnancy (namely repeat abortions).
The good news is that, for both men and women, weight loss and the achievement of a healthy weight are associated with the correction of the aspects mentioned and, therefore, greater fertility.
Tobacco is known to contain more than 4000 toxic substances that negatively affect health. Many of these damage the cells' DNA, causing mutations.
In addition to the significantly increased risk of cancer (lung, larynx, esophagus, stomach, bladder, etc.) and cardiovascular disease, smokers also have a higher risk of infertility.
In fact, the rate of infertility is approximately 2 times higher in smokers than in non-smokers, being the risk greater, the greater the number of cigarettes consumed daily.
Smoking men have, on average, a lower number of spermatozoa and a higher percentage of morphologically abnormal spermatozoa with less motility, therefore, with less fertilizing capacity.
As for women, tobacco leads to poor quality of oocytes and less ovarian reserve, so menopause occurs, on average, 1 to 4 years before that seen in non-smokers.
Also, the success rate of Medically Assisted Procreation treatments, such as in vitro fertilization, in smokers is lower than that observed in nonsmokers of the same age, with a lower number of oocytes obtained after stimulation and a pregnancy rate up to 30% lower.
On the other hand, children of smoking women will also have their
fertility reduced, both in males (with less spermatozoa) and in females (with less
In conclusion, take the advice: for your health (and also for your
children's health), stop smoking.
Sexually transmitted diseases (STD) are an unquestionable cause of infertility, especially among women, which can be avoided.
In particular, infection with Chlamydia or gonorrhea can reach the uterus and fallopian tubes and trigger a pelvic inflammatory disease, the scarring of which can lead to permanent obstruction of the tubes and, consequently, infertility, requiring later use of an in vitro fertilization treatment.
In women, these two STD may not cause symptoms, or these might be mild, so they are often not treated in a timely manner.
So, it is very important to practice safe sex using condoms, carry out periodic tests to screen for STD in men and women with an active sex life and, in the event of a suspected STD, the prompt recourse to the doctor to confirm/exclude it and, if necessary, timely treatment of the disease.
In women, moderate alcohol consumption (up to 12 grammes per day, which correspond to approximately 1 can of beer, or 1 glass of 165 ml of wine) does not seem to be associated with lower fertility, or a lower probability to get pregnant.
However, consumption above the mentioned amount (in particular, consumption of more than 115 grams of alcohol per week, which corresponds to less than 2 cans of beer or 2 glasses of wine per day) is associated with a significant decrease in fertility, resulting in almost 20% less chance of getting pregnant.
High alcohol consumption in men is also associated with a reduction in the number of spermatozoa.
So, if you want to get pregnant, avoid (or reduce) your intake of alcoholic beverages, and by the way, if you get pregnant, avoid drinking alcohol completely.
The available scientific data is not entirely conclusive on the influence of caffeine intake on female fertility, but most studies reveal that daily consumption of less than 300 milligrams of caffeine (an espresso contains between 70 to 100 mg of caffeine) is probably safe, not affecting the likelihood of becoming pregnant.
That being said, if you drink up to 3 coffees a day, you don't necessarily have to change your habits.
Consuming higher amounts of caffeine may decrease your fertility.
It should be stressed, however, that it is not just coffee that contains caffeine, so you should do the math correctly. In fact, a can of coca-cola contains about 35-40 milligrams of caffeine, energy drinks double that amount, and dark chocolate itself contains about 40 milligrams of caffeine per 100 grams.
In conclusion, it is recommended that you do not exceed your intake of more than 300 milligrams of caffeine per day.
The influence of the diet on fertility is not limited to the question of the weight alone.
In fact, the production of suitable oocytes and sperm can be affected by nutritional deficits.
Thus, it is important to maintain a healthy and varied diet, paying special attention to the adequate intake of foods rich in iron (not only meat and fish, but also vegetables, such as spinach, kale, etc.), zinc (meat, seafood, legumes, seeds, nuts, etc.), healthy fats (such as those found in olive oil and foods rich in omega-3, such as sardines, mackerel, salmon, flax seeds, etc.), folic acid (vegetables, especially green leafy ones) and other vitamins (fruit and vegetables). You should also reduce the intake of sugar and processed carbohydrates.
Available scientific data shows that regular and moderate physical activity can improve female fertility, regardless of the woman's weight.
The benefits of regular and moderate physical activity in terms of fertility do not seem to be related only with its influence on maintaining a healthy weight, but also with hormonal balance, reducing stress, improving sleep quality, among other advantages.
In men, moderate physical exercise also seems to be related to improved sperm quality (greater number and concentration of spermatozoa), probably due to a natural increase in testosterone levels.
It should be noted that moderate physical activity does not necessarily imply going to the gym, but things as simple as walking 30 minutes a day (preferably at a fast pace), dancing, cycling, etc.
Intensive physical exercise is not recommended, except in case of obese
In fact, in obese women, intensive physical exercise improves fertility,
but in all others it is associated with a higher incidence of infertility.
Also in men, intensive / extreme physical exercise seems to be associated with lower sperm production and lower testosterone levels.
The later the investigation of the possible infertility causes begins, the later treatments can begin.
Now, with the decrease in female fertility with age, with greater repercussion after the age of 35, to delay a fertility consultation can compromise the success of an eventual medically assisted reproduction technique that may be indicated.
Also, watch out for "warning signs" that may indicate disturbance of the normal functioning of the female or male reproductive system, such as a history of very irregular menstrual cycles, severe menstrual pain, previous cancer treatments or sexual dysfunction.
Joana Mesquita Guimarães
PROCRIAR’ Clinical Director, Porto