Decreased fertility is one of the most pressing social and medical issues in contemporary society. Despite the rapid development of reproductive medicine and the perfection of assisted reproductive technologies, the optimization of natural conception remains a significant challenge. This requires an assessment of female fertility and its components. In this article, we will explain what female fertility is and how it affects the possibility of natural conception.
What is female fertility and its components? Female fertility refers to a woman’s ability to produce offspring during her reproductive years. Fertility is determined by three components:
- Conception
- Pregnancy
- Live birth
If there are no issues with all three components, a woman’s fertility is preserved and considered normal.
Statistical data on pregnancy rates in women of reproductive age
A series of studies show that during the first month of regular sexual activity, pregnancy occurs in 20-22% of women under the age of 35. Fifty percent of women who had regular sexual intercourse and did not use any contraceptive methods became pregnant within three months, 60% within six months, and 90% within 1.5 years of active attempts.
The authors evaluated the frequency of pregnancy and established that if a couple has unprotected sexual intercourse for one year without resulting in pregnancy, it can be considered infertility in the marital couple.
Key Indicators of Fertility
The primary indicator of female fertility is ovarian reserve. This refers to the number of follicles present in a woman’s ovaries. Follicles contain immature eggs, known as oocytes. Each month, a certain number of follicles mature, but only one or two typically release an egg that is ready for fertilization.
To assess ovarian reserve, levels of Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) on the 2nd to 4th day of the menstrual cycle are considered, as well as the Antral Follicle Count (AFC) during an ultrasound. However, there is no perfect test for evaluating ovarian reserve.
Factors Affecting Fertility
Several factors can influence a woman’s ability to conceive, carry, and deliver a child:
- Lack of ovulation and issues with oocyte maturation.
- Blockage of the fallopian tubes.
- Changes in the condition of the endometrium, affect proper implantation (such as the presence of adhesions or polyps in the uterine cavity, submucosal fibroid nodes, internal endometriosis, and inflammatory processes).
- Anomalies in the development of female reproductive organs that can impact both embryo implantation and fetal carrying.
- Decreased ovarian reserve (due to age-related physiological decline, surgical interventions on the ovaries, and ovarian tumors such as endometriotic cysts).
- Cervical condition. The presence of stenosis (blockage of the cervical canal) can prevent sperm from entering the uterine cavity and fallopian tubes.
- Isthmic-cervical insufficiency, usually occurring in the second trimester of pregnancy, is a common cause of late miscarriages and preterm births.
- The presence of concomitant diseases, including autoimmune conditions, that can affect the ability to conceive and carry a pregnancy.
- Genetic factors.
- External factors, such as smoking, drug use, alcohol consumption, and exposure to harmful chemicals and allergens.
Physiological Factors
Physiological factors contributing to reduced fertility include a woman’s age, particularly after 35 years, due to the decrease in the number of oocytes.
Psychological and Emotional Aspects
The absence of children often negatively impacts the psychological and social well-being of partners. The World Health Organization emphasizes the presence of a psychogenic component and the state of chronic stress in childless marriages. Therefore, special attention should be given to this aspect, and specialized psychological support should be provided.
Lifestyle
A woman’s lifestyle plays a significant role:
- Smoking (both traditional cigarettes and electronic cigarettes, as well as tobacco heating systems) significantly impacts female fertility. Alcohol abuse and drug use also have negative effects.
- A high number and frequent change of sexual partners increase the risk of contracting sexually transmitted infections, which can subsequently negatively affect a woman’s fertility.
- Lack of adequate sleep, rest, and nutrition often negatively impacts a woman’s overall health, her psycho-emotional state, and, consequently, her fertility.
What are Fertile Days?
Fertile days are the period during which the probability of conception reaches its peak. There are no universal fertile days, as this period is individual for each woman and depends on the length of her menstrual cycle.
Important!
Ovulation and the fertility window are not synonymous terms. Ovulation is the process of an egg being released from a mature follicle, which retains the ability to be fertilized for approximately 24 hours.
The fertility window lasts longer, averaging about 5 days. This is due to the lifespan of sperm, which can remain active in a woman’s body for up to 5, and at most, 7 days. Therefore, the fertility window includes the day of ovulation and the 5 days leading up to it. If intercourse occurs several days after ovulation, the chances of pregnancy approach zero.
Modern Methods for Diagnosing and Treating Subfertility and Infertility
The primary methods for diagnosing fertility issues include:
- Ultrasound of the pelvic organs during different phases of the menstrual cycle.
- Hormonal testing (determining levels of FSH, LH, estradiol, prolactin, TSH, AMH, and androgens if indicated).
- Hysteroscopy.
- Diagnostic laparoscopy.
Various treatment options may be proposed to correct subfertility and infertility, depending on the cause:
- In the presence of uterine factors (such as endometrial polyps, Asherman’s syndrome, and submucosal fibroid nodes), surgical treatment via hysteroscopy is recommended.
- For tubal factors, laparoscopy is recommended.
- In cases of ovulatory dysfunction, the main task is to identify the causes and then proceed with the correction.
**Doctors also offer a wide range of accessible assisted reproductive technologies:**
- Controlled ovarian stimulation.
- Artificial insemination.
- IVF.
- ICSI in the IVF program.
- Donation of gametes (sperm, oocytes, embryos) and their cryopreservation.
- Surrogacy.
How to Increase Fertility in Women: Recommendations from Our Specialists
The primary task of a doctor is to identify and eliminate factors that may negatively affect fertility. For all women, the following is recommended:
- Increase the frequency of sexual intercourse within the couple. Ideally, sexual activity should occur every two days, especially during “fertile days.”
- Quit smoking (both traditional and electronic cigarettes), alcohol consumption, and drug use.
- Reduce caffeine intake (less than 5 cups per day).
- Normalize weight if overweight or obese, or address underweight issues.
- Follow healthy eating guidelines.
- Engage in regular, moderate physical activity.
- Avoid stress and emotional strain.
- Avoid harmful working conditions.
These general recommendations improve overall health and help increase the chances of conceiving naturally.
Threats to Fertility in the Modern World
An unhealthy lifestyle remains one of the main threatening factors today. Each year, the number of people with alcohol, tobacco, or drug dependencies increases, as does the number of individuals struggling with overweight and obesity. Hypodynamia and poor nutrition exacerbate this problem.
Additionally, the following factors contribute to reduced fertility:
- Stress, which women in Ukraine face daily, negatively impacts not only their psycho-emotional state but also their overall health and fertility.
- The current situation in Ukraine acts as both a stress factor and an environmental pollutant. Continuous shelling of populated areas, and destruction of industrial facilities, and critical infrastructure lead to the release of toxic substances into the environment, contaminating water, air, and soil.
- Negative social factors include a declining standard of living and rising unemployment.
- The increasing average age of first pregnancy. The older a woman is, the higher the risks of chromosomal abnormalities and developmental defects in children, complicated pregnancies, and preterm births. However, this does not mean that a woman over 40 cannot give birth to a healthy child. It is entirely possible.
Potential Consequences of Low Fertility for Society
The primary issue society may face due to declining birth rates is an inverted age structure. This means that each year, the number of elderly people surpasses the number of young individuals, leading to significant social changes.
For any country, urgent matters will include tax payments, healthcare costs for the elderly, and overall elder care, as well as changes to the retirement age. However, these challenges should not impede efforts aimed at improving women’s reproductive health, rights, and freedoms.
Conclusions
Here are the key takeaways from this article:
- The main factor in declining fertility among women is age.
- Women over 35 should consult a reproductive specialist after six months of unsuccessful attempts to conceive. Women under 35 are recommended to seek consultation if pregnancy does not occur within one year of regular sexual activity.
- Regular sexual intercourse (every 2 days) during identified “fertile days” is associated with the highest pregnancy rates.
- Couples should maintain a healthy lifestyle and avoid risk factors that can negatively affect fertility, as well as undergo regular preventive medical examinations.