India is a country that has seen drastic lifestyle changes in the recent years especially among the young population. From smoking cigarettes to excessive use of contraceptives there is a steady increase in the poor lifestyle choices which have adverse effects on all aspects of health. The effects on fertility however are often overlooked. The increase in lifestyle risk factors is found to be one of the key drivers for the high occurrence of infertility among Indian men and women.
The major lifestyle factors that have contributed to infertility are increased use of tobacco, high alcohol consumption, increasing prevalence of contraceptive use, rising levels of obesity, stress, career oriented women postponing marriage, couples opting to plan a child at a later age, late working hours, etc. Apart from those, certain medical conditions such as Poly-Cystic Ovarian Syndrome (PCOS), endometriosis, premature ovarian failure, congenital problems related to hormones (like LH/FSH) or organs (like uterus, tubes & ovaries) etc. also cause early onset of infertility. While clinical solutions can help overcome the medical factors, there is a dire need to create awareness on the lifestyle risk factors for infertility to avoid those and to combat difficulties in seeking early fertility care.
The evidence based review of lifestyle factors addresses the adverse impact of potentially modifiable, non-communicable lifestyle factors like age, weight, smoking, psychological stress, alcohol consumption, exposure to environmental pollutants on the reproductive outcome in the general populations. Evidence also suggests that modifications in the lifestyle factors can assist couples to conceive spontaneously and optimize the chances of conception in those undergoing ART treatment. Young population is aware that the negative lifestyle factors reduce fertility but falsely believe in fertility myths. Hence regular public education campaigns are necessary to avoid erroneous beliefs about pseudo-protective factors like diet, benefits of rural living, misperception of impact of age on fertility.
Routine well-women visits offer an excellent opportunity to begin to address the impact of selected risk factors for infertility. Clinicians can optimally utilize these visits to target appropriate interventions for initiating, repeating and reinforcing messages on fertility risks.
How Lifestyle affects fertility
Let us understand how some of the major lifestyle factors affect fertility.
- Tobacco usage: Smoking cigarettes or chewing tobacco may affect spermatogenesis, which is the process of sperm cell development. Tobacco use is also linked to lower sperm count, altered motility and hormonal imbalance in men. Women who smoke are known to reach menopause early and it also increases female infertility. Recent studies found that even passive smoking is likely to cause infertility. World Health Organization (WHO) reported in 2015 that the prevalence of tobacco use in India is at 17% and India is known to have one of the highest prevalence of smokeless tobacco use.
- Alcohol consumption: While the ill effects of excessive alcohol are many, fertility in men is affected in terms of reduced seminal quality, low testosterone levels, decrease in semen volume and sperm count, etc. Chronic alcohol consumption causes hormonal imbalance in women, causing irregular ovulation or an early menopause. Even moderate alcohol intake (~ 5 drinks/week) can impair conception.
- Use of contraceptives: Prolonged use of oral contraceptives significantly influences women’s fertility potential. It is known that contraceptives cause hormonal imbalance in the body, thereby causing irregularity in a woman’s menstrual cycle. Sometimes it may take several months before the ovulation becomes normal again. Recent studies indicate that contraceptive use in India has increased from 45% in 1988 to 59% in 2015.
- Abnormal weight:
- Overweight: Being overweight with body fat level that is 10-15% above normal can completely derange the hormone balance of a reproductive cycle.
- Underweight: Being underweight with body fat level that is 10-15% below normal can completely shut down the reproductive axis and its working.
- Environmental risks: Scientific evidence states that prolonged exposure to high mental stress, high temperatures, chemicals, radiations or to heavy electromagnetic or microwave emissions may reduce fertility in both men and women.
- Social risks: Delayed marriage and late conceptions in career-oriented women is associated with increased risks of non-conception, high chromosomal abnormalities, increased general health problems that interfere with fertility and increase risk of miscarriages. At 40 years, chances of pregnancy decreases to 90-67% and at 45 years the percentage decrease even more to less than 15%.
Certainly there are many other factors, including ethnicity, that lead to infertility apart from the above, and the given lifestyle risk factors result in assorted health problems apart from impaired fertility. Nonetheless, we need to understand that the problem of infertility is growing by leaps and bounds in the modern world, with an estimated 22-33 million Indian couples impacting the health of Indians. Hence, we need to spread more awareness on infertility and its causes, appropriate behaviours to prevent it and available treatments for infertility.
It is important for young women to lead a healthy lifestyle, ensuring a balanced diet and regular exercise. A doctor consultation is recommended in case of prolonged or irregular menstrual cycle for early evaluation. Couples who fail to conceive after one year of marriage and women who plan to start a family after 35 years of age are advised to get fertility check done. Today various advanced infertility treatments are made available in India, however 70% of all cases require only minimum treatment.