1. Ahmad Hammoud MD, MPH Utah Center For Reproductive Medicine University of Utah Enhancing Natural Fertility

2. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Important points The effect of age on natural fertility Other factor that can affect natural fertility Enhancing natural fertility Naturally enhancing fertility treatments

3. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM

4. Protect your eggs 1–2 million oocytes at birth 300,000–500,000 at puberty 25,000 at age 37 years 1,000 at age 51 years

5. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM IVF success rates and age

6. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Factors that reduce the number of eggs Age Smoking Toxins such as dry cleaning products Genetic conditions Chemotherapy Radiation Infections Multiple surgeries on the ovaries

7. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Additional factors that can affect fertility Weight Diet Exercise Pollution

8. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Weight and fertility Obesity in women Irregular ovulation Increased risk of miscarriage Increased risk of preterm birth Underweight women Loose menstrual cycle and ovulation Are at an increased risk for pregnancy complication such as intra-uterine growth restriction

9. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Weight and fertility In men, increased weight results in lower sperm count

10. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Diet and fertility Alcohol (more than 2 drinks per day ) can reduce fertility by 60% Caffeine (more than 250 mg =3 cups per day) can reduce fertility by 45% Illicit drugs can reduce fertility by 70% Avoid high intake of seafood: can increase blood mercury levels

11. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Diet and fertility Harvard study: Increased risk of ovulation problems in women with high intake of : Saturated fat compared to mono unsaturated Rapidly digested carbs compared to slow digested carbs Animal protein compared to plant protein High protein compared to low protein Low amount of whole milk products

12. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Exercise and fertility Natural pregnancy Excessive exercise can affect the menstrual cycle: Luteal phase defect Arrest of menstrual cycle IVF 30% reduction in pregnancy rate in IVF patients if cardiovascular exercise exceeds 4 hours per week

13. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Pollution and fertility

14. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Pollution and fertility Ahmad Hammoud MD

15. Natural solutions

16. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Fertile window of the month First day of flow 281 Ovulation 14 Fertile window

17. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Timing For couple who have infrequent intercourse because of work schedule or other reasons: Use LH predictor kit: when positive have intercourse the same day and the following day For couple that are capable of more: Frequent intercourse is better than ovulation predictor kits

18. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Myths Abstinence is better Some sex positions are better Certain times of the days are better I need to stay flat or the hip should be tilted upward after the intimate relation to save the sperm

19. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Lubricants Some lubricants can damage the quality of the sperm KY Jelly Astroglide Touch Olive oil Better lubricant if needed Canola Oil Pre-Seed

20. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Life style interventions Weight loss or weight gain if necessary Stop smoking Reduce alcohol or stop completely Reduce caffeine to less than 3 cups/day Avoid heavy exposure to chemicals, toxins, and solvents Reduce exercise to less than 4 hours per week while attempting pregnancy

21. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Weight loss

22. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Vitamins and supplements All women should be on folic acid 400 mg daily For men several antioxidants have been suggested to help sperm such as Vitamin C Vitamin D N-Acetylcysteine CoQ10 For women, a new study suggest that CoQ10 can fight the effect of aging on the quality of eggs

23. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Diet A balanced diet rich in antioxidants New study showed that women undergoing IVF have a higher rate of pregnancy with Mediterranean diet: Vegetable oil Legumes Fish Vegetables Low snacks

24. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Take home message If you are less than 30, no other infertility factors, you can try naturally for a year If you are more than 35, no pregnancy after 6 months, get checked : clock is ticking You can still try enhancing your fertility naturally while undergoing treatments such as insemination or IVF Discuss with your doctor your plan for natural treatment because some treatments can be counter productive

25. UCRM UTAH CENTER FOR REPRODUCTIVE MEDICINE UTAH CENTER FOR REPRODUCTIVE MEDICINE UCRM Ahmad Hammoud MD, MPH Utah Center For Reproductive Medicine University of Utah