Stilul de viata si fertilitatea Ce spun studiile ?
As you approach menopause, your ovaries begin to respond poorly to FSH and LH. As a result, your body produces more of these hormones in an attempt to “jump start” egg development in your ovaries. When your ovaries stop responding to FSH and LH, your menstrual cycles become shorter. Eventually your ovaries may not release an egg each month and you will skip a period. By the time you reach menopause, at about age 51, you’ll have few or no eggs left in your ovaries. tests are available to evaluate your ovarian reserve. Your RisculSeveral de infertilitate
Riscul de doctor avort may spontan recommend measuring your blood levels of FSH on the second, or fourth in functie de inthird, functie de day of your menstrual cycle. High levels of FSH indicate that your ovarian varsta materna varsta materna reserve is low, and that your chances of conception are poor. However, normal
levels of FSH may not indicate that you have a good chance of conception. Your Varsta materna Avorturi spontane age is the most important predictor of your potential (ani) to get pregnant. Other tests Grupa de varsta Infertile (%) of ovarian reserve (ani) (%) include the clomiphene citrate
challenge
test (CCCT),
circulating inhibin B levels, and ultrasound assessment of follicle
15-19
numbers.
10 ovarian and occurs due
20 - 24Diminished
7 reserve
is usually age related
20-24
to the
10 loss in the average quality of the
25 -natural 29
of eggs 9 and
decrease
25-29
eggs that remain.
10
30 -However, 34
young 15women
may
have reduced ovarian
30-34 due to smoking,
12 reserve
35 -family 39 history
22premature
menopause, prior ovarian
35-39
and even if they18 of surgery,
40 -have 44 no known
29
40-44
34 risk factors.
Cat de importanta este varsta mamei ?
≥45
53
Genetic Abnormalities
Menken J,Trussell J,Larsen U. Age and infertility. Science. 1986;23:1389.
P.R. Gindoff and R. Jewelewicz. Reproductive potential in the older woman. Fertility and Sterility. 46:989;1986.
As you age, the eggs in your ovaries also age and are more likely to have genetic abnormalities. For example, chromosomal disorders such as Down syndrome are more common in children born to older women (Table 2).
2. Riskcromozomiale of Chromosomal fetale Abnormality in Newborns Riscul deTable anomalii raportat la varsta materna by Maternal Age
Varsta materna (ani) Maternal Age (years) 20 25 30 35 40 41 42 43 44 45 46 47 48 49
Risc pentru Sindrom Down Risk for Down Syndrome 1/1,667 1/1,250 1/952 1/378 1/106 1/82 1/63 1/49 1/38 1/30 1/23 1/18 1/14 1/11
Risc total pentru Total Risk for anomalii cromozomiale Chromosomal Abnormalities 1/526 1/476 1/385 1/192 1/66 1/53 1/42 1/33 1/26 1/21 1/16 1/13 1/10 1/8
Source: Maternal Fetal Medicine: Practice Principles. Creasy and Resnick, eds. Maternal Fetal Medicine:Practice and and Principles. W.B. Saunders, Philadelphia, PA. 1994:71. Reproduced with permission. Creasy and Resnick,eds. W.B. Saunders,Philadelphia,PA. 1994:71.
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Riscurile fumatului:
❖ Pana la 13% din cazurile de infertilitate pot fi atribuite fumatului ❖ Fumatul accelereaza pierderea functiei reproductive si grabeste menopauza cu pana la patru ani ❖ Fumatul este asociat cu un risc crescut de avort spontan si sarcina ectopica ❖ Un posibil mecanism este producerea de mutatii genetice in celulele reproductive ❖ Fumatorii necesita de doua ori mai multe proceduri FIV, pentru a obtine o sarcina ❖ Parametrii spermei sunt in general mai slabi la fumatori, fara a se dovedi reducerea fertilitatii ❖ Fumatul pasiv are consecinte la fel de grave ca si fumatul activ
ASRM Practice Committee Smoking and infertility Vol. 90, Suppl 3, November 2008
Center for Disease Control Fast Facts
Fumatul afecteaza si dezvoltarea fatului , crescand riscul pentru:
❖ Greutate scazuta la nastere
❖ Nasterea unui fat mort
❖ Sindromul de moarte subita a sugarului
Greutatea corporala si fertilitatea:
❖ Obezitatea este asociata cu:
Scaderea fertilitatii
Menstruatii neregulate sau rare
Risc crescut de avort ❖ Obezitatea creste riscul de complicatii la gravida si la fat ❖ La barbati, obezitatea este asociata cu afectarea parametrilor spermei
❖ Tratamentul de prima intentie este schimbarea stilului de viata - dieta si exercitii fizice. ❖ Medicatia adjuvanta este indicata atunci cand modificarea stilului de viata nu da rezultate. ❖ Scaderea in greutate cu 5 – 10% imbunatateste semnificativ ovulatia si rata de sarcina. S26 ASRM Practice Committee Obesity and reproduction Vol. 90, Suppl 3, November 2008
Stilul de viata si fertilitatea:
Factor
Obezitate (BMI >35)
Subnutritia (BMI <19) Fumatul
Alcool (>2 pahare/zi)
Cafea (>250 mg/zi) Droguri
Toxine, solventi
Impact asupra fertilitatii
Creste de doua ori timpul pana la conceptie Creste de patru ori timpul pana la conceptie Riscul de infertilitate creste cu 60%
Riscul de infertilitate creste cu 60%
Fecundabilitatea scade cu 45%
Riscul de infertilitate creste cu 70%
Riscul de infertilitate creste cu 40%
Studii Hassan and Killick, 2004 Hassan and Killick, 2004 Clark et al., 1998 Eggert et al., 2004 Wilcox et al., 1988 Mueller et al., 1990 Hruska et al., 2000
BMI = IMC (Index de masa orporala)
Consumul moderat de alcool sau cafea (pana la doua pahare / cesti pe zi) nu pare a afecta fertilitatea. Fumatul, consumul crescut de alcool, drogurile sau lubrefiantii vaginali afecteaza fertilitatea si trebuie evitate. ASRM Practice Committee Optimizing natural fertility Vol. 90, Suppl 3, November 2008
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