Fertility made simple

After having written quite a few blogs on the subject of fertility and read quite a bit about it, especially on the internet, I am struck by how few articles give easy-to-understand and succinct explanations on the most important factors in fertility. So, here’s a primer on both male and female fertility.

What is most important for male fertility?

Sperm quantity and sperm quality

Many people may think this is a silly question as the answer is, of course, sperm. Notice that we are asking about the most important factor, not just any important factor. To be more precise, though: The answer is both the quantity and the quality of the sperm.

This is not to deny that there are other factors, such as erectile dysfunction or retrograde ejaculation, but none of these factors are as frequent or as decisive as the sperm’s quantity and quality.

Both the issues of erectile dysfunction and retrograde ejaculation can be bypassed by simply taking sperm directly from the testes, then carrying out IVF. However, if the sperm quality is no good, IVF will fail.

What is most important for female fertility?

Egg quality

While there is no difficulty at all to identify the most important factor for male fertility, when it comes to female fertility, most people seem to be at a loss. 

When checking the NHS website on infertility, many conditions for the female side come up. These include tubal issues, ovulation issues, endometriosis, PCOS, thyroid, premature ovarian failure, scarring from surgery, cervical mucus, fibroids, pelvic inflammatory disease, and others. It then cites a range of risk factors, which include age, weight, STIs, smoking, alcohol, environmental factors and stress.

While a woman’s reproductive organs are more complex than a man’s, it is difficult to understand why egg quality has not been cited as one of the important factors. It is even more curious that the NHS site says semen as the top decisive factor for male infertility, when there is no mention at all about eggs and egg quality with regards to female infertility.

After all, regardless of whether we are talking about natural conception or IVF, a sperm and an egg must meet and ideally form an embryo that eventually results in a fully grown baby.

The scientific literature, common sense and our over 20 years’ of clinical practice have made one thing clear: While many factors can impact on female fertility, the most important and decisive factor is egg quality. It is not difficult to understand why. 

A baby comes from of the meeting of a sperm and an egg. In the case of natural conception, millions of sperm are ejaculated into a woman while she is ovulating to impregnate the egg that has come out. To achieve success, on the male side, both the quantity of and quality of sperm matter. On the female side, despite widespread belief, the quantity of eggs (or egg reserve) is not an issue (unless one is talking about IVF — more on this later). During ovulation, only one egg comes out usually and natural conception depends on this one egg. If its quality is good and it meets a sperm, conception is likely.

IVF requires a good number of eggs to be collected. Some of these eggs will be paired up with some sperm with a view to develop embryos to put back into the uterus (implantation). Typically, in a successful cycle, only a few embryos develop and only 1 or 2 can be implanted in the end. That is to say, only a few eggs were viable for developing into embryos anyway and only 1 or 2 embryos are viable for implantation purposes in the end regardless of the size of egg reserve and the number of eggs collected. The quality of the eggs remains paramount as poor egg quality is often cited as the reason for IVF failure.

This is why, as far as female fertility is concerned, egg quality is the most important and the decisive factor, whether we are talking about natural conception or IVF.

What impacts egg quality?

Once we establish that egg quality is the most decisive factor for women, the next question is what impacts egg quality most. Again, a Google search on this topic brings up a dazzling array of factors. One fertility clinic offers ‘7 tips’ for egg quality. The 7 tips are: stay away from cigarettes, manage stress, eat healthily, achieve a normal BMI, boost blood flow, invest in supplements and freeze eggs.

While all these factors except the last one may impact on egg quality long-term, none of them is likely to have an immediate impact on egg quality. One just needs to pause and think for a moment, if cigarettes are such a big problem, they should have caused a lot of fertility issues 30 or 40 years ago, when smoking was common place. There is no evidence that this was the case.

In fact, before birth control pills became popular, most families were rather large. It was not uncommon for women to give birth to a dozen children or so, all through their fertile years until menopause, or close to menopause. This seems to demonstrate that a often cited reason for poor egg quality, namely age, is a bit of red herring. If age is the “cause” for poor egg quality, how did so many women have a dozen children, giving birth well into their mid-forties in the past?  

It should be clear by now that many reasons given for poor egg quality do not stand up to scrutiny.

What is the most important factor then?

The factor that seems to be glaringly missing from many websites discussing egg quality is hormones. Hormones directly impact periods, so, when a woman’s hormones are not balanced, she will find that her periods become irregular or even missing. Because of this, ovulation may not occur and, more importantly, egg quality is bound to be poor.

Whatever impacts periods most and most directly will thus most impact on egg quality directly. The scientific literature (although still not comprehensive) seems to agree, saying hormones are the most important factor impacting egg quality too.

How can egg quality be improved?

As hormones impact egg quality most and most directly, any improvement of hormones will mean egg quality improvement.

We at TCM Healthcare do precisely that. We start by asking patients to show us hormone test results. We have found that an overwhelming majority of them have hormonal imbalance conditions. And many of their hormonal imbalances have not been detected or acted upon as the focus is often IVF.

We help patients to improve their hormones, which, in turn, improves their egg quality — we confirm this by retesting their hormones after their treatment with us. Many found that they had better hormones — hence better egg quality — and they went on to have children. You can find many reviews from patients saying precisely that here.

You may also find other blogs on the website useful. Happy reading!