What are the recommendations for improving fertility in women?

Recommendations for Improving Fertility in Women

Women seeking to improve fertility should focus on optimizing timing of intercourse (every 1-2 days starting after menstruation ends), achieving healthy body weight, eliminating smoking and alcohol, and seeking early evaluation if age >35 years or after 6 months of trying. 1

Optimizing Natural Conception

Timing and Frequency of Intercourse

• Women with regular menstrual cycles should have vaginal intercourse every 1-2 days beginning soon after the menstrual period ends to maximize likelihood of pregnancy 1
• Educate about the 6-day fertile window ending on the day of ovulation, characterized by slippery, stretchy cervical mucus 1
• Consider using ovulation prediction methods including over-the-counter ovulation kits, digital applications, or cycle beads 1

Weight Optimization

• Fertility rates are significantly lower in women who are very thin or obese 1
• Achieving healthy body weight is a critical modifiable factor that directly impacts reproductive function 2, 3

Lifestyle Modifications to Eliminate

The following should be completely avoided as they reduce fertility:

• Smoking - must be discontinued entirely 1
• Alcohol consumption - should be eliminated 1
• Recreational drug use - must be stopped 1
• Most commercially available vaginal lubricants - interfere with fertility 1
• High caffeine intake (>5 cups per day) - reduces fertility rates 1

Dietary Recommendations

Beneficial Dietary Patterns

• Increase monounsaturated fatty acids in the diet 4
• Consume more fruits and vegetables as good sources of protein and nonheme iron 4
• Choose high-fat dairy products rather than low-fat alternatives 4
• Follow Mediterranean diet patterns, which have demonstrated impact in preserving and improving fertility 2

Dietary Components to Reduce

• Minimize trans fatty acids 4
• Reduce high glycemic index carbohydrate products 4

Supplementation

• Take daily multivitamin containing folic acid and iron 4
• This supplementation should begin when attempting conception 4

When to Seek Medical Evaluation

Standard Timeline

• Infertility evaluation is indicated after 12 months of regular unprotected intercourse 1, 5
• This affects approximately 15.5% of women and represents failure to achieve pregnancy despite adequate attempts 5

Earlier Evaluation Required (After 6 Months)

The following situations warrant evaluation after only 6 months of trying:

• Women aged >35 years - due to age-related decline in fertility 1, 5
• History of oligo-amenorrhea (infrequent menstruation) 1, 5
• Known or suspected uterine or tubal disease 1, 5
• Known or suspected endometriosis 1, 5
• Partner with known subfertility 1, 5

Understanding Infertility Causes

Common Identifiable Causes

• Male factor accounts for 26% of cases and should be evaluated simultaneously with female partner 5
• Ovulatory failure represents 21% of cases 5
• Tubal damage accounts for 14% of cases 5
• Polycystic Ovary Syndrome (PCOS) is the most common cause of anovulatory infertility, affecting at least 7% of adult women 5, 6
• Unexplained infertility occurs in 28% of couples despite thorough evaluation 5

Critical Pitfalls to Avoid

Common Misconceptions

• Regular menstruation does NOT guarantee normal fertility - ovarian reserve may be decreased despite regular cycles, resulting in lower conception chances and higher risk of early menopause 1
• Both partners must be evaluated simultaneously - approximately 50% of infertility involves male factors 5
• Do not delay evaluation in women >35 years, as fertility declines significantly with age 1, 5

Overlooked Factors

• Functional Hypothalamic Amenorrhea (FHA) from stress, excessive exercise, or inadequate nutrition accounts for 20-35% of secondary amenorrhea and requires addressing underlying stressors 7, 6
• Thyroid dysfunction and hyperprolactinemia must be screened as they are treatable causes of infertility 7
• Environmental pollutants and oxidative stress may impact fertility and should be considered 3

Special Considerations for Cancer Survivors

Fertility Preservation Context

• Women previously treated with cancer therapy may have compromised fertility despite regular menses 1
• Alkylating agents (particularly cyclophosphamide) carry the highest risk (≥80%) of permanent amenorrhea 1
• Oocyte donation is an established option for women with premature ovarian insufficiency from cancer treatment 1
• Women with cancer history should be considered high-risk for perinatal complications and require specialized care 1