By Dr. Hiruni Poornima
Subfertility is estimated to affect as many as 186 million people worldwide. Even though women are accused of being childless, male subfertility contributes to more than half of the cases globally. Among them, the majority is found in developing countries. It has been estimated that one in seven couples in the western world and one in four couples in the developing countries are suffering from subfertility. Fertility is the ability to undergo clinical pregnancy and the inability of this is known as infertility/ subfertility.
According to WHO “infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”. Subfertility can be classified as primary subfertility and secondary subfertility. If a woman is unable to undergo a clinical pregnancy after one year of regular unprotected sexual intercourse it is classified as primary subfertility. If a woman is unable to undergo a clinical pregnancy, after a previous successful pregnancy that is defined as secondary subfertility. Subfertility can be due to various reasons such as lifestyle changes, physiological changes, or disease conditions.
In disease conditions, both genders are prone to suffer from diseases that will lead to subfertility such as infections, systemic diseases, and metabolic syndromes. In female’s subfertility can occur due to uterine fibroids, poly cystic ovarian syndrome (PCOS), premature ovaries, endometriosis, endometrial polyps, uterine cysts, endocrine disorders. Age of the female and the physiological and anatomical changes in both genders because of the above mentioned diseases may lead to subfertility. In lifestyle patterns excessive alcohol intake, excessive tobacco intake, excessive caffeine intake, chronic exposure to environmental pollution, stress and dietary habits may be a contributing factor towards subfertility. Male subfertility also occurs due to disease conditions, physiological changes and lifestyle changes. Male subfertility is mainly detected as low sperm count (oligospermia), low vitality, low motility or reduced motility (asthenozoospermia), abnormal morphology (teratozoospermia).
Body Mass Index (BMI) value plays an important role in both genders. It is calculated as below: a person’s weight in kilograms divided by the square of height in meters. It gives an idea about the body fat masses. If BMI is less than 18.5, it falls within the underweight range. If the BMI is 18.5 to < 24.9 kg/m2, it falls within the normal. If the BMI is 25.0 to < 39.9 kg/m2, it falls within the overweight range. If the BMI is 30.0 kg/m2 or higher, it falls within the obese range. Obesity is frequently subdivided into categories: Class 1: BMI of 30 to < 34.9 kg/m2. Class 2: BMI of 35 to < 39.9 kg/m2. Class 3: BMI of 40 kg/m2 or higher. Class 3 obesity is sometimes categorised as “extreme” or “severe” obesity. The women who have a BMI more than 24.9kg/m2 and less than 18.5 kg/m2 take longer time to conceive. About 1-5% of women are subjected to weight-related amenorrhoea and among them delayed puberty can occur due to low BMI or extreme BMI.
The trend of obesity can lead to various disorders related to the female reproductive system. It is said that both over weight and obese women will associate with reduced pregnancy rate, higher rate in miscarriages and increase in gonadotropins. The relationship between obesity and reproductive disturbance was first identified by Stein and Leventhal in 1934 and in present it is known as the syndrome “O” which means over-nourishment, overproduction of insulin, ovarian confusion, and ovulation disruption. Poly cystic ovarian syndrome is commonly seen in women who are obese and who are suffering from abdominal obesity. Menstrual irregularity and subfertility are often worsening with central obesity. According to several studies done on subfertility they showed that increased BMI levels have a negative impact on men. BMI increases the fat tissue in men and this will make testosterone to change into oestrogen leading to low concentrations of testosterone, LH, and FSH. These low hormone levels will decrease sperm quality, motility and morphology. Heat of the body will also be increased with increasing fat tissues; this will lead to decrease in the production of sperms and the quality of sperms. Increased BMI will also lead to transformation of sperm DNA, fertilisation degeneration and increase the risk of miscarriages. Subfertility has become a common social problem around the world. Few changes in dietary habits can make a big change. Controlling the BMI levels and mindful eating with proper nutrients can help subfertility. Identifying the nutrition deficiencies, reproductive irregularities, discomforts and disorders at the early stage can be helpful during conceiving. Fulfilling these nutritive components and doing few medical tests to identify the functioning status of the body before planning a clinical pregnancy will help to avoid the challenges in subfertility.
(The writer holds a BAMS [Hons] from the University of Colombo and a Diploma in Panchakarma, is currently reading for an Msc in Food and Nutrition from the University of Peradeniya, and is a Residential Ayurveda Medical Officer at the Christell Clinic)
In disease conditions, both genders are prone to suffer from diseases that will lead to subfertility such as infections, systemic diseases, and metabolic syndromes. In female’s subfertility can occur due to uterine fibroids, poly cystic ovarian syndrome (PCOS), premature ovaries, endometriosis, endometrial polyps, uterine cysts, endocrine disorders. Age of the female and the physiological and anatomical changes in both genders because of the above mentioned diseases may lead to subfertility. In lifestyle patterns excessive alcohol intake, excessive tobacco intake, excessive caffeine intake, chronic exposure to environmental pollution, stress and dietary habits may be a contributing factor towards subfertility. Male subfertility also occurs due to disease conditions, physiological changes and lifestyle changes. Male subfertility is mainly detected as low sperm count (oligospermia), low vitality, low motility or reduced motility (asthenozoospermia), abnormal morphology (teratozoospermia).
Body Mass Index (BMI) value plays an important role in both genders. It is calculated as below: a person’s weight in kilograms divided by the square of height in meters. It gives an idea about the body fat masses. If BMI is less than 18.5, it falls within the underweight range. If the BMI is 18.5 to < 24.9 kg/m2, it falls within the normal. If the BMI is 25.0 to < 39.9 kg/m2, it falls within the overweight range. If the BMI is 30.0 kg/m2 or higher, it falls within the obese range. Obesity is frequently subdivided into categories: Class 1: BMI of 30 to < 34.9 kg/m2. Class 2: BMI of 35 to < 39.9 kg/m2. Class 3: BMI of 40 kg/m2 or higher. Class 3 obesity is sometimes categorised as “extreme” or “severe” obesity. The women who have a BMI more than 24.9kg/m2 and less than 18.5 kg/m2 take longer time to conceive. About 1-5% of women are subjected to weight-related amenorrhoea and among them delayed puberty can occur due to low BMI or extreme BMI.
The trend of obesity can lead to various disorders related to the female reproductive system. It is said that both over weight and obese women will associate with reduced pregnancy rate, higher rate in miscarriages and increase in gonadotropins. The relationship between obesity and reproductive disturbance was first identified by Stein and Leventhal in 1934 and in present it is known as the syndrome “O” which means over-nourishment, overproduction of insulin, ovarian confusion, and ovulation disruption. Poly cystic ovarian syndrome is commonly seen in women who are obese and who are suffering from abdominal obesity. Menstrual irregularity and subfertility are often worsening with central obesity. According to several studies done on subfertility they showed that increased BMI levels have a negative impact on men. BMI increases the fat tissue in men and this will make testosterone to change into oestrogen leading to low concentrations of testosterone, LH, and FSH. These low hormone levels will decrease sperm quality, motility and morphology. Heat of the body will also be increased with increasing fat tissues; this will lead to decrease in the production of sperms and the quality of sperms. Increased BMI will also lead to transformation of sperm DNA, fertilisation degeneration and increase the risk of miscarriages. Subfertility has become a common social problem around the world. Few changes in dietary habits can make a big change. Controlling the BMI levels and mindful eating with proper nutrients can help subfertility. Identifying the nutrition deficiencies, reproductive irregularities, discomforts and disorders at the early stage can be helpful during conceiving. Fulfilling these nutritive components and doing few medical tests to identify the functioning status of the body before planning a clinical pregnancy will help to avoid the challenges in subfertility.
(The writer holds a BAMS [Hons] from the University of Colombo and a Diploma in Panchakarma, is currently reading for an Msc in Food and Nutrition from the University of Peradeniya, and is a Residential Ayurveda Medical Officer at the Christell Clinic)