OPTIMIZING FEMALE FERTILITY: THE NEED FOR PERSONALIZED FERTILITY RISK by Laura Bunting, Ph.D. in Psychology - SPRING 2011

OPTIMIZING FEMALE FERTILITY: THE NEED FOR PERSONALIZED FERTILITY RISK

by Laura Bunting, Ph.D. in Psychology

Have you ever wondered about your personal infertility risk? If not, you are certainly not alone. Research studies have repeatedly shown that people do not have precise knowledge about the signs, symptoms and risks of disease in relation to fertility. This is somewhat surprising considering parenthood is a life goal for the majority of young men and women. Such a lack of knowledge about these risks may reduce a woman’s chances of having her wish to conceive a child fulfilled.

Three current phenomena explain why many women are indeed not optimizing their fertility potential. First, exposure to a number of fertility-compromising risk factors has steadily increased over the years, namely, obesity, smoking and sexually transmitted infections which are the most frequent nowadays. Secondly, parenting has gradually been delayed in our society to an age when fertility begins to decline. For example, the U.K.’s Office of National Statistics reports that maternal age at first birth has increased from 23 years in 1968 to 30-31 years in 2007. Finally, when couples cannot conceive naturally, estimates suggest that as many as 50% of them defer seeking timely medical attention. People who are not aware of risk factors, signs and symptoms of infertility could inadvertently put themselves at risk of never achieving their parenting goals. Increasing knowledge about risk factors, signs and symptoms of disease through better information may allow people to make informed decisions to optimize their fertility potential, by reducing risks and taking action when faced with a negative symptom.

So, what are the signs, symptoms and risk factors that reduce fertility potential, and what should one do to optimize one’s fertility? The first sign of fertility difficulties is indicated by the amountof time trying to conceive without success. Current guidelines define infertility as the inability to achieve pregnancy after 12 months of unsuccessful attempts (or 6 months if the woman is 34 years or older). Guidelines recommend that women who find themselves in this situation should seek medical attention. However, this is discovered only once the person has decided to try to become pregnant. There are a number of other risk factors that women should know about so that they can take positive action to diminish any possible risk before they attempt to conceive. A thorough review of the literature has revealed 19 risk factors.

Ten negative lifestyle habits have been identified: engaging in unprotected sexual intercourse with multiple partners; smoking 10 or more cigarettes a day; experiencing stress one cannot cope with; consuming 14 units or more of alcohol a week (1 unit = a small glass of wine, ½ pint of beer, a single measure of a spirit); consuming 7 or more units of caffeine a week (1 unit = a cup of coffee, ½ unit = a cup of tea or a can of soft drink such as cola); smoking marijuana more than four times a week; having contracted a sexually transmitted disease; being more than 13 kilos (28 pounds) overweight; having used class A drugs (e.g., cocaine, heroin, ecstasy); using anabolic steroids.

Age, of course, is also a significant risk factor as female fertility starts to decline after the age of 34.

Four reproductive risk factors have also been found: pelvic surgery, severe painful periods, endometriosis, and pelvic inflammatory disease. Finally, we can add four menstrual cycle risk factors: experiencing short (the menstrual cycle lasts less than 21 days), long (the menstrual cycle lasts more than 35 days), irregular cycles (the period often comes more than 5 days earlier or later than expected), or experiencing no period at all.

Everyone of the above 19 risk factors can have a negative impact on female fertility. However, as already mentioned, knowing about these risks may not be enough for women to assess their own level of risk or encourage them to take appropriate action. These 19 fertility risk factors can be categorised into the following four colour-coded recommendation categories (blue, yellow, orange and red):

Blue risk category and recommendations:
The recommendations for the ‘blue’ category apply only to women who have been trying to conceive for less than 12 months (or less than 6 months if the woman is under the age of 34) and who do not have any of the above-mentioned risk factors.
The recommendations for these women would be:
You have not checked for any risk factors but you should monitor your situation regularly because it may change and female fertility decreases after 34 years of age.

Yellow risks recommendations:
The ‘yellow’ category applies to anyone who has any of the following negative lifestyle factors: engaging in unprotected sexual intercourse with multiple partners; smoking 10 or more cigarettes a day; experiencing stress one cannot cope with; consuming 14 units or more of alcohol a week (1 unit = a small glass of wine, ½ pint of beer, a single measure of a spirit); consuming 7 or more units of caffeine a week (1 unit = a cup of coffee, ½ unit = a cup of tea or a can of soft drink such as cola); smoking marijuana more than four times a week.
The recommendations for these women would be:
You should consider changing your lifestyle, since all these factors may negatively impact fertility, whether or not you are trying to conceive. If you are not trying to become pregnant you should know that female fertility decreases after the age of 34.

Orange risks recommendations:
The following conditions place women in the ‘orange’ category: pelvic surgery, severe painful periods, endometriosis, pelvic inflammatory disease; experiencing short (the menstrual cycle lasts less than 21 days); long (the menstrual cycle lasts more than 35 days); irregular cycles (the period often comes more than 5 days earlier or later than expected); having a sexually transmitted disease; being more than 13 kilos (28 pounds) overweight.
The recommendations for these women would be:
These factors may be detrimental to your fertility. Consider seeking medical advice if you are trying to become pregnant. Your doctor may be able to offer you guidance and recommend positive action if needed. If you are not trying to achieve pregnancy you should know that female fertility decreases after the age of 34.

Red risks recommendations:
The following risks place women in the ‘red’ category: having tried to conceive for more than 12 months (or more than 6 months if the woman is over the age of 34); absence of periods; previous use of class A drugs (e.g., cocaine, heroin, ecstasy); using anabolic steroids.
The recommendations for these women would be:
If you are trying to become pregnant you need to see your doctor for further investigation. Drug and anabolic steroid use for non-medical reasons reduces fertility and you should consider changing these lifestyle habits. If you are not trying to conceive you should know that female fertility decreases after the age of 34.

The risk factors and recommendations mentioned in this article are taken from the Fertility Status Awareness Tool (FertiSTAT: Bunting and Boivin, 2010). The FertiSTAT is available free of charge and is a tool for women to consult when they are considering having children now or in the future.

About the author
Laura Bunting completed her Ph.D. studies at Cardiff Fertility Studies Research Group under the supervision of Professor Jacky Boivin (School of Psychology, Cardiff University). Her research to date has concentrated on the key factors that facilitate seeking help or advice when a fertility problem occurs. It has led to the development of a self-administered tool to allow women to assess and gain guidance about their own fertility status (Fertility Status Awareness Tool: FertiSTAT).