Being diagnosed with unexplained infertility can be a very difficult situation. Not knowing a cause of infertility that 'can be fixed', leaves the couple in despair. However, it is better than being diagnosed with something serious.
Overall chances of conception are very good for couples with unexplained infertility, especially for those where the female partner is less than 35 years and who are trying for pregnancy for less than three years. For those who have delivered before, have even better chances of success. Over 80% will conceive in the first year of trying and by end of the second year, over 90% will conceive.
As there is no definite cause, there is no definite treatment. However, there are many options.
First and foremost – optimise your natural chances
1. Do regular exercise
Can body weight play a role in infertility?
Both obesity (BMI>30) and being underweight (BMI<19) can impair fertility even in young and regularly ovulating women. Obesity can alter the egg and embryo quality (ref) and lower the chances of implantation of the embryo by negatively influencing the endometrium (lining of the womb) (ref). Obesity in men can also contribute to delaying conception by causing DNA damage in sperm (ref) and erectile dysfunction (ref).
Can exercise help with fertility?
Regular mild to moderate exercise three times a week will not only optimise your health and chances of conception but also help you to sleep well and cope with the stress. Exercise like Yoga, Pilates, walking (with or without a treadmill) and Stationary bike can be even continued during pregnancy (but preferably under guidance).
Can too much exercise make you infertile?
Excessive strenuous exercise can cause anovulation, menstrual irregularity and aggravate infertility (ref).
2. Stop smoking
Can smoking affect your chances of getting pregnant?
Both active and passive smoking can adversely affect the potential to conceive by reducing the ovarian reserve, by altering tubal function and the uterine environment (ref). In men, it impairs the fertilising capacity of sperm by reducing the mitochondrial activity and increasing DNA damage (ref).
‘Fortunately, quitting smoking can reverse the damages’.
How long do you need to quit smoking before getting pregnant?
Health benefit is noted almost immediately after quitting smoking. Since it takes 3 months to produce a fresh batch of sperm, the benefit in sperm parameters is noted at least 3 months after quitting smoking and in women within 1 - 3 months.
3. Cut down on alcohol intake
Can alcohol affect sperm count?
Excessive alcohol intake can cause infertility. In men, even habitual drinking over 5 units per week has been found to have an adverse effect on sperm quality (ref).
How does alcohol affect women's fertility?
Alcohol consumption in women can reduce fertility by decreasing the implantation rate, and by causing abnormal embryo development (ref).
Mild drinking does not cause infertility
Women should limit the alcohol intake to less than 1 to 2 units per week and men 3 to 4 units per week. Most importantly avoid binge drinking (episodes of excessive intake of alcohol in a short period of time causing intoxication, like having more than 7.5 UK units on a single occasion) (Ref )
4. Cut down too much caffeine:
Can caffeine keep you from getting pregnant?
Though there is no consistent evidence that coffee causes infertility, it is advisable to avoid too much caffeine intake. It is generally advised to have no more than 3 - 4 medium cups of coffee per day (around 300 – 400 mg). Try to cut down if you are having more (ref).
5. Eat balanced diet
What foods to eat to be more fertile?
Having a healthy balanced diet is very important to have optimum fertility outcome. Make sure to include adequate fruits, vegetables, monounsaturated fats rather than trans fat, more vegetable protein rather than animal protein, food rich in calcium like dairy products, whole grains and low glycaemic carbohydrates (ref).
Eating balanced diet will provide necessary minerals like selenium, zinc, folate and antioxidants like vitamin C, E to optimize sperm quality. There is some evidence that taking antioxidants by the male partner might improve chances of conception in couples undergoing IVF (ref). However, more evidence is needed to make it a regular recommendation.
Antioxidants are not found to be of particular benefit in females to improve chances of conception (ref).
6. Avoid recreational drugs
Many commonly used drugs, like cannabis, cocaine, marijuana can be toxic to sperm and eggs and contribute towards infertility (ref). Steroids, like testosterone intake (to build muscles), can cause low/absent sperm count in men, which might be difficult to reverse.
7. Scrotal temperature and sperm
There is evidence that raised scrotal temperature can reduce sperm count and motility (ref).
Various lifestyle adjustments can be made to avoid raised scrotal temperature like, avoiding using a laptop on the lap for long hours, avoid a prolonged repeated hot bath, heated car seat for a prolonged period. If you have the fever, it can temporarily affect your sperm quality. It is however uncertain whether changing to loose-fitting underwear improves sperm parameters.
8. Have intercourse at the right time
Ovulation occurs 14 days prior to the period. So in women who have a regular cycle (between 26 - 34 days), it is easy to work out the precise time of ovulation. Those with irregular cycles (cycles longer than 35 days) are unlikely to be ovulating consistently and should seek medical advice. The fertile period is the week prior to ovulation. The egg survives only for 1 day after being released, while sperms survive for 4 -5 days. Hence sex every other day, beginning a week before ovulation till the ovulation has the maximum potential for conception. Key is to have sex prior to ovulation so that sperms can fertilise the egg soon after its release.
‘Have sex every other day beginning a week before ovulation till the ovulation'.
9. Reduce the stress level
Can stress cause fertility problems?
Having difficulty in conceiving or undergoing fertility treatment can be stressful. It can cause significant anxiety and depression and affect the financial, spiritual, sexual, physical and emotional well-being of the couple. There is some evidence that stress has an association with the delay in conception (ref). However, it is difficult to say whether stress causes infertility or vice versa.
How to reduce stress when trying to conceive?
Various stress management methods can be adopted like yoga, meditation, and mindfulness depending on individual choice. However, do not hesitate to seek help from professional counsellors or mental health professionals if these techniques do not help.
10. Take folic acid
Take folic acid 0.4 mg daily (till 12 weeks of pregnancy) to prevent the risk of neural tube defect in the baby. However, those who have had the baby with neural tube defect, on anti-epileptic drugs or diabetics, should take 5 mg of folic acid daily.
Written by Dr Anupa Nandi