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    Coronavirus and treatment of infertility

    The coronavirus (COVID-19) pandemic in the U.S. and the rest of the world has caused fertility centers and their national societies to question the risks to patients, staff, and the developing fetus by this new virus. The virus is commonly spread by individuals who do not have symptoms, making avoidance very difficult. Patients with symptoms such as fever or dry cough should not go in for care, which risks other patients and health care workers, but rather should contact their health provider by phone. Their provider may recommend self-isolation at home with or without testing. In regions with a large number of cases, the focus of testing should be patients potentially needing hospital care, whereas in regions with fewer infections, widespread testing can allow for following up and testing contacts, thereby allowing more vigorous efforts to prevent spread.

    In the U.S., the extent of the epidemic and therefore the substantial possibility of infection being passed from patient to patient and to staff and among staff and patients, initialy led to recommendations by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) for fertility centers to treat only women for whom any delay would markedly affect their chance of being successful. For example, women with cancer generally only have a few weeks before starting chemotherapy to have their eggs or embryos frozen for use following their cancer treatment and a disease-free interval. As the pandemic has been brought under better control, in many areas of the U.S. a wider selection of patients can be treated, provided rigid precausions are maintained.

    Your fertility specialists realize the anxiety and concern that patients naturally have in adjusting to any delay of treatment. However, if that is what they recommend, you can be absolutely certain that their decision is based on your best interests and those of their team members. However, there are things that a couple can do during the time they are waiting that can improve their chance of being successful when treatment is resumed. The quality of the eggs and the sperm and therefore of the embryos are the main factors influencing success. The oocytes and sperm for the treatment cycle have been developing for 3 to 6 months and up to 90 days, respectively. Therefore improving the environment (the woman and her partner) surrounding and nurishing these gametes is critical. In fact, it would be entirely reasonable for all infertile couples to routinely maximize the health of their gametes for 3 to even 6 months before starting treatment. That time well spent may enhance their success enough to at least counterbalance and even exceed any loss in success due to the delay. Those efforts also may reduce miscarriage, which is particularly stressful and heart-breaking for the couple. During any imposed delay, that will also give you something very worthwhile on which to focus, and the great news is that those same improved lifestyle measures will also enhance your general health and longevity! There are also indications that these same measures may reduce the chance of suffering from a serious COVID-19 episode. Also, proceeding during such a stressful time is likely to decrease your chance for success. Stress has a marked effect on the health of the eggs, probably by constricting the flow of blood and therefore nurishment available to the ovaries.

    The following pages of this website will discuss in detail the lifestyle changes you should make, but they are also summerized below.

    1. Decrease stress and your response to stress. Do not plan to have a treatment cycle during a stressful time.

    2. Exercise at a moderate level, such as a 30 minute brisk walk most days of the week. This is of more critical importance for women who are obese.

    3. Improve your diet. A mediterranean diet with more fish, greens, fruits, and vegetables and avoiding red meat and excess fat and sugar has been related to improved fertility for both partners

    4. Stop smoking and alcohol, and avoid overcooking and charring of foods, trans fats and BPA; the male partner should not use hot tubs.

    5. These lifestyle changes will help with weight control. They are likely to help more than trying to lose a lot of weight in a hurry, which even could have negative effects.

    6. Consider taking supplements, which is particularly important if your diet is not optimal. Omega-3's and antioxidants are particularly important.

    Delay of fertility

    Couples are delaying their efforts to have a family because of careers and because contraception allows them to wait until their circumstances are more ideal. Unfortunately, fertility decreases with ages of the male (De la Rochebrochard, 2006, Fratterelli, 2008, Girsh, 2008) as well as the female. The antioxidant status of tissues of the body is lower as age increases. scaleThe older age at marriage often means contact with more sexual partners and sexually transmitted diseases like chlamydia which can damage the fallopian tubes. Endometriosis increases as more menstrual periods occur. Finally, more time allows more body weight to accumulate. Even an extra 100 calories per day causes a weight gain of 10 pounds per year and 100 pounds in 10 years. Obesity decreases fertility, increases miscarriage, and causes pregnancies to be more complicated (see weight and fertility).

    Personal habits

    smoking and alcoholPersonal habits such as smoking and alcohol can have effects on fertility. Surprisingly, even second hand smoke damages the sperm and eggs, apparently as much as smoking.

    Exercise and fertility

    Modern society has devised so many tools to avoid physical activity that we all have to make a conscious effort to set aside time for exercise. exerciseRecent studies show that fertility increases with moderate exercise in both the male and female partner. It makes sense, because exercise improves blood flow and the body's natural antioxidant status. On the other hand, high levels of exercise appear to reduce fertility. Two studies have suggested more than 3-5 hours of vigorous exercise per week for the female partner may reduce fertility (Morris, 2006, Wise, 2012), hence the above guidelines. Moderate or even high exercise for the male will enhance erectile function and will help prevent any decline of that function with aging. However, in a very thorough and well controlled study, normal young men assigned to regular high intensity exercise had significant reductions of most semen parameters and gonadotropin and testosterone levels (Safarinejad, 2009, Hayden RP, 2018). As it is likely that men with decreased semen quality would have similar or greater adverse effects, we do not recomment regular, high intensity exercise for the male partner. Biking for > or = 5 hours per week (Wise, 2011) has been reported to have negative effects on sperm. Overheating of the testicles may explain the effect of biking.

    Nutrition and fertility - click on "lifestyle and fertility"

    Sexual dysfunction and fertility

    Sexual difficulties are much more common with infertility (see sexual dysfunction and infertility). In one study almost a quarter of couples had sexual dysfunction. This is partly due to the same factors that can harm the eggs and sperm- excess body weight, a less than healthful diet, insufficient exercise, insufficient antioxidant intake, smoking, second hand smoke, and excessive alcohol all impair erectile function (see sexual dysfunction and infertility page on this site and "Survival of the Firmest" available for purchase on Amazon/kindle or "itunes"). Certainly the stress of infertility and fertility treatments and having to time relations to the time of ovulation are also factors, but sex doesn't have to be regimented. fertile timeHaving relations every 1-2 days around ovulation is ideal. Just don't let 3 days pass during that crucial time, and if your ovulation test turns positive, be sure to have relations that night or the next morning. Even before IUI, having regular ejaculation increases the success rate and that probably holds for IVF as well. The sperm's DNA remains more intact when sperm spend less time in the collecting system where oxidative stress can damage them. And, as a bonus, having more frequent erections also improves erectile function and will help to prevent erectile dysfunction in the future.

    Stress and fertility

    Stress is certainly a factor. stressThe level of stress for a woman with infertility has been compared to having a diagnosis of cancer or HIV. Also, some individuals are naturally more reactive to stress. In one study, women scheduled for IVF were tested with stressful visual and auditory stimuli (Facchinetti, 1997). Those who failed to conceive had significantly greater rises of their blood pressure and pulse rate. That study suggested the adverse effect of stress is due to constriction of blood flow to the pelvic organs.

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