ASRM and SREI issues guidelines to optimize natural fertility in absence of evidence of infertility.

 

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American Society for Reproductive Medicine(ASRM) in collaboration with the Society for Reproductive Endocrinology and Infertility(SREI) issued counseling guidelines for achieving pregnancy in couples who are perfectly normal or no abnormality is detected in any test results.

These guidelines were published in January,2017 issue of Fertility and Sterility. [1]

The guidelines and recommendations are:

1) Fertility declines with increasing age in women and women > 35 years of age should be advised to consult a physician if they do not achieve pregnancy after 6 months of uninterrupted intercourse. For women < 35 years the time window is 12 months.

2) Specific recommendations regarding frequency of intercourse brings in unnecessary tension among couples. But, reproductive efficiency is maximum if intercourse occurs every 1-2 days, but the couple should be counseled about it and advised to follow “their own preference” within the context.

3) The fertile window in the cycle is best defined as the 6 days’ period that ends on the day of ovulation, because viability of both sperms and ovum is maximum during that time. Chances of fertilization is highest if intercourse occur on the day prior to ovulation.

4) Most postcoital practices adopted by couples like lying supine after intercourse and avoiding using the bathroom has no scientific backup. Some commercially available vaginal lubricants inhibit sperm motility by as much as 60- 100% in vitro but no results in vivo. But if needed mineral oil, canola oil, or hydroxyethylcellulose-based lubricants should be recommended during this time.

5) Fertility decreases at the extremes of BMI but, variations in daily diet or any specific diet does not have an effect on the fertility. Healthy eating may help improve fertility and diet high in mercury because of seafood consumption is known to be associated with infertility.

6) Women who are trying to conceive should receive 400 mcg of folic acid daily.

7) Smoking has very deleterious effect on fertility with the odds decreasing by 60% in women who smoke and increasing the rates of miscarriage. Smoking also causes rapid follicular atresia accelerating the occurrence of menopause.

8) Alcohol and caffeine in heavy doses have a deleterious effect on pregnancy and should be avoided. That amounts to > 2 drinks/day, with 1 drink >10 g of ethanol for alcohol and 500 mg; >5 cups of coffee/day per day. Moderate coffee consumption of 1-2 cup per day have no effect.

9)Similarly, recreational drugs, environmental pollutants and toxicants are all recognized to decrease fertility and exposure to them should be avoided.

The full text of the article can be accessed from here.

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[1] http://www.fertstert.org/article/S0015-0282(16)62849-2/fulltext