Reproductive Health

Reproductive health spans fertility, sexual function and the endocrine health of the reproductive organs. Around one in six couples experience infertility, and the cause is male in roughly 40-50% of cases, which is why evaluation should always include both partners rather than defaulting to the female one. On the male side the measurable output is semen analysis: concentration, total count, motility and morphology, judged against WHO reference values. Because spermatogenesis takes about 74 days, nothing changes a semen analysis quickly, and any intervention needs at least three months before a repeat test means anything. Heat, smoking, heavy alcohol, obesity, anabolic steroid use and varicocele are the recurring modifiable causes. On the female side the central question is whether ovulation is occurring and whether the tubes and uterus are normal. PCOS is the commonest cause of anovulation, thyroid disease and hyperprolactinaemia are readily treatable contributors, and ovarian reserve declines with age in a way no intervention reverses. Supplement evidence is modest but not empty. A Cochrane review of antioxidants in subfertile men found low-quality evidence of possible benefit for live birth. Myo-inositol improves ovulation in PCOS. Folic acid before conception prevents neural tube defects and is the one genuinely established supplement recommendation. CoQ10, zinc and selenium have plausible but weaker support.

Evaluate both partners from the outset. For men, work the modifiable inputs and allow a full spermatogenic cycle of about 74 days before retesting: stop smoking, reduce alcohol, lose excess weight, avoid saunas, hot tubs and laptops on the lap, treat any varicocele, and stop anabolic steroids, which suppress spermatogenesis profoundly and sometimes irreversibly. Antioxidant support — CoQ10, zinc, selenium, vitamin C and E — has low-certainty Cochrane evidence in subfertile men and is a reasonable adjunct rather than a treatment. For women, confirm ovulation first, then treat what is disrupting it: correct thyroid dysfunction, address hyperprolactinaemia, and in PCOS use weight management and myo-inositol at 2-4 g daily, which improves ovulation rates in randomised trials. Both partners should ensure adequate vitamin D, and the female partner should start 400-800 mcg folic acid at least a month before conception. Seek specialist referral after twelve months of trying, or six months if she is over 35 — time matters more than any supplement.

• •Stop smoking — it lowers sperm count and accelerates ovarian ageing
• •Reach a healthy body weight; both obesity and being underweight impair fertility
• •Limit alcohol in both partners
• •Avoid scrotal heat: saunas, hot tubs, prolonged laptop use
• •Never use anabolic steroids or testosterone while trying to conceive
• •Start folic acid before conception, not after a positive test
• •Manage stress and protect sleep, both linked to cycle regularity
• •Time intercourse to the fertile window using LH testing or cycle tracking