Dr. Linda Farahani, Consultant in Reproductive Medicine at the Lister Fertility Clinic at The Portland Hospital talks to us about what it means to be “fertility fit”
IVFB: What does fertility fitness mean?
LF:There are a number of different areas I’m interested in when I assess whether someone is ‘fertility fit’. For both men and women, age is an important factor. In women age has a bearing on egg quality, while in men, it has an impact on sperm quality.
Age is a part of fertility fitness that can’t be changed and so, although it is an important factor when managing expectations of outcomes, it is necessary to consider factors that can be managed. Clinical factors that could have an impact on fertility include gynaecological conditions such as endometriosis, fibroids or a previous infection with chlamydia. Previous pregnancy outcomes such as ectopic pregnancy or recurrent pregnancy loss will also play a part in understanding future fertility outcomes, and could determine whether particular interventions could help improve chances of successful conception.
In men, optimal fertility fitness would include taking measures to prevent damage to sperm health. Sperm do not like excess heat so avoiding long cycle rides, hot baths etc. would help maintain sperm health.
Of course, it is important to consider lifestyle factors such as stress, diet and alcohol and smoking. During a consultation, I explore all these aspects, and more, with my patients and try to find ways to improve these areas.
IVFB: Does being fit for fertility enhance your chances of conception?
LF: When I assess patients for their fertility fitness, I speak to them about anything I feel could contribute to potential complications when trying to conceive. I explain any measures they could take now to enhance the chance of conception in the future. e.g. stopping smoking.
IVFB: Are there any tests you can have to see how fit for fertility you are?
LF: As well as a thorough consultation to understand a person’s medical and gynaecological history, the important tests include a pelvic ultrasound scan to assess the uterus and ovaries and the pelvis in general, as well as a blood test to check for the AMH (anti-Mullerian hormone) level, which will help us understand the egg reserve.
In men, a routine semen analysis is an important measure of sperm health and function.
IVFB: If you have an infertility cause, such as blocked tubes or PCOS, is it still important to be “fertility fit” even though you have been told is the only way you will achieve a pregnancy?
LF: I would say it remains just as important to be fit for fertility, regardless of whether someone is trying to conceive naturally or through the use of fertility treatments.
It’s important to make sure your overall fertility fitness is as good as it can be, whether you’re conceiving naturally or through the use of fertility treatments.
IVFB: Is it possible to achieve a level of fertility fitness if you are in your late thirties and older?
LF: As women age, the quantity and quality of eggs diminishes, and this is the reason why assisted conception techniques such as IVF have lower chances of success in older women. However, conception and pregnancy certainly occur in this age group, and maintaining a healthy lifestyle will also be of benefit to these patients.
IVFB: If you are not fertility fit according to your description above, what would you suggest a man and a woman do?
LF: The answer to this question depends on the underlying reasons and is not a one size fits all approach. If there is concern about egg quality or sperm quality, there are supplements that we can consider either prior to fertility treatment or during treatment.
IVFB: If there is a clinical condition that is impacting success, such as a varicocoele varicocele? in men or endometriosis in women, will they need to resolve this first?
LF: Clinical conditions such as those mentioned will have varying impacts on fertility and conception. Therefore, the management will be tailored to the individual. For example, not every man with a varicocele will have trouble conceiving, but in those that do, surgical management may be necessary. These issues should be explored with your doctor.
My advice in general would be to try to eat a nutritious, well-balanced diet, exercise in ways that feel good, try and manage stress in a way that works for you (e.g. meeting friends, reading a book, yoga- everyone is different), and try to have a regular sleep schedule.
IVFB: If your lifestyle has caused a decline in the quality of your eggs or sperm, can you do anything to reverse it?
LF: There are certain situations where we see irreversible effects on egg and sperm quality (e.g. certain types of cancer treatments). However, in general, lifestyle factors are unlikely to cause permanent damage to sperm or egg health. If you are considering conceiving in the near future, it would be beneficial to try and consider healthier lifestyle options, as detailed above, to try and optimise fertility.