Individuals feel complete when they attain parenthood. Rearing a child and upbringing it into a world-class citizen makes any mom or dad overwhelmingly happy and satisfied. When such is the joy and fulfillment of parenthood, don’t you think every individual living in this universe is entitled and deserving enough to attain the status of ‘mother’ and ‘father’? Sadly, we have entered a phase into which many couples suffer from infertility issues and yearn to be blessed with a lovely little bundle of joy. Modernization, economic improvements, globalization and what not, but the blame still falls mostly on the woman. So ignorant are we from the perspective of fertilization and reproduction! In fact, male infertility contributes to almost 50% cases of global childlessness. Is it necessary just because that the woman bears the child, she must be the sole reason for infertility? Please, move away from this one-sidedness and become aware of all other factors that can contribute to infertility.
If you are one of those struggling from infertility, you are not alone and one of every four couples suffer from infertility. Almost more than 180 million couples worldwide are affected by infertility with the main population residing in developing countries. Infertility rates range from 8 -12% in couples in reproductive age worldwide but some regions of the world (such as South Asia, sub-Saharan Africa, Middle East, North Africa, Central and Eastern Europe and Central Asia) have exceedingly high rates of infertility, almost 30%.
Infertility is the inability to conceive after one year of unprotected sex. Fertility rates are inversely proportional to age and infertility in women above the age of 35 is defined as the inability to conceive after 6 months of unprotected sex.
For a woman to be fertile, her body must produce healthy eggs that stay inside fallopian tubes waiting for a sperm to fertilize it. If this is successful, the egg joins the sperm and fertilization occurs. This does not happen if there are problems with the fallopian tubes (damage or blockage), endometriosis, ovulation disorders, elevated prolactin, PCOS, early menopause, uterine fibroids or pelvic adhesions involved. Coming to the critical point around which the whole infertility issue seems to revolve nowadays, factors that increase the risk of infertility in women include age (many women wait until their late 30s or early 40s to conceive owing to work prioritization), smoking, overconsumption of alcohol, extreme weight fluctuations (too much of weight gain or loss in a limited time period) and increased physical or emotional stress that results in missed periods. Ageing decreases the chances of delivering a healthy baby in various ways including decreased egg productivity, eggs produced cannot be defined as 100% healthy, the woman is at a risk of health conditions that can cause fertility problems and increased chances of having a miscarriage.
Fertilization is dependent on the sperms that try to collage with the egg. In most cases of male infertility, it is the sperm abnormalities that can be pointed out as the sole reason. Other reasons include decreased sperm count, improperly shaped sperms, immobile sperms or impaired delivery of sperms. Paternal age too seems to cause problems with fertilization. More than fertility, paternal age affects the delivery of healthy offsprings as these babies are at a higher risk of birth defects and developmental disorders.
There must be a full stop somewhere for every problem. When the couple feel that their chances of fertilization is minimal or impossible, they visit their doctor who starts collecting both, medical and sexual history from both husband and wife. The doctor then looks into semen analysis, tubal evaluation and ovarian reserve testing. According to the American Society of Reproductive Medicine, only 3% of the infertile couple need advanced reproductive technologies to conceive. If this is true, what about the propaganda surrounding IVF, IUI and all other assistive reproductive technologies used for conception? The world is focused on improving these technologies for better chances of pregnancy but keep forgetting the age-old concept of natural conception through good health and nutrition. ART is acceptable when there is problem with the fallopian tubes or other similar issues, but PCOS, overweight or obesity cannot be considered as a vital factor for pregnancy through ART.
Assisted Reproductive Technology (ART)
Almost 85-90% cases of infertility can be treated with drug therapy or surgical procedures. Only fewer than 3% of infertility cases require assisted reproductive technology for conception. ART involves all treatment types in which eggs and embryos are handles outside the body. Intrauterine insemination (IUI) and in-vitro fertilization (IVF) are the two commonly used ART methods.
IUI involves preparing sperm in the lab and inserting the best sperm into the uterus directly. IUI is usually applied on couples who suffer from poor sperm motility and hostile cervical mucus. For problems such as endometriosis, male factor infertility, premature ovarian failure and other unexplained causes of infertility, IVF might be the best solution. IVF includes:
Step 1: Administering medicines to stimulate ovaries and release eggs. Once mature, another medication is given and the patient gets ready for egg retrieval
Step 2: The mature eggs are collected for in vitro fertilization which takes barely more than 15-20 minutes
Step 3: Eggs and sperm are observed and prepared before combining them
Step 4: After combining, the healthy embryo is placed inside the uterus where it will hopefully lead to pregnancy
Any remaining good-quality embryos can be frozen for further pregnancy chances, if required.
While we talk about the risk of multiple pregnancies involved with IVF, its mainly because we try to increase the chances of pregnancy by transferring more than one embryo. Some of these ART treatments are quite invasive to the woman involved and it is the female partner who bears the burden of the man’s decreased fertility.
There is more and more evidence coming up on the nutrition front relating to fertility. These point to the well-known yet unpracticed fact that nutritional habits have a compelling effect on both male and female infertility. A healthy body weight is the key to foster many negative issues curbing pregnancy and elevate the positive ones that increase the chances of fertilization. It is not only obesity/overweight that greatly affect fertility but also underweight increases the risk of infertility. Overweight/obesity can trigger insulin resistance and polycystic ovarian syndrome (PCOS) in some women too. Also, infertility due to ovulation disorders can prohibit the maintenance of normal body weight. Studies show that total carbohydrate intake and glycemic load of the diet are positively associated with infertility caused due to ovulation disorders. This encourages an individual to choose carbs that have a lower glycemic index such as whole-wheat bread, vegetables and fruits while avoiding white bread, cakes and pastries. Dietary supplements that contain major chunks of iron and folic acid can be effective in treating infertility. Following a Mediterranean-style diet strictly along with consuming high quantities of vegetable oils, vegetables, legumes and seeds along with eating controlled portions of healthy snacks in between increased the chances of pregnancy by 40%. While all these are effective for the female partner trying to conceive, a different set of nutrition goals are necessary for increasing the fertility of the male partner involved. Most of the male fertility disorders are influenced by a free radical process. These not only affect the chances of fertilization but also increase the risk of miscarriage. Zinc, a particularly important nutrient for male fertility must be consumed in enough quantities to avoid impaired potency, reduced sperm count and infertility. Free radicals play a vital role in increasing chances of male infertility and it is up to the male involved to prevent it by taking adequate antioxidants. Men trying to conceive must consume foods rich in zinc, selenium and folic acid to enhance sperm quality.
Stay on a Healthy Weight
The National Infertility Association of USA reports that 30% of infertility cases are due to weight extremes that can affect hormone levels and curb ovulation. Overweight/obese women who even lose around 5% of their body weight have a higher chance of getting pregnant. At the other extreme are underweight women who experience irregular menstrual cycles. Other people who face increased risk of infertility include individuals participating in high-intensity activities such as gymnastics, dancing, weight lifting, those having an eating disorder or following crash diets. Remember to:
Equip your body with enough iron to reduce risk of ovulatory infertility as mentioned above. Ovulatory infertility affects almost 25% of infertile couples and is a prominent cause of infertility. Beans, eggs, lentils, spinach, fortified cereals and whole grains are excellent sources of iron. Consuming vitamin C-rich foods such as citrus fruits, berries or bell peppers helps to absorb maximum iron from the foods that you consume.
Folic acid will not make you fertile but any woman trying to conceive must take folic acid supplements after discussing with her healthcare provider to prevent neural tube defects. Eat plenty of dark leafy green vegetables and fortified grains along with a supplement (if prescribed) to pump up folic acid levels in your body.
The “Fertility” Diet
This diet was published by a team of Harvard researchers and found that women who practiced this type of dietary plan had a 66% reduced risk of ovulatory infertility and 27% reduced risk of infertility from all other causes compared to women who did not follow the diet. This diet proposes ten simple changes to your eating plan to boost fertility levels:
These dietary changes will not work in case of people who are unable to get pregnant because the woman has blocked fallopian tubes or the man’s ejaculation does not carry active sperms. Nutrition and dietary changes can do wonders for couples who suffer from ovulatory infertility, PCOS problems and weight issues, which form the majority of causes for infertility. A well-balanced diet can save you from infertility, a diet rich in antioxidants can prevent or treat infertility and making a healthy diet plan as your lifestyle food habit can go a long way beyond fostering infertility-it can improve your overall body health and make you a fitter person. If you are one of those couples who suffer from infertility problems, try to set right things with nutrition and fitness before opting for assisted reproductive technology. Those suffering from obesity, overweight, PCOS, ovulation infertility and similar other problems can get in touch with a registered dietitian nutritionist at www.firsteatright.com for a solution before jumping over to complicated procedures such as IUI or IVF. IVF or IUI techniques are a boon to mankind, no doubt about it. But why opt for these mentally and physically tiring procedures when the problem involved is not with the fallopian tubes, endometriosis or similar other ones that cannot be solved the nutrition way!
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Dietitian & Nutritionist Dr. Nafeesa Imteyaz.