September 7, 2011

It is clear that women’s fecundity, or fertility, decreases with increasing age. By the age of 35, a woman has half the chance of becoming pregnant than a 25-year-old. An assessment of the ovarian capacity for fertility can be accomplished with some simple tests. These tests do not have a high sensitivity or a high specificity. An abnormal test is associated with a poor pregnancy rate but a normal test does not guarantee a successful outcome. The most commonly used test for ovarian reserve is to measure follicle-stimulating hormone (FSH) and the hormone estradiol on day 3 of a menstrual cycle. A more sensitive test is to measure a day 3 FSH and estradiol, followed by ovarian stimulation with the medication clomiphene citrate 100 mg from days 5 to 9 of the cycle. Another serum FSH is performed on day 10, after completion of the clomiphene citrate. An elevated serum FSH (generally 12 IU/L, but this varies according to the lab) or estradiol (greater than 80 pg/mL) is associated with a poor prognosis with assisted reproductive technology.

A variety of environmental factors have been associated with decreased fecundity. Reproductive toxins such as ethylene glycol and toluene are commonly found in the workplace. Smoking and heavy use of marijuana will decrease fertility in men and women. Alcohol in high quantities (more than five drinks per week) is also associated with decreased fertility as well as a variety of pregnancy-related complications, such as preterm deliveries. Some studies have linked high caffeine intake with delayed conception. Commercially available lubricants and saliva are also spermicidal.

SEE ALSO: Endometriosis, Infertility

Suggested Reading

  • Clark, A. M., Thornley, B., Tomlinson, L., Galletley, C., & Norman, R. J. (1998). Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Human Reproduction, 13, 1502—1505.
  • Falcone, T., Goldberg, J. M., & Miller, K. F. (1996). Endometriosis: Medical and surgical intervention. Current Opinion in Obstetrics and Gynecology, 8, 178—183.
  • Hatch, E. E., & Bracken, M. B. (1993). Association of delayed conception with caffeine consumption. American Journal of Epidemiology, 138, 1082-1092.
  • Legro, R. S., Finegood, D., & Dunaif, A. (1998). A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 83, 2694-2698.
  • Pagidas, K., Falcone, T., Hemmings, R., & Miron, R. (1996). Comparison of surgical treatment of moderate (stage iii) and severe (stage iv) endometriosis-related infertility with IVF_ET. Fertility and Sterility, 65, 791-795.
  • Rowe, P., Comhaire, F., Hargreave, T. B., & Mahmoud, A. M. (Eds.). (2000). WHO manual for the standardized investigation, diagnosis and management of the infertile male. Cambridge, UK: Cambridge University Press.
  • Sharara, F. L., Scott, R. T., Jr., & Seifer, D. B. (1998). The detection of diminished ovarian reserve in infertile women. American Journal of Obstetrics and Gynecology, 179, 804-812.

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