Lifestyle and Fertility
There's lots of talk about how lifestyle can affect fertility, but is there any truth to it? Well here's the most up-to-date thinking and evidence on the subject.
Lifestyle factors are not only important to boost conception, but also to maximize a healthy pre-conceptual period and therefore a healthy ongoing pregnancy (both mother and baby).
Weight, Exercise and Diet
Female and Male Fertility is decreased by being either overweight or underweight. Overweight is defined as having a Body Mass Index (BMI) of ≥ 25 kg/m2 and underweight is a BMI of ≤20 kg/ m2. This holds true for whether you are trying to conceive naturally, having fertility medication, or having in-vitro fertilization (IVF).
- You can check out what you own BMI is at a number of sites such as mydr.com
- Getting your weight into the ideal range isn't just about conceiving, it's also about reducing the risks for both you and the baby during pregnancy. In obese mothers (those who have a BMI of ≥ 30) complications that can occur more frequently include miscarriage, physical abnormalities in the baby (spina bifida and other birth defects - including heart defects), large for gestational age babies (who can have an increased risk of certain complications such as low sugar levels), and for the mother there is a higher risk of high blood pressure, toxaemia, and gestational diabetes.
- Don't get despondent if you are overweight, remember that small attainable goals in weight change can make a big difference! For example in women who have Polycystic Ovary Syndrome (PCOS) and are overweight, a weight loss of 5% is associated with improved menstrual function, and reduced hormonal imbalance.
As exercise levels and diet affect weight, they also impact upon fertility. In general, moderate exercise levels are advised to establish a healthy weight to improve the possibility of fertility. Exercises can include walking, cycling, swimming and yoga. If you have health problems you should check with your family doctor first before starting an exercise program. An exercise program is developed slowly until you can work out for up to 30 minutes a day, three to four times a week. Lifestyle modification including exercise and a balanced diet improves women's well-being and reproductive functioning.
When you are trying to get pregnant it is essential to maintain a healthy, well-balanced diet that will give your body the daily nutrients to stay strong. Help is available from your health professional.
Stress and Fertility
Whilst men and women who are trying to conceive are frequently advised to take vitamin supplements, there isn't strong evidence that they have a benefit on fertility. However, you should remember that;
- It is important to take Folic Acid supplements for 2 months before trying to conceive and at least the first 12 weeks of pregnancy in order to reduce the risk of the baby having a neural tube defect such as spina bifida.
- Women should avoid vitamin A supplements and eating crustacean and liver products before and during pregnancy. Consider being screened for Iodine levels and Vitamin D deficiency before trying to conceive as you (and the baby) may benefit from vitamin D and/or iodine supplements.
Antioxidants include Vitamins C and E, zinc, selenium and certain essential fatty acids. There is a debate as to whether they can improve sperm quality and function in certain men, and more research is required. Furthermore, even if they do help it is not clear which men would benefit and which would not.
- Antioxidants are not recommended for routine use in women who are trying to conceive.
More research is required to clarify the association between alcohol intake and fertility. However, the latest recommendation is that women should avoid alcohol entirely when trying to conceive and during pregnancy. The rationale is as follows;
- Heavy alcohol intake can affect both male and female fertility because of more frequent impotence, deterioration in sperm counts, loss of libido and testicular atrophy in the male and altered hormone function and impaired implantation and blastocyst (embryo) development in the female.
- Drinking alcohol in pregnancy can increase the rate of miscarriage, premature birth, low birth weight, foetal death and physical abnormalities such as can be found in foetal alcohol syndrome.
There is conflicting information about caffeine intake and reproductive performance. The latest evidence suggests that mild intake (100-200 µg per day or the equivalent of no more than two cups of coffee per day) is acceptable. Remember, caffeine is present in certain foods, tea, cocoa, soft drinks, chocolate drinks, energy drinks, and certain across the counter and prescription medicines. So your total caffeine intake for the day isn't just how many cups of coffee you have had!
There is clear evidence that in men and women both active smokers and passive smokers (where you don't smoke but are exposed to someone else who does) have increased reproductive problems. Smoking is associated with;
- Increased rates of sperm abnormalities and reduced fertilization rates during IVF, even when single sperm microinjection (ICSI) is used.
- Decreased rates of conception and birth.
- Reduced success rates of treatment. Non-smokers are almost twice as likely to conceive from IVF, or put another way smokers may take twice as many IVF cycles to conceive (so the cost of smoking isn't just the cigarettes)!
- Increased pregnancy complications including miscarriage (2.65 times more likely) and ectopic pregnancy (15.69 times more likely), small for dates/low birth weight babies, and preterm birth.
So evidence supports the importance of quitting smoking at least two months prior to trying to get pregnant. If you are a smoker you should aim to stop smoking before trying to conceive!
Most prescription medicines are safe. However, some prescription medicines can reduce sperm production and/or function, fertilization rates, sexual function in both men and women, and ovulation. Other medicines can be associated with increased physical abnormalities for the baby. If you are trying to conceive and you are on prescription medicines or you regularly take across the counter medicines, you should check them out with your GP, pharmacist and/or fertility specialist. Don't stop medicines on your own without seeking the advice of your doctor.
Overuse of Herbs
Some herbs may increase the risk of infertility, such as St. John Wort. Make sure that you report all herbs that you take to your infertility professional.
Marijuana and other "Street Drugs"
Marijuana use is a problem for trying to conceive and pregnancy because it can;
- Reduce fertilization rates and fallopian tube transport of eggs, sperm and embryos. Infertility may be 1.7 times more common in marijuana smokers, and sperm production and function are impaired.
- Have an adverse impact on the development of the foetus and placenta. It is also associated with low birth weight, premature birth, congenital abnormalities, stillbirth and later in life a risk of impaired intellectual function in the baby.
Cocaine and other street drugs are associated with fertility problems and serious pregnancy complications.
The bottom line is that you should abstain from recreational drug use both when trying to conceive and during pregnancy.
Mercury and the amount of Fish in your diet
Fish at the top of the "food chain" such as salmon, tuna and shark can have high mercury levels and so two meals of 85g/week is the current advisable limit for eating those kinds of fish when trying to conceive and during pregnancy. Remember, there is a balance here because having some fish in your diet during pregnancy may be important for the baby's neurological development and so don't cut out fish altogether. If in doubt seek advice.
A number of pollutants have been linked to reduced reproductive potential and increased pregnancy complications. These pollutants include dioxins, pesticides, mercury, lead, radiation, and some solvents. Reduce your exposure to toxins such as organic solvents, oven cleaners, ammonia-based cleaners and certain paints. If you are trying to conceive, check out what you are exposed to at work, home and in the community and if in doubt seek medical advice.
Improvements in lifestyle and nutrition enhance the long-term health of prospective parents, and are important aspects of maximizing fertility and pregnancy outcome.
If you would like to read the evidence, you can send us an email at firstname.lastname@example.org and we will send you the references.