By P. D. Silva, J. L. Cool, K. L. Olson, from The Journal of Reproductive Medicine for the Obstetrician and Gynecologist, March 1999, Vol. 44, No. 3.
The purpose of this article is to provide information about the specific relationship between the lifestyle choices and infertility of reproductive-age women. In industrialized countries 14% of couples report infertility problems, and more and more patients attend fertility clinics.
In addition, the use of costly infertility treatments continues to increase. The information in this article intends to provide information that will help women make lifestyle changes, and thus positively affect their ability to conceive.
Possible sources of impaired fertility include sexually transmitted tubal pathogens, low weight, obesity, delayed childbearing, and substance abuse.
Tubal pathogens are disease-producing agents introduced into the fallopian tubes. The main cause of tubal infertility is pelvic inflammatory disease (PID) which, in turn, is caused by a sexually transmitted disease. Chlamydia, which is the most common STD in the U.S., often causes few symptoms, and carriers of the disease can spread it unknowingly. Up to 40% of untreated chlamydial infections can cause pelvic inflammatory disease, and about 20% of women with PID become infertile. Gonorrhea is the second most common STD in the U.S., and it also causes PID and consequent infertility. Given the frequency of both chamydial and gonorrheal infections, it is key that people are educated early about the importance of preventing these diseases in order to preserve a healthy reproductive system.
The risk of acquiring and transmitting STDs is highest among teens and young adults. The young are not as likely to avoid high-risk behavior: inconsistent barrier protection use, multiple sex partners, and failure to follow treatment regimens. Teens and young adults in their 20s tend to be unaware of the impact of STDs on their ability to have children in the future. For example, 15- to 19-year-olds have the highest number of cases of gonorrhea. Based on information like this, it is clear that early education of at-risk groups would help the cause of primary prevention. Doctors are urged to inform their young female patients that STDs may harm their ability to have children.
Women whose body weights shift continually far enough in either direction of the scientifically determined ideal body weight have been shown to have a higher percentage of ovulatory irregularities and fertility problems. Low weight and obesity affect fertility. Anorexia, bulimia, and other eating disorders can cause significantly reduced body weight and are associated with menstrual irregularities and infertility. A moderate weight loss, considered to be 10 to 15% below the individual norm, results in menstrual irregularities. So anorexia, which often involves a weight loss of 30% or more below the ideal healthy body weight, is even more harmful and potentially dangerous to fertility. The loss of body fat is the key here. So even those who exercise strenuously can have menstrual irregularities. These women may not be significantly underweight, but many have a low percentage of body fat. Therefore competitive athletes are potentially at risk for ovulatory dysfunction and infertility.
Based on the observation pregnancies requires around 50,000 more calories and lactation requires around 1,000 calories daily, scientists have theorized that the main biological function of stored fat in women is to provide a source of energy for pregnancy and lactation. This is useful information to know and pass on, especially for women with low weight and reproductive problems.
Studies have suggested that weight gain can reverse the ovulatory defects of women with low weight. Since eating disorders affect about 2 out of every 20 women, it is important that body weight and eating patterns are closely monitored and evaluated when patients have ovulatory dysfunction. Dietary changes and counseling under the supervision of a weight gain program is a suitable form of treatment.
Obesity has been shown to have a strong influence on infertility and menstrual irregularity. For example, women with polycystic ovarian syndrome tend to be more obese. As an intial treatment of obesity, physicians recommend loss of excess weight for women with menstrual irregularities, fertility problems, and polycystic ovarian syndrome. Group treatment programs, which include diet and exercise components, have been shown to work quite favorably, often resulting in the return of fertility. The group factor is important because there seems to be a psychological factor involved in both weight loss and infertility. Treatment in support groups tends to work better for most patients, and the resulting elevated moods make the return of fertility more likely.
Many women are choosing to take advantage of educational and job opportunities in their early adult lives. So they choose not to attempt childbearing until late in their 30s and in their 40s. It is unrealistic to expect women to start childbearing at younger ages, so it is best to inform women of ways to minimize the effects of aging on reproduction. It is also important that women avoid surgery that is poorly justified, such as operations for patients with apparent functional cysts. When surgery is necessary, the particular techniques used and their repercussions should be known and carefully considered.
The abuse of substances such as caffeine, tobacco, and alcohol has the potential to harm a woman’s reproductive health. About 20% of adults in the U.S. consume more than 350 mg of caffeine per day, which means they are physically dependent on caffeine. It is estimated that over 23 million women in the U.S. smoke. In addition, about 12-16% of obstetric and gynecologic patients have a history of alcohol abuse or dependence. Because of staggering figures like these, it is important that open discussions take place about the influence of such substances on fertility.
Physicians should encourage their female patients to reduce the consumption of caffeine as they attempt pregnancy. Some studies suggest that caffeine use is associated with an increase in the rate of spontaneous abortions. Also, it has been shown that caffeine intake during pregnancy has a negative influence on fetal growth. Most studies indicate that the consumption of 300 mg or more of caffeine daily can lead to fertility problems.
Most studies have also shown an effect of reproductive impairment associated with cigarette smoking. Women who smoke have markedly lower levels of all three major estrogens during their cycle. Smokers also have entered menopausal stages earlier than usual, a phenomenon that obviously decreases the time available for pregnancy. Additionally, smoking has been strongly associated wioth tubal factor infertility, and it has been linked to increased rates of spontaneous abortion.
Alcohol abuse, which is a behavior marked by harmful drinking patterns such as binge drinking (5 or more drinks at a time) and heavy routine consumption (2 or more drinks per day), increases the probability of menstrual problems and necessary gynecological surgery. Alcohol consumption is associated with altered estrogen and progesterone levels as well as menstrual irregularities. Excessive use can lead to abnormalities in the ovaries and the early onset of menopause. Even women considered to be mere social drinkers can have some of the same harmful effects, albeit to a lesser degree. There is an elevated risk of endometriosis among moderate (less than 100 g weekly) and heavy drinkers (more than 100g weekly).
Considering the rise of medical care costs, patient education seems a reasonable way to support the prevention of infertility. By implementing healthy lifestyle choices, women can exercise a good deal of control over their reproductive potential. It is key that women realize the harmful consequences of these types of high-risk behavior. A number of sources of infertility—including chlamydial and gonorrheal infection, eating disorders, age-related factors, and abuse of alcohol, caffeine, and tobacco—can be readily addressed by women themselves without the burden of costly medical procedures.
This article was reproduced with kind permission from The Journal of Reproductive Medicine for the Obstetrician and Gynecologist, March 1999, Vol. 44, No. 3.
