Why Lifestyle Advice Should Be Part of Fertility Counseling

Peter Kovacs, MD, PhD


January 24, 2017

Optimizing Natural Fertility: A Committee Opinion

Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Reproductive Endocrinology and Infertility
Fertil Steril. 2017;107:52-58. DOI:


Infertility, defined as the inability to conceive despite unprotected intercourse after 1 year, affects around 10%-15% of reproductive-age couples.[1]

Infertile couples often end up undergoing some form of assisted reproductive technology (ART) to help them start a family. ART has improved significantly over the years and is now a widely accepted treatment. As public awareness increases, many couples think of ART as a simple alternative should they fail to conceive on their own. Because ART treatments are considered safe, we providers are also quick to offer them instead of fully exploring the natural methods.

From time to time, it is worth reviewing what alternatives we have before proceeding with more invasive treatment options.


The American Society for Reproductive Medicine Practice Committee reviewed various lifestyle factors that have an impact on natural fertility. The following major points are discussed in this report:

  • Age plays an important role in infertility. For women, the chance of conception significantly declines over the age of 35. The age of the male partner also matters, but a decline can be observed at an older age—over 50.

  • The fertile window is the 6-day period ending on the day of ovulation; the chance is highest in the 3-day period ending with ovulation.

  • To optimize success, intercourse should take place every 1-2 days. Less frequent intercourse is acceptable if needed to avoid stress.

  • Checking cervical mucus to predict ovulation works just as well as ovulation prediction tools.

  • No particular coital practice improves the chance of conception.

  • A BMI too high (>35) or loo low (<19) increases the risk for infertility.

  • Smoking, alcohol consumption (more than two drinks per day), and high caffeine intake (more than five cups per day) are associated with decreased fertility.


Infertility affects 10%-15% of couples, and a smaller percentage are considered to have unexplained infertility.[1] In couples experiencing unexplained infertility, the woman is ovulating normally and has normal fallopian tubes, while the man has semen parameters in the normal range. If we look more closely, however, not all of these cases are actually "unexplained." Many couples that I come across in my practice are affected by advanced reproductive age.. While age is a nonmodifiable factor, if more general gynecologists educate young women about fertility decline, we may be able to prevent cases explained by diminished ovarian reserve and poor-quality eggs.[2,3]

Unexplained fertility could also be attributed to obesity, a significant health problem in the developed world. Many obese people consider themselves "healthy" and in fact may have all laboratory parameters in range. Yet their chance to conceive is affected by their BMI.[4] Other lifestyle factors, such as lack of exercise, unhealthy diet, toxic habits, and environmental exposure to toxins, can also negatively affect fertility. It may be tempting to just offer treatment to patients who are obese or who have unhealthy lifestyles. I would argue that it’s worth at least making an effort to help patients change modifiable lifestyle factors before committing them to a treatment that is likely to fail because of these factors.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: