There are several lifestyle factors that influence fertility, which are discussed in detail below and on this website, www.lifechoicesandfertility.com. This article discusses things both men and women can do to improve their chances of conceiving.
Lifestyle choices do effect your chance of becoming pregnant and having an uncomplicated pregnancy and delivery. You will have the maximal benefit if you attend to these issues at the beginning of your attempts to conceive, but they become increasingly important as your treatment becomes more complex, and particularly with IVF.
WEIGHT AND FERTILITY
Obesity (BMI over 30) decreases a woman’s fertility, increases the chance of miscarriage, and increases the chance of premature birth with all of its risks for the offspring. The higher the BMI the more pronounced these problems are. We generally recommend weight loss before attempting conception if your BMI is over 35. Exercise, even at a vigorous level, apparently does not have negative effects on obese women trying to conceive (Palomba, et al). In that study , IVF success rates increased over three-fold, even without losing weight! With a brisk walk for 30 minutes and only 200 fewer calories each day you could lose 30 pounds per year. If you start at the beginning of your attempts to conceive, by the time IVF would be considered you may have lost up to 60-90 pounds, which can reduce all of the above problems.
Excess body weight also contributes to sexual dysfunction in both sexes, but particularly for the male partner. At www.erectile-function.com you can download “Survival of the Firmest”, that has many helpful hints for losing weight and for healthy eating. Obesity in the male partner reduces sperm quality. The effects are not great, but even one fewer egg getting fertilized could reduce the chances of an embryo implanting.
Low body weight in women can also cause infertility by stopping ovulation and menstrual periods, and low body weight increases the chance of poor fetal growth (small for dates); weight gain is highly advisable in these women before embarking on a pregnancy.
EXERCISE AND FERTILITY
Moderate exercise increases both male (Vaamonte, 2012) and female fertility (Wise, 2012). Moderate exercise (e.g. a brisk walk) for 30 minutes most days of the week is the current recommendation for all adults and this level is fine for fertility. Two studies have suggested more than 3-5 hours of vigorous exercise per week for the female partner may reduce fertility (Morris, 2006; Wise, 2012), hence the above guidelines. Moderate or even high exercise for the male will enhance erectile function and will help prevent any decline of that function with aging. Only more marked exercise like biking for > or = 5 hours per week (Wise, 2011) or marathon running has negative effects on sperm. Overheating of the testicles may explain the effect of biking.
NUTRITION AND FERTILITY
Recent studies have suggested that a “prudent” diet improves fertility for both partners, i.e less red meat and saturated fat, more seafood, and more fruits and vegetables, often referred to as the “Mediterranean diet” (Vujkovic, 2010; Twigt, 2012; Gaskins, 2012). Trans fats should be avoided entirely (Chavarro, 2011), for example, doughnuts, Danish pastries, French fries and fried foods in general. Studies point to antioxidants, monounsaturated oils, and omega-3’s as the factors involved in these benefits and these are therefore discussed in detail below.
Oxidative stress increases, and the level of antioxidants in semen decreases with age, and sperm DNA fragmentation increases as men get older (Schmid, 2007; Tirado, 2009; Quant, 2009). Men with reduced semen quality have a significantly lower intake of dietary antioxidants (Mediola, 2010). Antioxidants improve sperm motility. Sperm are very sensitive to oxidation because they have to shed their cytoplasm in order to be able to move rapidly. The cytoplasm (all of the cell’s bulk except the nucleus carrying the chromosomes) contains the cell’s natural antioxidant defenses. In men with increased fragmentation of their sperm DNA, 1,000 mg of vitamin C and vitamin E decreased the proportion of sperm with fragmented DNA (from 22 to 9 %) (Greco, 2005). We do not currently recommend vitamin E because it has been linked to all-cause mortality and a recent study associated it with increased prostate cancer. Most likely any strong level of antioxidant will have a similar impact, such as a small bowl of berries each day, or 1,000 mg of vitamin C and 2 cups of green tea daily. A commercial antioxidant, pycnogenol, has been shown to improve semen quality (Stanislavov, 2009); two 40-60 mg capsules daily would also provide a good antioxidant dose. All fruits and vegetables contain antioxidants but berries have the most with blackberries having almost twice as much as blueberries (Halvorsen, 2006). Dark chocolate is also an excellent source of antioxidants. Carotenoids, particularly lycopene (which is particularly high in tomatoes) has been positively correlated to sperm motility (Zareba, 2013).
As women get older, the amount of antioxidant in the fluid around the egg decreases. Without antioxidant protection, the cells surrounding the egg are less able to provide nutrition for the egg as it matures. The resulting poor function of those cells correlates with reduced embryo quality and lower chance of pregnancy (Suh, 2002; Elgindy, 2008). The same suggestions for increasing antioxidant intake given above for the male also apply for the female, except women should not take vitamin E during the IVF cycle if they are also taking low dose aspirin, as it could increase the chance of bleeding with the egg retrieval, and we recommend no caffeine except one cup of decaf tea or coffee. Soy may be a particularly good source of antioxidants. A recent study found soy intake was significantly related to live birth in women having IVF (Vanegas, 2015).
Dark chocolate –low sugar
Vegetables –particularly cooked
Spices –e.g. ginger, oregano, tumeric, cumin
Omega-3 Fatty Acids Omega-3’s, as well as antioxidants, increase blood flow by increasing a chemical called nitric oxide. Blood flow is very important for ovarian response to stimulation (Jadaon, 2012), and blood flow around the mature egg has been correlated with improved egg and embryo quality (Lozano, 2007). Blood flow presumably is also very important for function of the testicles. In one study two agents known to increase nitric oxide increased sperm count and motility as well as the circulating level of testosterone. Omega-3’s are also important in the make-up of sperm membranes. In various recent studies, fish intake (Afeiche, 2014), and omega-3’s have been associated with improved sperm quality (Chavarro, 2009; Safarinejad, 2011; Attaman, 2012).
An easy and inexpensive way to get omega-3’s is from fish oil. A reasonable dose is 500 to 1,000 mg, but make sure that is the amount of EPA and DHA (the two principal omega-3’s) and not just the amount of oil. They are listed on the nutrition label on the back of the bottle. If you take this amount you will not need a more expensive prenatal vitamin containing DHA. There are some early indications that omega-3’s may decrease premature birth. DHA has been added to some prenatal vitamins as it may aid fetal brain development, although a study at age 4 did not confirm any benefit. Because omega-3’s may improve sperm morphology, 1,000 to 2,000 mg may be considered for men with low sperm strict morphology. In one study of 1,840 mg given for 8 months, strict morphology increased from 7.4 to 12.8%. Lesser doses or durations of treatment have not been examined, but there could be a need for loading to have maximal benefits. We recommend 2,000mg per day. Also, significant increases of sperm numbers (16 to 29 million per ml) and motility (19 to 27%) were seen in this study (Safarinejad, 2011, https://www.ncbi.nlm.nih.gov/ pubmed/21219381).
Omega-3’s themselves are very sensitive to oxidation so always take a good level of antioxidants along with boosting your omega-3 intake. Also, they work together to increase blood flow for fertility or male sexual function.
Best Fat Sources
In an extensive analysis of fat intake from Harvard presented at an international fertility meeting in Istanbul (Chavarro, 2012), the authors found that higher saturated fat was associated with retrieval of fewer fertilized eggs, higher trans fat and polyunsaturated fat were associated with decreased embryo quality. This study suggests strongly that the best outcome will occur by limiting meat intake, and by choosing olive oil for all salads and cooking. For snacks, choose nuts. Avocado is great on salads and omelettes, and try some on multigrain bread having lots of nuts and seeds, with olive oil instead of butter. When dining out have any bread with olive oil and balsamic. Trans fats should be avoided entirely, as mentioned earlier, so no doughnuts, Danish pastries, French fries and fried foods in general. The bonus will be if you stick with this diet for good, you will also live a longer and healthier life. Infertility is turning out to be a wake-up call for general health!
Cook Foods Less
When foods are overcooked, such as with barbequing, broiling, grilling, and frying, toxic compounds called advanced glycation end products (AGE’s), are produced that accumulate in the body as people age, cause oxidative stress, and are thought to be involved in diabetic vascular disease and aging. In a study measuring levels in the circulation and in the fluid surrounding the eggs, higher levels of AGE’s were associated with poor follicular and embryonic development and with a lower likelihood of ongoing pregnancy (Jinno, 2011). In this picture from a supermarket supposedly specializing in wholesome food choices, note the prominent grill marks on these otherwise healthy salmon filets! Besides increasing AGE’s, the char contains cancer-causing chemicals.
A Canadian team has done some intriguing studies on egg quality in the aging rat (the older female rat’s eggs show very similar changes compared to eggs from older women), and most of those changes were reversed with co-enzyme Q-10 (Ben-Meir, 2015). As yet there is only a small study in humans (Bentov, 2014). The dose suggested based on the amount given in the animal model is 600 mg per day. There were strong trends toward a lower rate of chromosome abnormality (47 vs 63%) and higher clinical pregnancy (33 vs 27%). We currently recommend 800mg a day (see our handout on vitamins). It has been taken for other reasons without apparent problems observed, but usually at lower doses. It should be stopped with a positive pregnancy test.
Smoking by the female decreases the chance of success by 50% (Hughes, 1994) and increases miscarriage. It is absurd for a woman to not stop smoking before fertility treatments, particularly IVF. Second-hand smoke causes a similar reduction in the chance of pregnancy (Neal, 2005) and also decreases ovarian reserve. Menopause occurs four years early in women who smoke. The effect of smoking is also seen in egg donation recipients (Soares, 2007), showing that smoking also influences the ability of the uterus to support implantation.
Smoking by the male partner reduces success with IVF and ICSI (Zitzmann, 2003), decreases semen quality and increases DNA fragmentation. Of course the serious health risks of smoking are more important reasons to quit. However, if the male partner is unable to quit, he should take high amounts of antioxidants (above), which may counteract some of the adverse effects on sperm and on the cardiovascular system.
One study suggested the female partner should not have more caffeine than one cup of decaf coffee or tea (5 mg or less) before and during an IVF cycle (Klonoff-Cohen, 2002), although two other studies showed no effect of caffeine in women simply attempting conception (Hatch, 2012) or with IVF (Choi, 2011). Chocolate contains about 20 mg per serving and sodas about 80 mg. The sperm are not as sensitive to caffeine, but the male should not drink more than the equivalent of 3 cups of coffee (one cup contains about 150 mg). Larger amounts have been reported to increase sperm DNA fragmentation. Until further data are available, women having IVF should limit cafeine consumption to 0-2 mg per day.
Neither partner should drink alcohol during an IVF cycle; studies have shown a decreased pregnancy rate (Hakim, 1998; Rossi, 2009) and possibly an increased rate of miscarriage (Klonoff-Cohen). However, when first attempting to conceive, in one study drinking 5-6 glasses of wine per week by the female partner reduced the time to become pregnant.
Men should avoid significant heat exposure to the testicles (hot tubs, Jacuzzi’s, steam baths) and they should not use a lap top directly on the lap (hot showers are OK). The testicles are outside of the body because sperm production and movement require a lower temperature. It is probably better to wear boxer rather than jockey shorts. Recent studies have also suggested that extensive use of a cell phone transmitting from a front pocket should be avoided (Agarwal, 2009). Trans fats also adversely affect sperm, so avoid doughnuts, French fries and Danish pastries and anything without a nutrition label that says no trans fats. Plastic recycle number 7 (polycarbonate and “other”) should be avoided. Polycarbonate is also in food can linings. Polycarbonate releases the hormone disruptor Bisphenol A. BPA levels have been associated with reduced sperm count and motility and with poor ovarian response (Mok-Lin, 2010), although any relationship of BPA to fertility and IVF outcome is not clear at present .
Finally, any discussion of life choices and fertility would be incomplete without discussing the effects of anxiety, stress, and depression. Various studies have shown a reduced success rate in achieving pregnancy in women experiencing these symptoms (Sanders, 1999; Smeenk, 2001; Ebbesen, 2009), and an intensive stress reduction program (Mind/Body) has been shown in controlled studies to reduce the time to achieve a pregnancy in couples just beginning to attempt conception and to increase the pregnancy rate with IVF (Domar, 2009). Most importantly, reducing stress may help couples better cope with failed cycles. In countries or states that cover the costs of IVF, the primary reason for failing to be successful is giving up because they just can’t tolerate another failed cycle.
Actually, luck has relatively little to do with it. One of the most insightful sayings is “it doesn’t matter so much what happens to you as much as how you handle it”. If you pay attention to the factors outlined above, and if you are persistent, you will very likely be successful. Even more important is to not let the infertility wear away at your relationship, including your sexual enjoyment. Challenges can strengthen the bond between you and your partner if you support each other and handle them together, and if you pay attention to all of our recommendations at www.erectile-function.com, you might well find your sexual relationship better than at any time in the past.
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For references, please go to: https://fertileweb.com/life-choices-and-fertility-article-references/