Fertility of women

Age is no barrier to achieving many things. But it can reduce the chance of a woman getting pregnant and having a healthy baby. A woman’s age is the single most important factor affecting her fertility. As a woman ages, it takes longer to conceive and the risk of not being able to get pregnant increases. Also, the risk of miscarriage, and complications in pregnancy and childbirth, increase. At 30, the chance of conceiving each month is about 20% and at 40 it’s around 5%. This is because a woman is born with finite number of eggs in her lifetime. As she ages her eggs age with her, decreasing in quality and number.

The fertile window

These are the days in a woman’s menstrual cycle when pregnancy is possible which are during the five days before ovulation through to the day of ovulation. For those women who are not aware of their ‘fertile window’ or when they ovulate, sexual intercourse is recommended every 2 to 3 days to help optimize their chance of conceiving.

Health issues that may affect fertility

Obesity

Carrying around extra pounds can affect hormone production and make it more difficult for a woman to get pregnant

Being too thin

Just as excess body fat can impact fertility, so can not having enough of it. That may be because women who have very low BMI are deficient in leptin, the hormone that controls hunger and feelings of satiety. Having low leptin contributes to the absence of menstrual periods

Getting older

When a woman reaches menopause, usually in her 40s or 50s, she no longer ovulates and is unable to get pregnant. But even in the decade or so before menopause officially occurs, she may experience fertility problems as her ovulation becomes less regular and her egg count declines—a time known as perimenopause.

Household chemicals

Exposure to pollutants, pesticides, and industrial compounds can decrease a couple's ability to have children by up to 29

Smoking

Smoking can hurt a developing fetus, but lighting up can also drastically affect a woman's chances of getting pregnant in the first place. Smoking causes up to 13% of all infertility cases.

Alcohol

Having more than one drink a day for women has been linked to an increased risk for ovulation disorders leading to difficulty in conceiving

Thyroid Disorder

It can contribute to ovulation and pregnancy problems, and suggests that women having trouble conceiving be tested for over- or underactive thyroid.

Caffeine

Interferes with the muscle contractions that help eggs travel from the ovaries and through the fallopian tubes to the womb. It should be consumed in moderation and no more than 200 milligrams a day (that's1 to 2 8-ounce cups of coffee).

Medical conditions

Health issues such as polycystic ovary syndrome (PCOS), endometriosis, polyps, ovarian cysts and uterine fibroids can affect a woman's chances of getting pregnant or successfully carrying a pregnancy to term. Women with autoimmune disorders (such as lupus or rheumatoid arthritis) may also have trouble conceiving. Working with a medical team to manage and improve symptoms, and seeing if fertility help is needed can increase the chances for success. Sexually transmitted infections like Chlamydia and gonorrhea can cause pelvic inflammatory disease and cause fertility problems, even years after a woman contracts them.

Stress

Women with higher levels of an enzyme linked to stress have a harder time getting pregnant.

Fertility treatment options

Infertility treatment depends on:

• What's causing the infertility
• How long one has been infertile
• Age of both partner
• Personal preferences

In cases where spontaneous pregnancy doesn't happen, couples can often still achieve a pregnancy through use of assisted reproductive technology.

Treatment for men

Men's options can include treatment for general sexual problems or lack of healthy sperm. Treatment may include:

• Altering lifestyle factors - Improving lifestyle and behavioral factors can improve chances for pregnancy, including discontinuing select medications, reducing/eliminating harmful substances, improving frequency and timing of intercourse, establishing regular exercise, and optimizing other factors that may otherwise impair fertility
• Medications - Certain medications may improve a man's sperm count and likelihood for achieving a successful pregnancy. These medicines may increase testicular function, including sperm production and quality.
• Surgery - In select conditions, surgery may be able to reverse a sperm blockage and restore fertility. In other cases, surgically repairing a varicocoele may improve overall chances for pregnancy.
• Sperm retrieval - These techniques obtain sperm when ejaculation is a problem or when no sperm are present in the ejaculated fluid. They may also be used in cases where assisted reproductive techniques are planned and sperm counts are low or otherwise abnormal.

Treatment for women

Although a woman may need just one or two therapies to restore fertility, it's possible that several different types of treatment may be needed before conception.

• Stimulating ovulation with fertility drugs - Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation.
• Intrauterine insemination (IUI) - During IUI, healthy sperm are placed directly in the uterus around the time of ovulation.
• Surgery to restore fertility -  Uterine problems such as endometrial polyps, submucosal fibroid, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery. Laparoscopic fertility enhancing surgeries can be performed in cases of endometriosis, adhesions, tubal blockages, fibroids and ovarian cysts. Laparoscopy is a keyhole surgery; which involves inserting a fiber-optic telescope into the abdomen and allowing doctors to examine the ovaries, uterus, fallopian tubes, and abdominal cavity. It can help to both diagnose and treat conditions at the same time.
• Assisted reproductive technology - In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man's sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization. Various techniques used in an IVF cycle : Intracytoplasmic sperm injection (ICSI)- A single healthy sperm is injected directly into a mature egg. Assisted hatching - This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo.
• Donor eggs or sperm - if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
• Gestational carrier - Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple's embryo is placed in the uterus of the carrier for pregnancy.

Genetic Testing

Genetic testing, also known as DNA testing, allows the determination of bloodlines and the genetic diagnosis of vulnerabilities to inherited diseases. It can provide important information for diagnosing, treating and preventing illness. Several types of genetic testing are done for different reasons:

• Diagnostic testing - If you have symptoms of a disease that may be caused by genetic alterations, genetic testing can reveal if you have the suspected disorder.
• Presymptomatic and predictive testing - If you have a family history of a genetic condition, undergoing genetic testing before you have symptoms may show if you're at risk of developing that condition.
• Carrier testing - If you have a family history of a genetic disorder — such as sickle cell anemia or cystic fibrosis — or you are in an ethnic group that has a high risk of a particular genetic disorder, you may choose to have genetic testing before you have children.
• Pharmacogenetics - If you have a particular health condition or disease, this type of genetic testing may help determine what medication and dosage will be most effective and beneficial for you.
• Prenatal testing - If you are pregnant, tests are available that can detect some types of abnormalities in your baby's genes. Down syndrome and trisomy 18 are two genetic disorders that are often screened for as part of prenatal genetic testing.
• Newborn screening - This is the most common type of genetic testing. This type of genetic testing is important because if results show there's a disorder such as congenital hypothyroidism or phenylketonuria (PKU), care and treatment can begin right away.
• Preimplantation testing - Also called preimplantation genetic diagnosis, this test may be used when you attempt to conceive a child through in vitro fertilization. With in vitro fertilization, eggs are removed from a woman and sperm are collected from a man. The eggs are then fertilized with the sperm outside the body to create embryos. The embryos are then screened for genetic abnormalities. Embryos without abnormalities are implanted in the uterus in hopes of achieving pregnancy.

Before you undergo genetic testing, gather as much information as you can about your family's medical history. Discuss the same with your doctor or a genetic counselor; this can help you understand your risk better. Depending on the type of test, a sample of your blood, skin, amniotic fluid or other tissue will be collected and sent to a lab for analysis. The amount of time it takes for you to receive your genetic testing results will depend on the type of test and your health care facility. No matter what the results of your genetic testing, talk with your doctor or genetic counselor about questions or concerns you may have. This will help you understand what the results mean for you and your family.