What is fertility, and how can a person determine the signs of poor fertility?
Fertility refers to the
capability of conceiving offspring; however, in fact, it is the very question
of human health. It affects both women and men. According to the Centers for
Disease Control and Prevention, in 35% of couples who cannot bear children,
reasons can be found within factors associated with both male and female
reproductive systems. Fertility is different from fecundity, which displays the
biological capacity for reproduction. In its turn, it does not depend on
people's desire to have children. It is determined by the ability to produce
gametes, to fertilize them, and to carry a pregnancy to term.
Female Fertility: Women's health conditions include not only the possibility
of conception but also the possibility of carrying pregnancy until birth with a
healthy child. The fertility levels may be considered in a low range when at
least two problems out of these three are there in women. Normal fertility is
the ability of a woman to get conceived normally without any medical
assistance, sustaining pregnancy, and delivering. Ovarian reserve includes the
number of egg cells a woman is having, and thus, it is the measure of her
amount of fertility status. During embryonic development, the number of formed
egg cells is around 7,000,000; however, by the time of commencement of the
menstrual cycle, their number decreases to 500,000. The number of egg cells a
woman has is not all viable for conception, and the number further reduces for
each menstrual cycle; this greatly affects the fertility level of the woman,
more so when above 32 years of age.
Male Fertility: Male fertility is at the crux of successful
conception or not and thus one of the general reproduction functions of the
couple. It is not only a matter of the number of sperm in the seminal fluid but
also a question of the quality of sperm; the morphology, for example, and
motility. Some criteria measure the male's ability to fertilize, meaning at
least 15 million healthy and active sperm per 1 ml of seminal fluid. With the
help of some kinds of nutrients, the quality and motility of the spermatozoon
can be increased. Other important substances for the formation of good quality
sperm are vitamins A and E, zinc, selenium, folic acid, and Omega-3 fatty
acids. Some other beneficial antioxidants include coenzyme Q10 and vitamin C,
which helps in fertility by protecting the sperm from being exposed to
oxidative stress.
Reduced
male fertility is manifested by a decreased ability of sperm to fertilize an
egg cell. This can be related to various factors, including the number of
sperm, their structural features, and motility. Several reasons can affect the decrease in
male fertility:
1. Lack
of vitamin C and zinc:
Vitamin C and zinc play a critical role in maintaining the health of the male
reproductive system. Vitamin C helps protect sperm from oxidative stress,
increasing their viability, while zinc is necessary for the development and
function of the sex glands and also contributes to improving the quality and
quantity of sperm.
2. Smoking
and alcohol consumption:
Smoking and excessive alcohol consumption can negatively affect the number,
motility, and shape of sperm. Tobacco and alcohol contribute to the production
of free radicals, which can damage the DNA in sperm, reducing their fertility.
3. Presence
of antibodies attacking sperm: Sometimes, a man's immune system may mistakenly
identify sperm as foreign agents and produce antibodies against them, hindering
the sperm's ability to move freely and penetrate the egg cell.
4. Use
of anabolic steroids:
Steroids exceeding the natural level of testosterone can disrupt the hormonal
balance, suppressing sperm production and reducing their quality. Prolonged use
of steroids can lead to long-term fertility impairment.
5. Diseases
of the genitourinary system: Diseases such as prostatitis, chlamydia, venereal
diseases, as well as complications from childhood illnesses like mumps and
rubella, diabetes, and viral hepatitis, can lead to deterioration in sperm
quality and reduced fertility.
6. Increased
temperature in the testicular area: Optimal sperm production requires a
temperature slightly below body temperature. Elevated temperature can disrupt
spermatogenesis and reduce the number of healthy sperm.
7. Exposure
to radiation and chemicals:
Certain chemicals and radiation can cause mutations in the DNA of sperm,
reducing their ability to fertilize and increasing the risk of genetic
anomalies in the offspring.
8. Lifestyle
and physical activity:
An unhealthy lifestyle, including a lack of physical activity or, conversely,
excessive training, can negatively affect male fertility.
9. Excessive
weight:
Obesity can affect the hormonal balance and lead to a reduction in testosterone
and sperm production, decreasing fertility.
10. Oxidative
stress:
Cellular damage due to oxidative stress can lead to a decrease in the number
and quality of sperm, impairing the chances of successful fertilization.
Assessment of Fertility: Necessary Medical Procedures
for Both Sexes
The fertility assessment process requires undergoing a complex of medical
examinations. Key diagnostic stages include:
1. Ultrasound to assess reproductive organs: Ultrasound (US) is a non-invasive diagnostic procedure that uses sound waves to create images of internal organs. In the context of fertility assessment, US is aimed at studying the structure and function of reproductive organs. In women, this includes checking the condition of the uterus, ovaries, fallopian tubes, and endometrium, as well as monitoring the maturation of oocytes in the follicles. In men, US can be used to assess the condition of the testicles, appendages, and other structures of the scrotum.
2. Checking
hormone levels:
Hormonal analysis is important for assessing reproductive function, as hormones
play a key role in regulating fertility.
·
FSH
(follicle-stimulating hormone) in women stimulates the growth of follicles in
the ovaries, and in men, it promotes spermatogenesis.
·
LH
(luteinizing hormone) in women triggers ovulation and stimulates the formation
of the corpus luteum, while in men, it stimulates the production of
testosterone in the testicles.
· AMH (anti-Müllerian hormone) in women reflects ovarian reserve, i.e., the quantity and quality of remaining egg cells. Additional hormonal tests may include checking levels of prolactin, testosterone, estradiol, and thyroid hormones, depending on individual indications.
3. Visiting
a reproductive specialist for consultation: Consulting with a reproductive
specialist is a key stage in fertility assessment, where the specialist
collects a complete anamnesis, including medical and reproductive history, and
discusses the results of conducted examinations. The doctor evaluates overall reproductive
health, identifies potential issues, and develops an individual treatment plan
or recommendations for improving fertility. During the consultation, options
for medical intervention, lifestyle changes, or further research to clarify the
diagnosis may be discussed. During ultrasound diagnostics, attention is paid to
assessing the maturity of oocytes, hormonal status, and follicular structure.
The doctor also checks the condition of the endometrium and the patency of the
fallopian tubes. Such analysis should be conducted exclusively by an
experienced reproductive specialist. When planning a pregnancy, one should not
rely solely on home methods of determining fertility. Ovulation tests help
identify the most favorable time for conception, usually the period 5 days
before and 1-2 days after ovulation. To assess male fertility, a spermogram is
necessary. This thorough examination, performed by an embryologist, includes a
recheck after 3 hours and involves counting healthy sperm compared to defective
ones, according to Kruger's criteria, where the norm is not less than 30%.
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