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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.
