Written by Athanasios Papadimitriou Obstetrician Gynecologist Scientific Associate MITERA
15% of couples worldwide face infertility problems, according to data from the World Health Organization. The causes can be many and correspondingly many are the treatments that can be applied.
What role does age play?
The number one enemy of female fertility is time. A woman’s best fertile period is between her 20s and 30s. Fertility is high during this period, while after the age of thirty, it will begin to decline progressively and rapidly after the age of 40-42. So, the earlier a woman has a child, i.e. at 20-30 years old, the better natural priority she gets, for having more children. Early childbearing is therefore encouraged.
What bad habits hurt fertility?
Smoking is an aggravating factor. It has proven to cause infertility, due to aseptic inflammation-fibrosis and destruction of the genitals. Alcohol consumption and poor diet also affect fertility, as does stress. Stress in particular creates a vicious cycle in fertility problems, but also the diagnosis of infertility causes additional stress, which makes conception even more difficult.
Is it true that obesity is related to infertility?
Obesity combined with metabolic syndrome can contribute dramatically to worsening infertility. The resulting hormonal imbalance often leads to anovulatory cycles and difficulty achieving a natural pregnancy. Fat, mothers-to-be should know, is a hormone producer and therefore adversely affects the hormonal balance, because it overproduces ectopic estrogens. So today the BMI (Body Mass Index) must be less than 26 to ensure the smooth outcome of the female hormonal function that is reproduction. The same instructions should be followed by expectant mothers with polycystic ovary syndrome.
What diet should women follow to improve their fertility?
The appropriate diet is the Mediterranean, because it is based on complex raw carbohydrates. Women are advised to eat fruits and vegetables that are rich in folate and to replace animal protein with plant-based protein, found in legumes and nuts, instead of red meat. But here there is also a surprise. It is preferable not to consume low-fat dairy, but full-fat dairy, because the synthesis of hormones, estrogen and progesterone, is based on cholesterol. Avoiding caffeine and caffeinated beverages is also recommended, as they have been linked to reduced fertility.
Is it true that inflammation is another aggravating factor?
Chronic inflammation that has been neglected has an adverse impact on fertility. In the chronic development of an inflammation, e.g. chlamydia, there are no clear symptoms, with the result that over time adhesions and progressive destruction are created, primarily and mainly of the fallopian tubes. The fallopian tubes are the most sensitive part of a woman’s genitals that will suffer the result of genital inflammation, which is the blockage of the fallopian tubes.
Another factor that is affected by the existence of inflammations is blood coagulability, which seems to differ significantly between all of them. Thus, the term thrombophilia has been established in every prospective and ongoing pregnancy, since its study and possible therapeutic intervention aim to ensure fertility – parenthood.
The combination of underlying aseptic inflammation and thrombophilia activates a potent pathological mixture that prevents the development of the candidate embryo-newborn from the first moments of implantation, resulting in miscarriages and retrograde pregnancies. Early diagnosis of the level of thrombophilia ensures the viability of the pregnancy always in combination with endometrial PCR.
One in 10 women of reproductive age suffer from endometriosis, how burdensome is it on fertility?
Endometriosis is sneaky. The condition also appears at a young age, with pain – dysmenorrhea, while its diagnosis with standard imaging and symptoms can hardly be confirmed. Here the clinical experience of the gynecologist is needed to protect the expectant mother from a high degree of endometriosis. Conservative treatment (contraceptives – progesterone – analogues), if it does not work, diagnostic laparoscopy will follow for comprehensive diagnosis and treatment.
Another infertility factor is the endometrial presence of microbes that remain intracellular in the endometrial cavity, as a result of which they cause and are responsible for the largest number of miscarriages and recurrent pregnancies. Today the application of PCR, where it can reveal all the intracellular microbes of the endometrium with a few drops of menstruation, is an important weapon for increasing fertility. Appropriate medication after the results that will show specific microbes significantly reduces miscarriages and recurrent pregnancies with the final result being a healthy newborn.
Do other pathologies inhibit fertility?
There are pathologies of the genital organs that affect fertility, such as the existence of benign fibroid tumors, ovarian cysts, endometriosis cysts, where laparoscopic surgical intervention should be seriously considered. Also, in cases of uterine bleeding, hysteroscopic intervention should be considered for the restoration of uterine bleeding in case of organic damage due to the existence of polyps, fibroids and hyperplasia. The results after the laparoscopic procedures are spectacular, regarding the impending conception that occurs most of the time.
Congenital uterine septums are treated laparoscopically and hysteroscopically, such as in cases of bicornuate uterus, diaphragmatic uterus or even a uterus with adhesions, with the assumption of course of the existence of easy patency of the fallopian tubes.
The thyroid and its diseases are five times more common in women and the prospective mother should be examined for any diseases of this gland, which are indirectly often related to infertility.
Unfortunately, in not a few cases, fertility is irreparably damaged by early reproductive age cancer (breast, genital, or other organ). In this case, the modern treatments for preserving the woman’s fertility have to demonstrate solutions on a case-by-case basis, such as: cryopreservation of eggs before chemotherapy, preservation of ovarian tissue, before chemotherapy – radiation, always in collaboration with the oncologist and the treating physician.
Before a woman resorts to the solution of IVF should the above problems that you developed be solved?
If a woman has followed the aforementioned in an exemplary manner, in a large percentage she will become pregnant on her own and will not need IVF.
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