Health, Sports & Psychology

Fertility - A Doctor's Advice

Updated Saturday 1st July 2006

Dr Natheera Indrasenan gives advice on fertility for men and women

Most couples will seek their GP's advice after a year or so of trying for a baby, but it's possible for couples to seek advice at an earlier stage - before embarking on 'starting a family'. GPs will provide pre-pregnancy counselling, giving advice on strategies to maximise your chances of becoming pregnant, and ways to ensure the best possible health of both parents prior to conception.

The medical definition of infertility is not conceiving after a year of trying at least three times a week. One in seven couples suffer infertility and nearly a fifth of this is caused by male infertility.

Men

Sperm production occurs in cycles of 74 days and sperm develops best at 34 degrees. Interestingly, it has been observed that, generally, the average sperm count has been dropping over the years - although we don't know definitively know why!

There's a number of variables which can affect your chances of conceiving. Some of these are:


• Ejaculate volume (the average is 3-5ml per ejaculation);


• Sperm count ('normal' is greater than 20 million per millilitre);


• Sperm motility at 1 and 3 hours after ejaculation ('normal' is greater than 50%);


• Sperm morphology ('normal' is greater than 60%)

 

DIY plaster casts Copyrighted image Icon Copyright: Used with permission

In the surgery, I would offer the following advice to men to maximise the chance of conception:

Improve Your Sperm Quality

1. Manage stress
Stress can have an effect on fertility and many of the patients I see in the surgery are running at a baseline stress level, which they consider acceptable. Some patients say "Yes, but who isn't stressed?", but I always advise relaxation techniques. You would be surprised how something as simple as yoga or meditation can influence your health for the better.

2. Quit smoking
Smoking may reduce fertility, and there are many other health benefits from quitting.

Interestingly, I find that women are highly motivated to stop when they are planning a pregnancy but the men don't seem to. This may be because they aren't aware that smoking can have a direct effect on the man's fertility.

Do seek advice about how to stop smoking correctly. Far too many patients buy some Nicotine gum, try it for a week or two and stop; to be successful most people need a course of nicotine replacement appropriate for their level of smoking for at least three months.

Good news – it's currently available on prescription!

3. Reduce your alcohol intake
Too much alcohol may decrease fertility, so ease off on the booze if you want to maximise your chances.

If you think you drink too much (more than 28 units per week) and can't stop, then seek help from your GP now. You may be referred to a team of counsellors, therapists, doctors who all specialise in managing the alcohol problem in partnership.

4. Zinc
There are some studies that suggest that zinc supplements could improve sperm quality, as zinc is essential in the formation and maturation of sperm cells.

5. Tight Pants
Sperm quality is best at 34°C, a little cooler than core body temperature. Sperm cannot survive at body temperature, which is why testicles hang on the outside! So wear loose fitting underwear to avoid your testicles getting too warm.

Erectile dysfunction

Apart from sperm quality, some men suffer with erectile dysfunction, defined as an ongoing inability to achieve or to maintain an erection sufficient for sexual intercourse. This happens if the flow of blood to the penis is reduced, and can be caused by certain medications, diseases such as diabetes, or injury. In any case, the chance of erectile dysfunction increases with age.

The bad news - many men don't come to the surgery to discuss this problem.

The good news - for most of these men treatments work. They range from medications (like Viagra) to psychotherapy and even devices like implants. Your GP should be well placed to discuss what would be best suited to you.

Abstaining

Your sperm numbers will be greater in an ejaculate if you abstain for 2-3 days. This can be synchronised with your partner's most fertile time to maximise your chance of a pregnancy.

 

sperm Copyrighted image Icon Copyright: Used with permission

Women

There are several areas where women can improve their fertility too. Some of these are similar to the advice for men.

1. Alcohol

Alcohol should be taken in moderation, and certainly avoided during pregnancy. In the first three months abstinence is especially important as it can affect the growth of the baby as well as its intellectual development.

2. Quit smoking

Smoking can reduce your fertility, and there is also increasing evidence that there is a higher chance of your baby suffering cot death if you or your partner smokes. Smoking during pregnancy is also linked to reduced growth of your baby and an increased chance of the baby being born prematurely.

I would strongly suggest seeking support from your GP to give up smoking, ideally in advance of trying to become pregnant. Nicotine replacement therapy over a course of three months can be really effective.

3. Diet

A healthy balanced diet will help your fertility as well as your general health. In addition I suggest you speak to your nurse or GP about a list of foods you should avoid during pregnancy like liver, soft cheeses, any uncooked meats and vitamin A. Surgeries usually provide a leaflet listing the foods to steer clear of.

4. Review existing medical conditions

The pre-pregnancy counselling is an excellent time to review any pre-existing conditions to maximise your fertility and chance of a successful pregnancy. If you are diabetic, ensuring good blood glucose control before getting pregnant is important. If you have asthma then you should ensure you have this controlled as your asthma can be affected by your pregnancy.

5. Medications

There are medications you can buy over the counter, which may affect your fertility and pregnancy. You should always consult the pharmacist if you are, or are trying to become, pregnant.

6. Timing

You can maximise your chance of conceiving by targeting your ovulation time. Typically this occurs between day 11 and day 15 of your cycle, where day one is the first day of your period. This does assume that your cycles are regular. Some women's cycles vary but your GP should be able to help you calculate your most fertile period. Alternatively you can buy packs at the chemist which help you predict your ovulation by measuring your body temperature, which rises as you ovulate.

If you are planning a pregnancy I suggest checking your Rubella status with your GP and to start taking a vitamin called Folic Acid, which you can buy over the counter. This has been shown to reduce the risk of your baby developing spina bifida defects.

Seeking GP's advice

If you haven't been successful after trying for a year you may want to discuss possible causes with your doctor. Typically this involves a series of blood tests for women and a sperm count for men.

The good news - six out of seven couples are perfectly fertile so, along with the advice above, the best thing you can do to maximise your chance of a pregnancy is to enjoy sex at least three times per week!

 

For further information, take a look at our frequently asked questions which may give you the support you need.

Have a question?

Other content you may like

Hip replacement surgery: routine or rationed? Creative commons image Icon New hip / Oka Tai-Lee / CC BY-NC-ND 2.0 under Creative-Commons license article icon

Health, Sports & Psychology 

Hip replacement surgery: routine or rationed?

Linda Kenward looks at how hip replacement surgery has become a more common procedure over the years and wonders whether a healthier, longer-living population stretches the NHS's resources

Article
Does counting calories work? Creative commons image Icon Mike Mozart under Creative Commons BY 4.0 license video icon

Health, Sports & Psychology 

Does counting calories work?

If you're finding your new diet frustrating because you can't make the calories add up, you're not alone. Cynthia Graber and Nicola Twilley investigate why the calorie might be broken.

Video
5 mins
David Milstead: It's the Race for the Pole Copyrighted image Icon Copyright: OU audio icon

Health, Sports & Psychology 

Audio
10 mins
The Other Medicine: Why is CAM so popular? Copyrighted image Icon Copyright: Used with permission article icon

Health, Sports & Psychology 

The Other Medicine: Why is CAM so popular?

Anna Ford attempts to explain the rise in numbers of patients seeking treatment beyond the mainstream.

Article
Alternative Therapies: What can mainstream medicine learn? Copyrighted image Icon Copyright: Screengrab from video audio icon

Health, Sports & Psychology 

Alternative Therapies: What can mainstream medicine learn?

If people gain benefits from some of the methods used by alternative therapists, does this mean there are lessons for all medical practitioners?

Audio
5 mins
How do I tell friends I have cancer? Copyrighted image Icon Copyright: Used with permission article icon

Health, Sports & Psychology 

How do I tell friends I have cancer?

This is the second in a series of posts from ex-OU academic Dr Jill Reynolds on living with a shortened life expectancy.

Article
Ever Wondered About... Pancakes? Copyrighted image Icon Copyright: Subbotina | Dreamstime.com article icon

Health, Sports & Psychology 

Ever Wondered About... Pancakes?

To celebrate Shrove Tuesday (Pancake day) take a look at the science and history of the pancake.

Article
Polyclinics and walk-ins Copyrighted image Icon Copyright: photos.com article icon

Health, Sports & Psychology 

Polyclinics and walk-ins

Shirley Reveley finds mixed messages about the role of polyclinics and walk-in centres while watching Can Gerry Robinson Fix The NHS?: One Year On.

Article
What's in a title: Understanding meanings in community care Copyrighted image Icon Copyright: Used with permission free course icon Level 2 icon

Health, Sports & Psychology 

What's in a title: Understanding meanings in community care

What do we mean by 'community', 'care' and 'welfare'? In this free course, What's in a title: Understanding meanings in community care, you will explore the meanings of these words in their historical and cultural settings. The course does not discuss these terms exclusively in terms of social work practice so service users, carers or anyone interested in community care and the ways in which welfare services are provided would find this course useful.

Free course
4 hrs