Your browser fingerprint:

What you need to know when you want a baby

Factors that have an impact on fertility

Conceiving a child depends on both partners in equal amounts.
Usually, couples who want to have a baby look for advice on what they can do to maximise their likelihood of conceiving.
This chapter aims to inform you about the effects of age and lifestyle on fertility and about the importance of synchronisation and good health before conception.

La fertilità diminuisce con l’avanzare dell’età della donna in ragione della normale diminuzione del numero di ovuli che rimangono nelle sue ovaie e del loro invecchiamento. Questa diminuzione può avvenire molto prima di quanto la maggior parte delle donne si aspettino.


Age, menstrual cycle and ovulation

In early adolescence, girls often have ovulation at irregular intervals, which also means irregular menstrual cycles, but around the age of 16 ovulation and the menstrual cycle are regulated. Cycles will remain regular, with a length of 26 to 35 days, generally until the age of 45, when they become shorter. After not having menstruation for one year, a woman has entered menopause.

As women age, fertility decreases as a result of the normal changes in the ovaries related to age. Unlike men, who continue to produce sperm throughout their lives, women are born with all follicles (containing ova) that they will ever have. At birth, the ovaries contain about one million follicles. By puberty, their number will have dropped to approximately 300,000. Of these, only about 300 are released during the reproductive years, and the others are lost through atresia, a degenerative process that occurs regardless of whether women are pregnant, they have normal menstrual cycles, they use contraceptive methods or not, or they undergo a fertility treatment.

Fertility of elderly women

The frequency of infertility and miscarriages increases with age. Fertility peaks at the age of 27 for women, and starts to decline after the age of 30, mainly due to the aging of eggs. Every month she tries to conceive, a healthy 30 year-old woman has a 20% chance of getting pregnant. By the age of 40, the likelihood decreases gradually to about 5% during each cycle.

Women do not remain fertile until menopause. The average age for menopause is 51, but most women become unable to have a successful pregnancy around the age of 45. These percentages are valid for natural conception, as well as for conception through fertility treatments, including in vitro fertilisation. Loss of female fertility due to aging occurs as a result of the gradual decrease of the quality and number of eggs.


The quality and quantity of eggs are directly influenced by aging.

A healthy lifestyle can improve a woman’s ability to conceive.


The most important step you can take to prepare for conception is to analyse your overall health and make changes to improve it. Not only will you increase your likelihood of conceiving a child, but you will also prepare your body for a healthy pregnancy.
There are some key lifestyle changes that are directly related to fertility and the health of a child.
You can improve your lifestyle by adding physical exercise, relaxation techniques and more sleep and rest to your daily routine, as well as by choosing balanced meals and taking prenatal vitamins.


Diet influences every phase of the reproductive process, from sperm formation and egg maturation to breast milk formations processes based on the vitamins, minerals, aminoacids and fatty acids that the body takes from food.

There are some nutrients that directly affect fertility in women, such as zinc and vitamins B6, C and E.
Choosing a balanced diet is an investment in your body, fertility and your baby's health. It is important to start preparing for a healthy pregnancy before conception, so as to ensure the healthy development of the foetus and to minimise or prevent pregnancy complications.

The healthy development of the foetus

Probabilmente i seguenti nutrienti non influenzano le tue possibilità di rimanere incinta, ma contribuiscono allo sviluppo sano del bimbo sin dall’inizio. Dovresti includere le seguenti vitamine e minerali nella tua dieta, in quanto necessari per il bimbo fin dai primi giorni di sviluppo e durante gravidanza:The following nutrients may not impact your chances of getting pregnant, but they contribute to the healthy development of the baby from the start. You should include the following vitamins and minerals in your diet, as they are necessary for the baby from the very first days of development and throughout the pregnancy:

  • Folic acid: make sure you have a daily intake of at least 400 micrograms before conception. After getting pregnant, you should increase the daily dose to 600 micrograms. Folic acid can be obtained by eating dark green leafy vegetables, whole grains, bread and fortified cereals and prenatal vitamins;
  • Calcium: it is important for women to take at least 1,000 mg of calcium per day. Calcium contributes to bone development. It can be found in milk, cow's cheese, yoghurt and some cheeses.

ProFecund contains 400 mcg of Quatrefolic™, which is an active folate (bio-active, 100% bioavailable folic acid)

Prevention of pregnancy complications/h3>

The following nutrients should be part of your fertility diet, because they help prevent foetus anomalies during pregnancy and they help reduce the risk of miscarriage: make sure you include foods that are sources of magnesium, selenium and manganese in your diet.


If you are trying to get pregnant (or you plan to do so in the future), you must know that excess weight affects your chances of conceiving and having a healthy baby.
Being overweight can affect a woman�s fertility. If you intend to get pregnant in the following year or years, a healthy diet and regular physical exercise can boost your fertility. Losing weight can make a difference, even if it is just a few kilos. The future father�s weight may also affect your chances of getting pregnant.
It is particularly important for women with diabetes mellitus to plan their pregnancy. If possible, it is advisable to review your general health at least three to six months before attempting to get pregnant.


Women who smoke need more time to conceive than those who do not and they are also more likely to have fertility problems.

Most components in cigarette smoke interfere with the ovarian cells' ability to produce oestrogen, making the eggs prone to genetic anomalies. As smoking affects the genetic material in eggs and sperm cells, the rates of miscarriage and having newborn babies with congenital birth defects are higher among couples who smoke. Women who smoke are more likely to have a chromosomally unhealthy pregnancy (such as a pregnancy affected by Down syndrome) than non-smoker mothers. In addition, ectopic (extrauterine) pregnancies and premature labour occur more often among female smokers.

The various harmful substances in the composition of tar infiltrate into the mucous membrane of the cervix, making it difficult for the sperm to pass to the uterus.

In the mucous membrane of the cervix, the nicotine concentration is 10-20 times higher than in the blood. On the one hand, this prevents the implantation of the fertilised egg, while on the other hand it has a toxic effect on the embryo. In female smokers, certain components of nicotine jeopardise the maturation of uterine follicles, which prevents normal egg development.

The risk of infertility may be twice as high as that of non smokers, and during pregnancy smoking exposes the baby to health problems.

The good news? It is estimated that most of the negative effects that smoking can have on fertility are reversed one year after you quit smoking.

Do you want to get pregnant? Then why wait to get there to quit smoking? Quit now and act as if you were already pregnant! This will increase your likelihood of getting pregnant.


There is little scientific evidence of how low to moderate alcohol consumption can affect female fertility. People often have difficulty in accurately reporting alcohol consumption, so it is difficult to conduct research that can isolate the impact of alcohol as a factor influencing fertility.

Certainly, however, excessive alcohol consumption can affect fertility, by increasing the amount of time needed to conceive and by reducing the chances of having a healthy baby. In women, alcohol causes imbalance in the hormonal system controlling reproduction. Even small amounts of alcohol may affect the menstrual cycle and reduce the chances of conceiving a baby.

The healthiest option is not to consume any alcohol during the period when you are trying to get pregnant. If a woman who wishes to get pregnant chooses to consume alcohol, she should not exceed one to two units of alcohol once or twice a week (two units of alcohol are the equivalent of 175 ml of wine) and she should definitely not exceed the lucidity limit.

Physical exercisei

Moderate physical exercise (for instance, a brisk walk) for 30 minutes a day is the current recommendation for all adults and this level of exercise is beneficial for fertility. Some studies suggest that more than 3 to 5 hours of intense physical exercise per week may reduce fertility in women. High intensity training programmes can alter hormonal balance, disturb ovulation and the entire menstrual cycle. At the same time, studies show that a sedentary lifestyle may be detrimental to fertility, so moderation should be considered. Intense, exhausting, prolonged exercises increase cortisol levels and decrease thyroid hormone levels. Thyroid hormones stimulate the metabolism and we certainly do not want a slower metabolism after physical exercise. Even after 24 hours of post-exercise recovery, the cortisol level remains high, and that of thyroid hormones remains low. These hormones are correlated with good adrenal health, which in turn has a direct influence on thyroid function and the manner in which the body manages long-term stress, all of which may have a negative impact on general hormonal balance and fertility.

It has been proven that moderate regular physical exercise strengthens muscles, increases flexibility, stimulates circulation, reduces stress, and prevents depression and anxiety, while promoting excess hormone detoxification and the release of toxins from the body. All of these benefits make moderate regular physical exercise essential when you are preparing for pregnancy. Women who are trying to get pregnant should regularly follow a moderate physical exercise programme, for 30 minutes a day, 3 times a week.


It may seem unreal, but our bodies are built in such a way that they do not allow conception during periods of extreme stress.

Recent research has shown that stress increases the level of stress hormones such as adrenaline, noradrenaline and cortisol in men and women alike. These hormones may inhibit the release of gonadotropin (GnRH), the main hormone of the body responsible for the release of sex hormones. Subsequently, this may suppress ovulation in women or reduce sperm count in men, decreasing libido in women and men alike. Chronic stress may lead to a lack of libido, as well as a decrease in fertility in general. This has become such a common issue that it even got its own specific name: stress-induced reproductive dysfunction.

The attempt to take a pregnancy to term in periods of intense stress exposes the foetus to risk. The body knows it, which is why it creates an unfavourable environment for conception. Generally, a stressed person is an unhealthy one. People who permanently live with a high level of stress are usually tired and full of nervous tension, which may determine them to choose an unhealthy diet and lifestyle. If you have taken fertility tests and found there is no medical reason for your infertility, it is time to assess the level of stress you are facing. Try to make changes in your life so that you may feel more relaxed. A healthy diet, physical exercise and yoga or meditation may help reduce stress.

Or perhaps you just need a holiday with your partner...

Conception primarily depends on the time when sexual intercourse occurs

People do not know when to have sex.

In all animals, except for humans, the sexual impulse is correlated with the time of ovulation in the female. The desire to have sex at any time of the month or the year is specific to the human species only; it separates us from the rest of the Animalia kingdom and, as regards the reproduction of the species, it is completely inefficient.

There is just a very short period of time, of a mere few days each month, when sexual intercourse may lead to pregnancy. If sex does not occur in the period around ovulation, the likelihood of getting pregnant drops significantly. In most animals, except for humans, sexual intercourse occurs only at this precise moment, when the chances of getting pregnant are highest.

The menstrual cycle may hint at the time when the woman's body is ready for pregnancy.

As regards the egg, there is a period of only 12 to 24 hours in which a woman can conceive. So how do we know the fertile window? The answer is around ovulation and menstrual cycle. By understanding the menstrual cycle and ovulation, you can identify the optimal time frame for conception, i.e. your fertile days. We are talking about the days in a woman’s menstrual cycle when conception is possible, that is, just the five days before ovulation, plus ovulation day. These six days are the fertile window of a woman’s cycle and they reflect the lifespan of sperm (about 5 days) and the egg (just 24 hours).D’altronde, questo è il metodo più semplice, economico e sicuro per concepire un bimbo.

If a woman has sexual intercourse six or more days before ovulation, the odds of getting pregnant are basically zero. If sexual intercourse occurs five days before ovulation, the likelihood of conception is approximately 10%. The chances to conceive grow steadily in the two days before ovulation and on ovulation day. If a woman has sexual intercourse in any of these three days, she has a 27-33% chance of getting pregnant.

At the end of the fertile window, the likelihood of conceiving drops rapidly and, 12 to 24 hours after ovulation, a woman is no longer able to get pregnant during that cycle.

To help optimise the chances of conceiving, for those women who fail to detect their fertile period or their ovulation, sexual intercourse is recommended every 2-3 days. Sperm can live in a woman’s body for 3 to 5 days. However, an egg released by the ovary lives only 12 to 24 hours. The highest rates of conception were reported when the egg and sperm met in the first 4 to 6 hours after ovulation.

It is important to know that monitoring your ovulation is not impossible; you can find more information in the chapter Identifying fertile days. For most couples, however, it is all about having sexual intercourse frequently enough during the appropriate period of the menstrual cycle.

Besides, this is the easiest, cheapest and safest method of conceiving a child.

Although you may have a healthy lifestyle, your fertility may be affected by other health problems. Before you conceive, it is recommended to undergo a medical examination, where the doctor will assess if you have or are prone to diabetes or gestational diabetes risks, high blood pressure, anaemia, thyroid conditions, or sexually transmitted diseases. In addition, they will assess immunity to rubella and chickenpox.

The doctor will examine your medical history, assessing any medical treatment you may be following, your previous pregnancies, physical health and diet, physical activity and family history. The doctor will know what recommendations to make according to your needs

Ovulatory dysfunction

When ovulation does not take place regularly, your doctor will tell you that you suffer from an ovulatory dysfunction. Fortunately, you have just purchased ProFecund, and this is one of the conditions for which the product has proven its efficacy.

Ovulation is a complex process, which depends on a proper amount of certain hormones necessary at certain times of the menstrual cycle. Anything that disrupts the hormonal regulation of the female cycle may lead to ovulatory dysfunction. The hypothalamus and the pituitary gland, organs that can be found in the brain, have an important part in regulating the amount of FSH and LH. Inadequate amounts of these hormones at the beginning of the menstrual cycle may lead to ovulatory dysfunctions. Therefore, any changes in the functioning of the hypothalamus and the pituitary gland can affect ovulation.

Up to 30-40% of women may experience ovulatory dysfunctions.

Ovulation dysfunctions can occur for various reasons, including: hormonal imbalances caused by dysfunctions of the hypothalamus, pituitary gland and ovaries (the most common condition caused by these imbalances is polycystic ovary syndrome), hyperprolactinemia, obesity and underweight, excessive physical exercise, thyroid dysfunction, premature ovarian failure, low ovarian reserve, and stress.

The most common symptom seen in women with ovulatory dysfunction is the lack of regularity (or even absence) of the menstrual cycle. Women with ovulatory dysfunction usually have cycles shorter than 21 days or longer than 35 days. The duration of cycles often varies greatly from one month to another, and usually none of the common symptoms of the onset of the menstrual cycle are reported.

Amenorrhea is the medical term for an absence of menstruation lasting for six months or longer. Occasionally, there are uterine disorders that can cause a loss of menstruation, but it generally means that the ovary does not release an egg and therefore the uterus does not receive any hormonal message from the ovary that the normal ovulation cycle should begin.

The most important effect of the treatment with ProFecund is precisely balancing the hormonal system and, therefore, regulating ovulation

Oligomenorrhea is another symptom of ovulatory dysfunction. It means having irregular menstrual cycles, with a long interval between them, of two up to four months. Women who have only three to six menstrual cycles per year may ovulate occasionally, but generally the irregular bleeding that occurs is anovulatory, being caused by a low amount of oestrogen. This causes the endometrium (uterine lining) to thicken, without this being associated with the full development and maturation of an egg.

Finally, one last symptom we describe is the short cycle (or luteal phase deficiency). It occurs in women who have menstrual cycles shorter than 25 days, particularly if the second part of the cycle, after ovulation, is shorter than it should be. This phenomenon is called luteal phase deficiency (or insufficiency) and it means that the uterus does not have enough time to prepare for pregnancy. Luteal phase deficiency is often associated with low progesterone values in the second part of the menstrual cycle.

Ovulatory dysfunction can be recognised only if the woman has difficulties in conceiving a child. However, there are exceptions, where even women with very regular, consistent cycles are unable to ovulate. Women’s medical history is useful in diagnosing ovulatory disorders. The doctor may require further tests to confirm the diagnosis, and usually the symptoms will dictate which hormonal tests and ultrasounds will be necessary during the examination.

If ovulation does not take place, medications to stimulate ovulation are recommended. During treatment the ovulation period should also be monitored closely; this involves performing ultrasounds and blood tests.

The special standardised extract of Vitex agnus castus in ProFecund restores the hormonal balance, thus regulating the menstrual cycle

Polycystic Ovary Syndrome (PCOS)

PCOS is a disturbance of the ovarian function caused by hormonal imbalances that restrict or prevent ovulation. In general, women suffering from this syndrome have an inadequate production of follicle-stimulating hormone (FSH) and luteinising hormone (LH), which leads to an incomplete egg development and an increase in the level of testosterone and other androgens. They also have an abnormal insulin metabolism, which worsens with anovulation, increases the level of androgens and leads to obesity.

The causes of PCOS are not fully understood. It is clear that there is a genetic cause, because the likelihood is higher for a woman to develop PCOS if her mother or sister has this problem. It is also known that incoherent signals from the brain to the ovaries affect the production of ovarian hormones, which further worsens the woman’s condition.

The hormonal imbalance experienced by women with PCOS leads to irregular menstrual cycles:

  • Amenorrhea and oligomenorrhea: as the ovaries certainly do not produce eggs, the oestrogen level is often low. Therefore, the uterus receives very few messages to thicken its lining. As ovulation does not occur, the progesterone level does not increase enough to trigger menstruation either. Patients with this syndrome therefore often have rare or completely absent periods.
  • Abundant or irregular menstruation: they are more common in women with PCOS whose weight is above average. Women with this type of menstruation need an investigation of the uterine lining through hysteroscopy and biopsy, so as to make sure that they do not develop cancerous or precancerous changes.Mestruazioni abbondanti o irregolari: sono più frequenti nelle donne con sindrome dell’ovaio policistico con un peso oltre la media. Le donne con questo tipo di mestruazioni richiedono un’indagine della mucosa dell’utero mediante isteroscopia e biopsia, per controllare che non si sviluppino alterazioni cancerose o precancerose.

  • Many women with PCOS have high levels of male hormones (androgens) in their blood. They are mainly produced by the ovaries, which act abnormally, but they are also produced in the adipose tissue of the body. In about half of the women suffering from PCOS, obesity is the main problem, and excessive fat tissue contributes to abnormally high levels of androgens. These male hormones contribute to some of the PCOS symptoms, including acne, abnormal hair growth and, more rarely, a deeper voice.

    Furthermore, there seems to be an association between endometriosis and PCOS. There are many theories regarding the causes of endometriosis, but this condition seems to be more common in women with an imbalanced hormonal environment and inadequate ovulation. This may be a clue to examine women with PCOS and fertility issues for associated endometriosis.The medical history and the pelvic examination are necessary for the diagnosis of PCOS. Other tests are usually required to confirm the diagnosis, such as blood hormone levels (FSH, LH, oestrogen, and androgens), ultrasound, and endometrial biopsy.

    IThe treatment will depend on your specific needs. Obesity may worsen your condition, so losing weight could help improve hormonal balance. If you want to get pregnant, then ovulation stimulants could be prescribed. Drugs used in diabetes can also be prescribed, which can help the body increase its sensitivity to insulin and thus lead to regular ovulation.

    Fallopian tube issues

    Some of the most common causes of infertility are Fallopian tube conditions, where one or both tubes are blocked or affected.

    The Fallopian tube is the channel through which the egg goes from the ovaries to the uterus. During ovulation, the egg is released from the ovary and is taken up by the fimbriae at the end of the Fallopian tube, which look like tiny fingers embracing the neighbouring ovary. The egg remains here for one day and this is where fertilisation will occur if it meets the sperm that passed through the cervix and the uterus to the inside of the Fallopian tubes. Subsequently, the cilia inside the tube will push the fertilised egg to the uterus, where it will remain for another three days before implanting itself in the uterine wall.

    Nearly 25% of cases of infertility are due to tubal causes. This is a medical condition that can be successfully treated by surgery or bypassed by in vitro fertilisation.

      Causes of tubal infertility

      Tubal infertility is caused by various disorders located in the Fallopian tubes:

    • total or partial tube blocking
    • scars or adhesions on the tubes, or other lesions or damage caused by cysts, abdominal surgical procedures, etc.
    • past history of ectopic pregnancies
    • infections not treated in due time

    • The main cause of this type of infertility is frequent pelvic infections. The most common of them is pelvic inflammatory disease (or annexitis). It is caused by sexually transmitted infections caused by two bacteria, Chlamydia trachomatis and Neisseria gonorrhoeae, respectively. These infections can travel from the cervix, through the uterus, to the Fallopian tubes.

      Infection in these tissues causes an intense inflammatory response. While the body is fighting the infection, bacteria, white blood cells and other fluids (a liquid popularly known as pus) fill the Fallopian tubes. The lining of the Fallopian tubes can be permanently damaged and the opening of the tube near the ovary may be partially or completely blocked. Scar tissue will often form on the outside of the tubes and the uterus. Infections may damage the cilia, which enable the egg transportation, found in the Fallopian tube lining. Without them, the egg cannot meet the sperm or, if it is fertilised, the egg can no longer reach the uterus. All of these factors can compromise the normal functioning of the ovaries or the Fallopian tubes and reduce future chances of conception or may lead to an ectopic pregnancy that may further damage the Fallopian tubes.

      Another cause of infertility caused by Fallopian tubes is scar tissue resulting from endometriosis (see the following pages) or abdominal surgery (including Caesarean section). These may block the egg’s entry into the Fallopian tube or its passage through to the uterus. Tubal ligation can also damage the Fallopian tubes.

      La diagnosi di infertilità tubarica

      Most conditions that cause tubal infertility are asymptomatic. Often, women suffering from such conditions do not realise their Fallopian tubes are blocked until they are experiencing fertility problems. However, women with extensive damage of the Fallopian tubes may have chronic pelvic pain.a maggior parte delle condizioni che causano infertilità tubarica sono asintomatiche. Spesso, le donne in questo stato non si rendono conto che le loro tube di Falloppio sono bloccate fino a quando si verificano problemi di fertilità. Tuttavia, le donne con gravi danni alle tube possono avere dolore pelvico cronico.

      Medical history and pelvic examination are necessary to diagnose Fallopian tube disorders. Other procedures are also recommended to confirm the diagnosis, such as: sonohysterography, hysterosalpingography (HSG), or laparoscopy, during which the doctor may remove scar tissue or endometrial tissue blocking the Fallopian tubes.

      With relatively minor Fallopian tube conditions, it may be difficult to determine whether the infertility problem is due solely to Fallopian tube damage. There may also be other important causes that contribute to the state of infertility.

      Tubal infertility treatment

      Typically, the treatment for tubal infertility is either a surgical intervention on the Fallopian tubes, so as to repair some of the damage, or in vitro fertilisation. If the scar tissue around the Fallopian tubes is the cause of the problem, it can often be surgically removed. If the Fallopian tubes are damaged, they can be repaired with surgery, depending on the type and degree of damage


    Endometriosis is the condition in which the tissue lining the inside of the uterus, called endometrial tissue, grows outside the uterus.

    Endometrial tissue inside and outside the uterus responds to the hormones of the menstrual cycle in a similar way: it swells and thickens, and it is subsequently discharged, thus marking the beginning of the following cycle. Unlike the menstrual blood in the uterus, which is discharged through the vagina, the blood in the endometrial tissue in the abdominal cavity has no way of leaving the body. In the areas where blood accumulates, an inflammation occurs, which forms scar tissue. This can block the Fallopian tubes or interfere with ovulation. Besides, the growing endometrial tissue inside the ovaries may form a type of ovarian cyst called endometrioma, which may interfere with ovulation.

    Endometriosis is a progressive conditions. It tends to worsen over time and may recur after treatment. It usually improves after menopause.

      Causes of endometriosis

      With all the scientific progress, medicine has yet to provide a full explanation for this condition. There are several theories about the causes of endometriosis, but none of them has been proven with certainty. The three main theories include:

    • retrograde menstruation: the menstrual blood that has not been discharged with the menstrual flow, containing endometrial cells, may rise into the abdomen through the Fallopian tubes. This reverse menstruation leads to abnormal endometrial tissue implantation in the pelvis
    • endometrial tissue being spread in the blood and lymph vessels
    • • coelomic metaplasia, i.e. the ability of cells in the pelvic cavity to turn into endometrial tissue.

    • Risk factors

      Endometriosis tends to be more common in women with uninterrupted menstrual cycles for a longer period of time. These women often include those who have never been pregnant, those with an early menstruation onset, as well as those who reach menopause at an older age. On the other hand, endometriosis is rarer in the women who experience interruptions in their menstrual cycle, such as those with several pregnancies and long breastfeeding periods.

      Endometriosis also has a genetic component, as it can be inherited. Women with first-degree relatives diagnosed with endometriosis have a 7% chance of developing the condition, compared to 1% chances in those with no such family history. Moreover, endometriosis tends to be more frequent in Caucasian women compared to African American and Asian women. In addition, there is a significantly higher endometriosis prevalence in women with infertility compared to fertile ones.

      How fertility is affected by endometriosis

      Endometriosis can affect fertility through several mechanisms:

    • abnormal or distorted pelvic anatomy
    • increased pelvic inflammation
    • modified pelvic immunology
    • hormonal dysfunction
    • In the presence of significant anatomical adhesions or distortions, infertility can be explained logically by the mechanic interference when taking and carrying the oocyte and by the modified peristalsis of the Fallopian tubes. In the absence of anatomic pelvic distortions, however, endometriosis associated infertility is still poorly explained.

      There are several theories that explain low fertility. Some of them include modified folliculogenesis, ovulatory dysfunction, sperm phagocytosis, impossible fertilisation, defective implantation, inhibition of early embryo development, luteal phase deficiency and immunological changes. Chronic inflammatory changes in the peritoneal cavity in women with endometriosis are associated with an increase in the volume of peritoneal fluid and the number of macrophages, their concentration and activity. The leukocytes in the peritoneal fluid interfere with fertility through direct cytotoxic effects or by releasing cytokines and proteolytic enzymes in the pelvic environment, which may affect the reproductive function or the growth of the embryo.

      Endometriosis symptoms

      Endometriosis may be associated with pelvic pain, dysmenorrhoea and/or infertility, abnormal and irregular bleeding, but it may also be asymptomatic. Infertility is usually the most common symptom for which women are diagnosed with endometriosis. The incidence of infertility in women with endometriosis is unknown, but the incidence of endometriosis in infertile women varies from 4.5 to 33% (with an average of 14%).

      Diagnosing endometriosis

      The definitive diagnosis of endometriosis requires surgical biopsy or laparoscopic visualization of pelvic lesions. Sometimes laparoscopy removes scar tissue and endometrial tissue attached to other organs. The presence of an endometrioma in a pelvic sonogram may also help establish a clinical diagnosis of certainty.

      Endometriosis treatment

      Fortunately, there are medical and surgical options for the treatment of endometriosis

      Drugs soothe the pain associated with endometriosis, but they do not cure the condition. Besides, there is no evidence to suggest that the medical treatment improves fertility. Medical therapy includes hormonal treatments and anti-inflammatory drugs, which may be used separately or in combination. The efficacy of these various options of medical treatment is comparable.

      The surgical treatment of endometriosis is recommended to restore normal pelvic anatomy, often modified due to adhesions, as well as to remove as much abnormal tissue as possible. Furthermore, surgery is recommended for the removal of endometriomas, particularly when these cysts are larger than 2 cm.

      Generally, within 1 to 2 years from the surgical treatment, pregnancy may occur in about 65% of the women operated on.

    Endometriosis is a very serious condition. If you experience heavy menstrual flow, painful periods or pain during intercourse, you must see a doctor!

    Sexually transmitted diseases

    Sexually transmitted infections, especially gonorrhoea and Chlamydia, may affect fertility in women and men alike.

    There is only one way to avoid sexually transmitted infections. In fact, there are two, but the second one involves total abstinence. So it is best to have safe sex, by using a condom. When both partners are ready to start a family, they can be tested for sexually transmitted diseases, so as to remove the risk of transmitting the infection to the other partner or to the baby.

    Chlamydia is a very common bacterial infection, which can affect anyone who has had unprotected sex. It is estimated that at least 75% of women and 40% of men have no symptoms. Moreover, as the symptoms of Chlamydia trachomatis infection may be similar to those of other conditions, such as yeast infection or cystitis, they can be overlooked. If they occur, the symptoms may include pelvic pain, painful, heavy menstruation, deep pain during vaginal intercourse, bleeding between periods or after sexual intercourse, frequent urination with burning sensations, and unusual vaginal discharge.

    Chlamydia produces the inflammation of the urethra (the tube connecting the bladder to the urinary opening) and/or the cervix. If left untreated, the infection can go up to the uterus, the Fallopian tubes and the ovaries, turning into pelvic inflammatory disease. This may form scar tissue and adhesions. As we have seen above, these can lead to serious health problems, including chronic pelvic pain, ectopic pregnancy and fertility problems.

    Symptoms of pelvic inflammatory disease include: abdominal pain and tenderness, deep pain during sexual intercourse, painful, heavy menstruation, fever, abnormal vaginal discharge, yellow, brownish or greenish, or heavy vaginal discharge.

    Chlamydia infection is treated with antibiotics.

    Gonorrhoea is a bacterial infection that usually affects the genital area (although the neck or anus may also be affected). Gonorrhoea can affect both men and women and it can be easily transmitted during intercourse, whether vaginal, anal or oral.

    Gonorrhoea may be asymptomatic, which means it can remain undetected for a long time in women. Half of the infected women do not know they are sick, and 10-40% of them develop an even more serious condition. When symptoms occur, they include: abnormal vaginal discharge, pain during urination, pain during intercourse, pelvic pain, irregular menstrual periods, sore throat (for throat gonorrhoea), pain and anal bleeding (for anal infection), itching.

    If left untreated and if it spreads in the body, gonorrhoea may affect the uterus, exposing the woman to the risk of developing pelvic inflammatory disease, a possible cause of infertility. The symptoms of pelvic inflammatory disease include: lower abdominal pain and tenderness, deep pain during sexual intercourse, painful, heavy menstruation, heavy or abnormal vaginal discharge, yellow, brownish or greenish, or fever.

    As you can see, the symptoms of the two infectious processes are similar. If you feel any of them, do not try to self-diagnose. Make an appointment with your doctor, as they will be able to determine a correct diagnosis and treatment.

    Uterine fibroids

    Fibroids are the most common tumours of the female reproductive system. A fibroid is a firm, compact tumour, consisting of smooth muscle cells and fibrous connective tissue that develops inside or outside the uterus. It is estimated that 20% to 50% of women of reproductive age have fibroids, although not all of them are diagnosed. Other research estimates that 30% to 77% of women will develop fibroids at some point during their fertile period, although only about one third of these fibroids are large enough to be detected by a doctor during a physical examination. In over 99% of the fibroid cases, the tumours are benign (non-cancerous). These tumours are not associated with cancer and do not increase a woman’s risk of uterine cancer. Fibroids may vary in size, from that of a pea to that of a small grapefruit.

      Causes of fibroids

      It is not clear what causes fibroids. It is believed that each tumour develops from an abnormal uterine muscle cell that multiplies rapidly under the influence of oestrogen.

      How fibroids affect fertility

      Approximately 5%-10% of infertile women have fibroids. Their size and location determines whether or not they affect fertility. Among the aggressive fibroids in this respect there are the intramural, submucosal or very large ones (with a diameter of over 6 cm). Those that grow on the inner uterine wall may cause changes in the endometrial tissue and may affect the blood flow to the uterine cavity, which makes it difficult for the fertilised egg to implant itself on the uterine wall. Subserosal fibroids may interfere with the pregnancy by compressing or blocking the Fallopian tubes, thus preventing sperm from reaching the egg. Moreover, fibroids that change the shape of the cervix can affect the number of sperm cells that enter the uterus, and those that change the shape of the uterus may interfere with sperm or embryo motility.


    Prolactin is a hormone produced by the pituitary gland. The main functions of prolactin are related to the pregnancy and the production of breast milk for the newborn baby. However, prolactin levels may be high even when the woman is not pregnant or breastfeeding, causing a variety of conditions that may affect menstrual function and fertility.

      Causes of hyperprolactinaemia

      There are several conditions that can raise the level of prolactin. Prolactin levels increase normally during pregnancy, as a response to nipple stimulation (usually after the baby is born) and during stressful times. Prolactin levels may increase abnormally when prolactin producing cells inside the pituitary gland (lactotropic cells) produce more hormone than necessary or when lactotropic cells grow abnormally, thus forming tumours (prolactinomas). In addition, high prolactin levels may occur as a side effect of certain psychiatric drugs. Another cause of excess production of prolactin may be hypothyroidism. Sometimes the cause is unknown.

      Hyperprolactinaemia symptoms

      Hyperprolactinaemia may cause irregular ovulation or even the lack thereof, thus leading to infertility. Women who have this disorder often have irregular menstrual cycles and may have lactation when they are not pregnant (the so called galactorrhoea). In addition, excess prolactin can directly influence ovarian steroidogenesis, which causes menstrual cycle disorders. Hyperprolactinaemia is a relatively common cause of secondary amenorrhea (interruption of menstrual bleeding after the first menses) and metrorrhagia (vaginal bleeding outside of the menstrual flow). In the absence of menstrual disorders, hyperprolactinaemia is often undiagnosed.

      Diagnosing hyperprolactinaemia

      A simple blood test to measure the amount of serum prolactin may confirm a diagnosis of hyperprolactinemia. As every person has daily variations in prolactin levels, it may be necessary to repeat the blood test to determine a diagnosis, provided that the hormone levels are only slightly elevated. Many women receive this diagnosis after an infertility assessment or irregular menstruation, but others have no symptoms. Slight increases in prolactin levels do not usually cause noticeable changes in menstrual cycles, although they may lead to a decrease in the overall fertility. Higher levels of prolactin may cause irregular menstrual cycles and significantly reduce a woman’s fertility, sometimes causing menopausal symptoms (lack of menstrual cycles, hot flashes or vaginal dryness) and infertility.

      Hyperprolactinaemia treatment

      The treatment will depend on the cause of excess prolactin production. If hypothyroidism is diagnosed, a drug for thyroid will be prescribed. Once the thyroid issue is solved, the amount of prolactin in the blood should drop to a normal level. If there is a tumour on the pituitary gland or the cause of hyperprolactinaemia is unknown, the drug treatment may reduce prolactin levels. Moreover, drugs also lead to a reduction of pituitary tumours. Although these drugs are very efficient in bringing prolactin levels to a normal range, they cannot cure the disorder. If you stop the treatment, prolactin levels may rise again and the symptoms may also return. Once the levels of prolactin in the blood are within normal limits, menstruation should become more regular and ovulation should occur. Increases in prolactin levels often respond well to medication and rarely require surgical interventions.

    Other conditions

    Congenital abnormalities of the genitals are anatomical birth defects located in the female genital organs. There are also anomalies that occur at some point in life and that can be caused by certain conditions or drugs. They need to be corrected before conceiving a baby, as they may cause infertility or jeopardise the evolution of the pregnancy if fertilisation takes place. Such anomalies are present at birth and relate to the uterine shape, development (septate, unicornuate, bicornuate, didelphic, double, arcuate) or position (retroverted uterus), endometrial anomalies, egg shape anomalies, as well as anomalies of the adrenal and thyroid glands or abnormalities of the hypothalamic pituitary ovarian axis.

    Uterine anomalies favour the occurrence of infertility, yet this is not because conceiving is impossible, but because a miscarriage may occur at any time due to the abnormal shape and structure of the uterus, making it impossible for the foetus to develop properly.

    Abnormal cervical mucus affects the movement of sperm from the vagina to the cervix. It may have two causes: either congenital cervical anomalies are present (lack of cervical glands, lack of hormone receptors, etc.), or some interventions have destroyed the endocervical mucous membrane.

    Antisperm antibodies develop inside the cervical canal and they occur as an immune reaction to sperm. These antibodies affect sperm motility and prevent fertilisation. Antibodies are protein molecules from the family of immunoglobulins, which may interfere with the sperm activity in various ways: immobilising sperm cells, agglutinating them, limiting their ability to cross cervical mucus or preventing them from penetrating the egg. Recent studies have found correlations between genital tract infections and antisperm antibody production, and one of the closest links has been found with Chlamydia trachomatis infection.

    Rh incompatibility occurs in the case of a blood transfusion from an Rh positive person (donor) to an Rh negative one. In obstetrics, the term of “Rh incompatibility” is used to describe a situation where an Rh negative mother is pregnant, while the foetus has a positive Rh. The foetus will always inherit the Rh gene from the father, so it is important to know the partner’s Rh factor before conception. Rh incompatibility does not influence the possibility of conceiving a child, but in the following pregnancies, if the foetus has a positive Rh, the mother’s blood may mix in variable quantities with that of the foetus and different degrees of haemolysis may occur, from mere neonatal jaundice to the death of the foetus in utero.

    When the mother is Rh negative and the father is Rh positive, anti-Rh immunoglobulins are administered after the first pregnancy (or the first abortion).