This document discusses subfertility, or reduced fertility, and treatments. It notes that about 25-30% of healthy couples conceive per month, with 50% conceiving within 3 months, 75% within 6 months, and 90% within a year. Subfertility is defined as no pregnancy after 12 months of unprotected sex. About 5% of couples have fertility problems and 10% may need medical treatment. Treatments discussed include tracking ovulation, hormonal therapy, treating infections, ovarian stimulation, and less than 3-5% need IVF. Male fertility can be improved with micronutrients like L-carnitine, L-arginine, and antioxidants. Better sperm quality may reduce the need for

1. Fertility Europe
United in Europe – helping the storks to fly
Treatment of Subfertility
Martin Imhof
Fertility Europe, ESHRE, Stockholm July 4, 2011

2. Regular Fertility
• conception = 25-30% per female month
healthy couples conceive
• 50% after 3 month
• 75% after 6 month
• 90% after 12 month
• medium 4 month to conceive

3. Definition of Subfertility
• reduction of male and female fertility
• no pregnancy after a period of 12
months of sexual intercourse

4. • every 5th couple has problems in
reproduction
• every 10th couple needs
medical treatment
Subfertility

6. Age first Delivery

7. Age and Fertility
-- % abortion
-- % fertility

8. Time delay
Wish to start family
Causal treatment
up to 7 years

9. Fertility Check
day 1 day 30
First
Consultation
Blood check
Semen analysis
8-10 days
Sonography
Hysteroscopy
Fallopian Tubes
Infection screening
Summary
Next steps1-3 days

10. Female Treatment
• Track ovulation
• Hormonale therapy
• Therapy of infections
• Ovarian stimulation
• Laparoscopy
• .....
• Less than 3-5% need IVF

11. Swan et. al. – National Institute of
environmental health sciences
•Review of 101 published studies
•Data collected 52 years (1938-1996)
Average annual decrease of
U.S. minus 1.5%/year
Europa minus 3.1%/year
Semen Quality

12. Male Subfertility
Guidelines on food fortifcation
with micronutrients
by Lindsay Allen et al. World Health Organization and
Food and Agriculture Organization of the United Nations
2006
Male factor subfertility: possible causes
and the Impact of nutritional factors
Wong WY et al., Fertil Steril 2000 73:435-442

13. Profertil Study with 120 men, Ø 35,9 a (23-58)
Intake 2x1 Capsule daily for 3 Month
L-Carnitin 440 mg
L-Arginine 250mg
Vitamin E 120 mg
Selenium 60 μg
Glutathione 80 mg
Folic-acid 800 μg
Coenzyme Q10 15 mg
Zinc 40 mg
Improvement of Male Fertility

14. Concentration
in Mio/ml
53,19
mio
29,46
mio
20
mio
10
mio
50
mio
60
mio
40
mio
30
mio
+ 80,54%
Prog. MotilityEjaculate in ml
3,61
ml
2,91
ml
1ml
0 ml
4 ml
5 ml
3 ml
2ml
+ 24,05%
19,27
%
8,95%
5 %
0 %
20 %
15 %
10 %
+115,3%
Sperm Quality
Improves with Micronutritients

15. natural conception
insemination
In vitro fertilisation (IVF)
Intracytoplasmatic sperm injection (ICSI)
Better Sperm - Less Intervention

16. Martial Fertility
First line
• Age
• Lost time
Second line
• Medical condition

17. Fertility Treatment
Question of supporting not
replacing nature
IVF treatments:
treatment of majar medical
conditions
not a reaction to lost time

18. Thank You for Your Attention

19. Reasons of Infertility
unknown
male
hormones
endometriosis
abortion
fallopian tubes
myoma
cervix
others

20. The Road to Conception