CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(03): 183-190
DOI: 10.1055/s-0039-1677838
Febrasgo Statement
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Increasing the Chances of Natural Conception: Opinion Statement from the the Brazilian Federation of Gynecology and Obstetrics Associations - FEBRASGO - Committee of Gynecological Endocrinology

Aumentando as chances de concepção natural: Parecer da Comissão Nacional de Ginecologia Endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia
1   BONVENA - Medicina Reprodutiva, Brasília, DF, Brazil
Ionara Diniz Evangelista Santos Barcelos
2   Department of Gynecology and Obstetrics, Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brazil
Sebastião Freitas de Medeiros
3   Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade Federal do Mato Grosso, Cuiabá, MS, Brazil
Cristina Laguna Benetti-Pinto
4   Department of Tocogynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
Daniela Angerame Yela
4   Department of Tocogynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
Andrea Prestes Nácul
5   Hospital Fêmina, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
Gustavo Arantes Rosa Maciel
6   Department of Gynecology and Obstetrics, Faculdade de Medicina de São Paulo, Universidade de São Paulo, São Paulo, SP, Brazil
José Maria Soares Júnior
6   Department of Gynecology and Obstetrics, Faculdade de Medicina de São Paulo, Universidade de São Paulo, São Paulo, SP, Brazil
Ana Carolina Japur de Sá Rosa e Silva
7   Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
Laura Olinda Bregieiro Fernandes Costa
8   Faculty of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil
› Institutsangaben
Weitere Informationen


09. November 2018

05. Dezember 2018

15. Februar 2019 (online)


Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.


Uma vez que mitos e equívocos sobre a procriação natural se espalham rapidamente na era do fácil acesso à informação e às redes sociais, o aconselhamento adequado sobre a fertilidade natural e a concepção espontânea deve ser encorajado em qualquer tipo de assistência à saúde. Apesar do fato de não haver evidências fortes sobre qualquer dos aspectos relacionados à fertilidade natural, existe literatura sobre como aumentar as chances de uma gravidez espontânea. No presente artigo, a Comissão Nacional de Ginecologia Endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) oferece sugestões para otimizar o aconselhamento a pessoas que tentam a concepção espontânea, na ausência do diagnóstico de infertilidade.

  • References

  • 1 Wesselink AK, Rothman KJ, Hatch EE, Mikkelsen EM, Sørensen HT, Wise LA. Age and fecundability in a North American preconception cohort study. Am J Obstet Gynecol 2017; 217 (06) 667.e1-667.e8 . Doi: 10.1016/j.ajog.2017.09.002
  • 2 Menken J, Trussell J, Larsen U. Age and infertility. Science 1986; 233 (4771): 1389-1394 . Doi: 10.1126/science.3755843
  • 3 Lobo RA. Potential options for preservation of fertility in women. N Engl J Med 2005; 353 (01) 64-73 . Doi: 10.1056/NEJMra043475
  • 4 Mesen TB, Steiner AZ. Effect of vaginal lubricants on natural fertility. Curr Opin Obstet Gynecol 2014; 26 (03) 186-192 . Doi: 10.1097/GCO.0000000000000066
  • 5 Habbema JD, Eijkemans MJ, Leridon H, te Velde ER. Realizing a desired family size: when should couples start?. Hum Reprod 2015; 30 (09) 2215-2221 . Doi: 10.1093/humrep/dev148
  • 6 Eisenberg ML, Meldrum D. Effects of age on fertility and sexual function. Fertil Steril 2017; 107 (02) 301-304 . Doi: 10.1016/j.fertnstert.2016.12.018
  • 7 Dunson DB, Colombo B, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Hum Reprod 2002; 17 (05) 1399-1403 . Doi: 10.1093/humrep/17.5.1399
  • 8 Bertoncelli Tanaka M, Agarwal A, Esteves SC. Paternal age and assisted reproductive technologies: problem solver or trouble maker?. Panminerva Med 2018 •••. Doi: 10.23736/S0031-0808.18.03512-7
  • 9 Verón GL, Tissera AD, Bello R. , et al. Impact of age, clinical conditions, and lifestyle on routine semen parameters and sperm kinematics. Fertil Steril 2018; 110 (01) 68-75.e4 . Doi: 10.1016/j.fertnstert.2018.03.016
  • 10 Zitzmann M. Effects of age on male fertility. Best Pract Res Clin Endocrinol Metab 2013; 27 (04) 617-628 . Doi: 10.1016/j.beem.2013.07.004
  • 11 Oldereid NB, Wennerholm UB, Pinborg A. , et al. The effect of paternal factors on perinatal and paediatric outcomes: a systematic review and meta-analysis. Hum Reprod Update 2018; 24 (03) 320-389 . Doi: 10.1093/humupd/dmy005
  • 12 Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Reproductive Endocrinology and Infertility. Electronic address:; Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril 2017; 107 (01) 52-58 . Doi: 10.1016/j.fertnstert.2016.09.029
  • 13 Dunson DB, Baird DD, Wilcox AJ, Weinberg CR. Day-specific probabilities of clinical pregnancy based on two studies with imperfect measures of ovulation. Hum Reprod 1999; 14 (07) 1835-1839 . Doi: 10.1093/humrep/14.7.1835
  • 14 Bigelow JL, Dunson DB, Stanford JB, Ecochard R, Gnoth C, Colombo B. Mucus observations in the fertile window: a better predictor of conception than timing of intercourse. Hum Reprod 2004; 19 (04) 889-892 . Doi: 10.1093/humrep/deh173
  • 15 Levitas E, Lunenfeld E, Weiss N. , et al. Relationship between the duration of sexual abstinence and semen quality: analysis of 9,489 semen samples. Fertil Steril 2005; 83 (06) 1680-1686 . Doi: 10.1016/j.fertnstert.2004.12.045
  • 16 Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995; 333 (23) 1517-1521 . Doi: 10.1056/NEJM199512073332301
  • 17 Jurema MW, Vieira AD, Bankowski B. , et al. Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination. Fertil Steril 2005; 84 (03) 678-681 . Doi: 10.1016/j.fertnstert.2005.03.044
  • 18 Ayad BM, Horst GV, Plessis SSD. Revisiting the relationship between the ejaculatory abstinence period and semen characteristics. Int J Fertil Steril 2018; 11 (04) 238-246 . Doi: 10.22074/ijfs.2018.5192
  • 19 Kunz G, Beil D, Deininger H, Wildt L, Leyendecker G. The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy. Hum Reprod 1996; 11 (03) 627-632 . Doi: 10.1093/HUMREP/11.3.627
  • 20 Settlage DS, Motoshima M, Tredway DR. Sperm transport from the external cervical os to the fallopian tubes in women: a time and quantitation study. Fertil Steril 1973; 24 (09) 655-661 . Doi: 10.1016/S0015-0282(16)39908-3
  • 21 Steiner AZ, Long DL, Tanner C, Herring AH. Effect of vaginal lubricants on natural fertility. Obstet Gynecol 2012; 120 (01) 44-51 . Doi: 10.1097/AOG.0b013e31825b87ae
  • 22 Sandhu RS, Wong TH, Kling CA, Chohan KR. In vitro effects of coital lubricants and synthetic and natural oils on sperm motility. Fertil Steril 2014; 101 (04) 941-944 . Doi: 10.1016/j.fertnstert.2013.12.024
  • 23 Goldenberg RL, White R. The effect of vaginal lubricants on sperm motility in vitro. Fertil Steril 1975; 26 (09) 872-873 . Doi: 10.1016/S0015-0282(16)41350-6
  • 24 Kutteh WH, Chao CH, Ritter JO, Byrd W. Vaginal lubricants for the infertile couple: effect on sperm activity. Int J Fertil Menopausal Stud 1996; 41 (04) 400-404
  • 25 Anderson L, Lewis SE, McClure N. The effects of coital lubricants on sperm motility in vitro. Hum Reprod 1998; 13 (12) 3351-3356 . Doi: 10.1093/humrep/13.12.3351
  • 26 Frishman GN, Luciano AA, Maier DB. Evaluation of Astroglide, a new vaginal lubricant: effects of length of exposure and concentration on sperm motility. Fertil Steril 1992; 58 (03) 630-632 . Doi: 10.1016/S0015-0282(16)55279-0
  • 27 Agarwal A, Deepinder F, Cocuzza M, Short RA, Evenson DP. Effect of vaginal lubricants on sperm motility and chromatin integrity: a prospective comparative study. Fertil Steril 2008; 89 (02) 375-379 . Doi: 10.1016/j.fertnstert.2007.02.050
  • 28 McSweeney L. Successful sex pre-selection using natural family planning. Afr J Reprod Health 2011; 15 (01) 79-84
  • 29 France JT, Graham FM, Gosling L, Hair P, Knox BS. Characteristics of natural conceptual cycles occurring in a prospective study of sex preselection: fertility awareness symptoms, hormone levels, sperm survival, and pregnancy outcome. Int J Fertil 1992; 37 (04) 244-255
  • 30 France JT, Graham FM, Gosling L, Hair PI. A prospective study of the preselection of the sex of offspring by timing intercourse relative to ovulation. Fertil Steril 1984; 41 (06) 894-900 . Doi: 10.1016/S0015-0282(16)47904-5
  • 31 Gray RH, Simpson JL, Bitto AC. , et al. Sex ratio associated with timing of insemination and length of the follicular phase in planned and unplanned pregnancies during use of natural family planning. Hum Reprod 1998; 13 (05) 1397-1400 . Doi: 10.1093/humrep/13.5.1397
  • 32 Chiu YH, Chavarro JE, Souter I. Diet and female fertility: doctor, what should I eat?. Fertil Steril 2018; 110 (04) 560-569 . Doi: 10.1016/j.fertnstert.2018.05.027
  • 33 Byrne J. Periconceptional folic acid prevents miscarriage in Irish families with neural tube defects. Ir J Med Sci 2011; 180 (01) 59-62 . Doi: 10.1007/s11845-010-0629-5
  • 34 Gaskins AJ, Rich-Edwards JW, Hauser R. , et al. Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Obstet Gynecol 2014; 124 (01) 23-31 . Doi: 10.1097/AOG.0000000000000343
  • 35 Hasan R, Olshan AF, Herring AH, Savitz DA, Siega-Riz AM, Hartmann KE. Self-reported vitamin supplementation in early pregnancy and risk of miscarriage. Am J Epidemiol 2009; 169 (11) 1312-1318 . Doi: 10.1093/aje/kwp050
  • 36 Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility. Fertil Steril 2008; 89 (03) 668-676 . Doi: 10.1016/j.fertnstert.2007.03.089
  • 37 Cueto HT, Riis AH, Hatch EE. , et al. Folic acid supplementation and fecundability: a Danish prospective cohort study. Eur J Clin Nutr 2016; 70 (01) 66-71 . Doi: 10.1038/ejcn.2015.94
  • 38 Chavarro JE, Rich-Edwards JW, Rosner B, Willett WC. A prospective study of dairy foods intake and anovulatory infertility. Hum Reprod 2007; 22 (05) 1340-1347 . Doi: 10.1093/humrep/dem019
  • 39 Møller UK, Streym S, Heickendorff L, Mosekilde L, Rejnmark L. Effects of 25OHD concentrations on chances of pregnancy and pregnancy outcomes: a cohort study in healthy Danish women. Eur J Clin Nutr 2012; 66 (07) 862-868 . Doi: 10.1038/ejcn.2012.18
  • 40 Somigliana E, Paffoni A, Lattuada D. , et al. Serum levels of 25-hydroxyvitamin D and time to natural pregnancy. Gynecol Obstet Invest 2016; 81 (05) 468-471 . Doi: 10.1159/000443397
  • 41 Zhang H, Huang Z, Xiao L, Jiang X, Chen D, Wei Y. Meta-analysis of the effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss. Int J Gynaecol Obstet 2017; 138 (03) 242-249 . Doi: 10.1002/ijgo.12209
  • 42 Wise LA, Wesselink AK, Tucker KL. , et al. Dietary fat intake and fecundability in 2 preconception cohort studies. Am J Epidemiol 2018; 187 (01) 60-74 . Doi: 10.1093/aje/kwx204
  • 43 Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol 2007; 110 (05) 1050-1058 . Doi: 10.1097/01.AOG.0000287293.25465.e1
  • 44 Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Protein intake and ovulatory infertility. Am J Obstet Gynecol 2008; 198 (02) 210.e1-210.e7 . Doi: 10.1016/j.ajog.2007.06.057
  • 45 Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr 2009; 63 (01) 78-86 . Doi: 10.1038/sj.ejcn.1602904
  • 46 Gaskins AJ, Chiu YH, Williams PL. , et al; EARTH Study Team. Maternal whole grain intake and outcomes of in vitro fertilization. Fertil Steril 2016; 105 (06) 1503-1510.e4 . Doi: 10.1016/j.fertnstert.2016.02.015
  • 47 Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology 2009; 20 (03) 374-381 . Doi: 10.1097/EDE.0b013e31819d68cc
  • 48 Abbasi AA, Prasad AS, Rabbani PR. Experimental zinc deficiency in man: effect on spermatogenesis. Trans Assoc Am Physicians 1979; 92: 292-302
  • 49 Mitchell M, Bakos HW, Lane M. Paternal diet-induced obesity impairs embryo development and implantation in the mouse. Fertil Steril 2011; 95 (04) 1349-1353 . Doi: 10.1016/j.fertnstert.2010.09.038
  • 50 Palmer NO, Bakos HW, Fullston T, Lane M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis 2012; 2 (04) 253-263 . Doi: 10.4161/spmg.21362
  • 51 Palmer NO, Bakos HW, Owens JA, Setchell BP, Lane M. Diet and exercise in an obese mouse fed a high-fat diet improve metabolic health and reverse perturbed sperm function. Am J Physiol Endocrinol Metab 2012; 302 (07) E768-E780 . Doi: 10.1152/ajpendo.00401.2011
  • 52 Ng SF, Lin RC, Laybutt DR, Barres R, Owens JA, Morris MJ. Chronic high-fat diet in fathers programs β-cell dysfunction in female rat offspring. Nature 2010; 467 (7318): 963-966 . Doi: 10.1038/nature09491
  • 53 Morgan DH, Ghribi O, Hui L, Geiger JD, Chen X. Cholesterol-enriched diet disrupts the blood-testis barrier in rabbits. Am J Physiol Endocrinol Metab 2014; 307 (12) E1125-E1130 . Doi: 10.1152/ajpendo.00416.2014
  • 54 Rato L, Alves MG, Cavaco JE, Oliveira PF. High-energy diets: a threat for male fertility?. Obes Rev 2014; 15 (12) 996-1007 . Doi: 10.1111/obr.12226
  • 55 Giahi L, Mohammadmoradi S, Javidan A, Sadeghi MR. Nutritional modifications in male infertility: a systematic review covering 2 decades. Nutr Rev 2016; 74 (02) 118-130 . Doi: 10.1093/nutrit/nuv059
  • 56 Salas-Huetos A, Bulló M, Salas-Salvadó J. Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Hum Reprod Update 2017; 23 (04) 371-389 . Doi: 10.1093/humupd/dmx006
  • 57 Fullston T, McPherson NO, Zander-Fox D, Lane M. The most common vices of men can damage fertility and the health of the next generation. J Endocrinol 2017; 234 (02) F1-F6 . Doi: 10.1530/JOE-16-0382
  • 58 Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod 1998; 13 (06) 1532-1539 . Doi: 10.1093/humrep/13.6.1532
  • 59 Camlin NJ, McLaughlin EA, Holt JE. Through the smoke: use of in vivo and in vitro cigarette smoking models to elucidate its effect on female fertility. Toxicol Appl Pharmacol 2014; 281 (03) 266-275 . Doi: 10.1016/j.taap.2014.10.010
  • 60 Anifandis G, Bounartzi T, Messini CI, Dafopoulos K, Sotiriou S, Messinis IE. The impact of cigarette smoking and alcohol consumption on sperm parameters and sperm DNA fragmentation (SDF) measured by Halosperm(®). Arch Gynecol Obstet 2014; 290 (04) 777-782 . Doi: 10.1007/s00404-014-3281-x
  • 61 Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility: a committee opinion. Fertil Steril 2012; 98 (06) 1400-1406 . Doi: 10.1016/j.fertnstert.2012.07.1146
  • 62 Adena MA, Gallagher HG. Cigarette smoking and the age at menopause. Ann Hum Biol 1982; 9 (02) 121-130
  • 63 Aboulmaouahib S, Madkour A, Kaarouch I. , et al. Impact of alcohol and cigarette smoking consumption in male fertility potential: Looks at lipid peroxidation, enzymatic antioxidant activities and sperm DNA damage. Andrologia 2018; 50 (03) e12926 . Doi: 10.1111/and.12926
  • 64 Soares SR, Melo MA. Cigarette smoking and reproductive function. Curr Opin Obstet Gynecol 2008; 20 (03) 281-291 . Doi: 10.1097/GCO.0b013e3282fc9c1e
  • 65 Sharma R, Harlev A, Agarwal A, Esteves SC. Cigarette smoking and semen quality: a new meta-analysis examining the effect of the 2010 World Health Organization laboratory methods for the examination of human semen. Eur Urol 2016; 70 (04) 635-645 . Doi: 10.1016/j.eururo.2016.04.010
  • 66 Anderson K, Norman RJ, Middleton P. Preconception lifestyle advice for people with subfertility. Cochrane Database Syst Rev 2010; ; ( (04) CD008189 . Doi: 10.1002/14651858.CD008189.pub2
  • 67 Cinar O, Dilbaz S, Terzioglu F. , et al. Does cigarette smoking really have detrimental effects on outcomes of IVF?. Eur J Obstet Gynecol Reprod Biol 2014; 174: 106-110 . Doi: 10.1016/j.ejogrb.2013.12.026
  • 68 Steiner AZ, Pritchard D, Stanczyk FZ. , et al. Association between biomarkers of ovarian reserve and infertility among older women of reproductive age. JAMA 2017; 318 (14) 1367-1376 . Doi: 10.1001/jama.2017.14588
  • 69 Greenwood EA, Cedars MI, Santoro N. , et al; National Institutes of Health/Eunice Kennedy Shriver National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network. Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility. Fertil Steril 2017; 108 (06) 1070-1077 . Doi: 10.1016/j.fertnstert.2017.09.015
  • 70 Bozkurt B, Erdem M, Mutlu MF. , et al. Comparison of age-related changes in anti-Müllerian hormone levels and other ovarian reserve tests between healthy fertile and infertile population. Hum Fertil (Camb) 2016; 19 (03) 192-198 . Doi: 10.1080/14647273.2016.1217431
  • 71 Hvidman HW, Bentzen JG, Thuesen LL. , et al. Infertile women below the age of 40 have similar anti-Müllerian hormone levels and antral follicle count compared with women of the same age with no history of infertility. Hum Reprod 2016; 31 (05) 1034-1045 . Doi: 10.1093/humrep/dew032
  • 72 Hvidman HW, Bang AK, Priskorn L. , et al. Anti-Müllerian hormone levels and fecundability in women with a natural conception. Eur J Obstet Gynecol Reprod Biol 2017; 217: 44-52 . Doi: 10.1016/j.ejogrb.2017.08.015
  • 73 Casadei L, Manicuti C, Puca F, Madrigale A, Emidi E, Piccione E. Can anti-Müllerian hormone be predictive of spontaneous onset of pregnancy in women with unexplained infertility?. J Obstet Gynaecol 2013; 33 (08) 857-861 . Doi: 10.3109/01443615.2013.831050
  • 74 Sominsky L, Hodgson DM, McLaughlin EA, Smith R, Wall HM, Spencer SJ. Linking stress and infertility: a novel role for ghrelin. Endocr Rev 2017; 38 (05) 432-467 . Doi: 10.1210/er.2016-1133