Infertility, which is defined as not conceiving after one year of unprotected intercourse, affects about 10% to 15% of couples. Infertility testing and treatment is a costly and emotional “adventure” you may be able to avoid by taking a proactive approach when planning for pregnancy. The factors that can affect fertility include age, body weight, diet, smoking status or exposure to tobacco smoke, stress, alcohol consumption, exercise, environmental chemicals, medications, and street drugs.
There’s a good chance that simply improving your diet, becoming more active, more effectively dealing with stress, or just taking a vacation will help your odds of getting pregnant.
One of the most important factors affecting fertility is weight. Conceiving is more difficult if you’re underweight or overweight. In fact, it’s believed that weight issues cause 12% of infertility.
Body fat seems to be the synchronizing factor (or the conductor) for the harmonious hormonal symphony that must take place in order for pregnancy to occur and be carried to term. Because fat cells make estrogen, having too many or too few fat cells affects the amount of estrogen in the body, which then affects fertility (1).
It’s best to get close to your ideal weight before you seek help with fertility treatments since this simple change often can result in normal ovulation and pregnancy. It also can reduce the risk of pregnancy complications and of having a baby who’s too large or too small at birth.
A certain amount of body fat is needed for regular ovulation and menstrual cycles because some estrogen is produced in women’s fat stores. In fact, body weight changes of just 10% to 15% below normal can disrupt menstrual cycles.
If you’re seeking help for infertility, please make sure you’re not underweight. Research shows being underweight increases your chances of having a low birthweight infant or a baby who’s born preterm (2). Some fertility treatments greatly increase your chances for having twins or other multiples, and this further increases the odds of having low birthweight infants (3).
A maternal body weight closer to your ideal weight is best for conceiving and carrying a healthy baby to a healthy weight at term.
For women, excess body fat can affect the amount and types of circulating hormones, which influence fertility. It’s estimated that 25% of ovulatory infertility can be attributed to being overweight (4). Overweight is linked to polycystic ovary syndrome (PCOS), a cause of infertility. Insulin resistance, which can result from having PCOS or being overweight, also is related to infertility (4).
But there’s good news: Studies show overweight women have great success in conceiving once they’re closer to their ideal body weight. In fact, losing just 5% to 10% of total body weight can dramatically improve ovulation and pregnancy rates. In one small study, losing just 14 lbs. drastically improved ovulation and pregnancy rates (5).
An expanding waistline also can affect a man’s fertility. In fact, it’s double trouble if both partners are overweight because it increases the likelihood that it will take more than a year to get pregnant (6).
Overweight men tend to have lower testosterone and increased estrogen levels, and decreased ejaculate volume. Men with a BMI greater than 35 are more likely to have a lower sperm count and higher numbers of sperm with DNA damage compared with normal-weight men (7). Sleep apnea, which is more common in men who are obese, also can cause a decrease in testosterone levels. Excess fat in the inner thighs and pubic region also may cause warmer temperatures in the pubic area, which is enough to alter sperm production (8).
PCOS affects as many as 10% of women. Seventy-five percent of women diagnosed with PCOS are thought to have problems with infertility (9). The condition tends to run in families, so pay attention to whether women in your family have problems with irregular periods, acne past adolescence, excessive facial hair, or diabetes.
PCOS is caused by an imbalance of hormones—especially insulin—that leads to an overproduction of male sex hormones (or androgens), which can lead to small benign cysts on the ovaries; irregular, heavy, or no periods; acne; and excessive hair growth on the face and body (hirsutism). While being overweight often is common in women with PCOS, you can be of normal weight and still have it.
Other symptoms of PCOS may include unexplained fatigue; low blood sugar (hypoglycemia) after meals; lightheadedness; sweating; intense carbohydrate cravings; mood swings; hot flashes; recurrent spontaneous miscarriages; rough or velvety dark skin in skin folds such as the neck, armpits, or thighs (also called acanthosis nigricans); and sleep disorders such as sleep apnea (10).
According to Angela Grassi, MS, RD, author of The PCOS Workbook: Your Guide to Complete Physical & Emotional Health, a healthy eating plan for PCOS often includes lower carbohydrate intake (but not a low-carb diet); a higher intake of lean protein and monounsaturated fats; making most grains whole; consuming a minimum of 25g of fiber per day; and avoiding sweetened beverages, including juice and soda. Engaging in daily physical activity and taking a vitamin D supplement also are beneficial.
Women involved in competitive sports (and those who just exercise a lot) sometimes reduce their body fat so much that they stop menstruating. Strenuous exercise, low body weight, and body fat are related to reproductive problems, including infertility. Regular exercise is important for good health and can improve or control many conditions that lead to infertility, including overweight, emotional stress, and PCOS. However, if you take exercise to the extreme and are having trouble conceiving, you may need to slow down.
If your partner is a dedicated athlete, encourage him to tone down his routine a bit or mix it up to keep the family jewels cool and unencumbered. If he’s a biker, ask him to switch to swimming or running for a while (or if he won’t stop biking, buy him a bike saddle with fertility-boosting engineering). If he likes to pound the pavement in the heat of summer, encourage him to run when it’s cool instead or to switch to the treadmill or elliptical at the gym. And remember, tight briefs and shorts may look good, but they’re not good for his fertility (12).
Cigarette Smoke: Yours and Theirs
For women, the hazardous chemicals in cigarettes are poisonous to the ovaries because they decrease blood flow, interfere with estrogen production, and cause genetic abnormalities in the eggs. Women who smoke take twice as long to conceive and are more likely to have a miscarriage. The effects of smoking are dose responsive. While some of the damage that smoking does to ovaries is irreversible, stopping smoking can improve fertility rates (13).
In men, smoking causes lower sperm count and motility plus abnormalities in sperm shape and function, and also can cause oxidative damage to sperm, which could be responsible for birth defects and other diseases (14).
That said, tobacco is extremely addictive, and quitting is not easy. Because the effects on fertility depend on how much you smoke, start now by cutting down with the goal of quitting for good—for you and your partner.
Secondhand Smoke Also Snuffs Your Fertility
Secondhand tobacco smoke contains more than 7,000 chemicals, including at least 69 known to cause cancer. It’s estimated that 40% of nonsmokers are exposed to tobacco smoke. Secondhand smoke is just as bad as or even worse than the smoke inhaled by a smoker because it isn’t filtered. Recent research suggests that secondhand smoke, like mainstream tobacco smoke, may cause mutations in the DNA of sperm (15).
While many a babe has been conceived after a New Year’s Eve party or other celebration, this is not a tradition you want to follow. Alcohol intake by men and women during the week of conception is associated with a higher risk of miscarriage. Alcohol can be found in semen shortly after drinking, thus it can directly interfere with conception and implantation, and it may impact early miscarriage. Even small amounts of alcohol increase the formation of free radicals and the amount of antioxidants you need, so if you were a regular drinker before, you may need to boost your antioxidant intake (16).
For all these reasons, when you’re serious about trying to conceive, both men and women should avoid alcohol. If you choose to have that rare drink while trying to conceive, it’s safer for women to indulge during their period—the time when ovulation and conception are unlikely. For men, sex and alcohol don’t mix—at least when you’re trying to make a baby.
Celiac Disease and Gluten Sensitivity
While you can’t control whether you have celiac disease, you can control the disease through diet. Celiac disease, also called celiac sprue or gluten enteropathy, is an autoimmune disease that prevents people from properly digesting gluten, a protein found in wheat, rye, and barley. Research suggests there’s a higher rate of undiagnosed celiac disease in women having trouble conceiving. Untreated celiac disease also may be associated with recurrent miscarriage and other pregnancy problems such as low birthweight.
Celiac disease, once thought to be a rare disorder, now is estimated to affect as many as one in 133 people (both in the United States and Europe). However, less than 1% has been diagnosed (17). Symptoms can occur at any time in life and since the symptoms are sometimes vague and may not be gastrointestinal, celiac disease often is mis- or undiagnosed. One study showed the average time between the first symptoms and diagnosis was 11 years (18). Celiac disease is most common in first- and second-degree relatives with the disease.
If you suspect you have celiac disease, visit your health care provider. A simple blood test that looks for the presence of certain antibodies is one common test. A biopsy of the small intestine, done during an endoscopy, can confirm the diagnosis.
People whose tests for celiac disease are negative still may have some form of gluten sensitivity. The only way to know for sure is to try a gluten-free diet.
Amenorrhea (lack of menstrual periods) and oligomenorrhea (infrequent periods) often occur in women with anorexia nervosa and bulimia. Reproductive hormones also are reduced in women who maintain a lower-than-normal body weight. An increase in body weight and a balanced food intake will help restore normal reproductive functions.
You can’t control all the stress in your life, but you may have more control than you think. Always saying yes to volunteer projects and in general overscheduling yourself can increase stress. Take an inventory of your stress and see how you can decrease it or deal with it in a healthful way. Make your health and stress level a priority.
A natural alternative is ashwagandha, which is a highly valued herb in Ayurvedic medicine, the oldest form of natural medicine in the world. Ashwagandha has been used for over 6,000 years! It’s the countless number of active compounds found in ashwagandha that are responsible for all its healing attributes. Ashwagandha demonstrates remarkable stress and anxiety-relieving properties because it’s an adaptogen, meaning it enhances the body’s resilience to stress; improves your ability to cope with physical and psychological stressors. Studies show ashwagandha lowers levels of the “stress hormone” cortisol, which is important for reducing the degenerative effects of stress on the immune system. Not only does ashwagandha relief stress, it also is a potent antioxidant, and has also been used to boost fertility for thousands of years.
Oxidative Stress and Antioxidants
You’ve heard much about antioxidants and their overall health benefits. In fact, they also play an important role in your fertility.
Free radicals also can damage the reproductive system and have been correlated with problems of sperm motility, sperm number, and DNA damage in sperm. Free radicals can affect virtually every step in the reproductive process, from egg maturation to pregnancy (19).
That’s why an antioxidant-rich diet, for both moms- and dads-to-be, can improve fertility. Examples of antioxidants include vitamins C and E and folate plus carotenoids such as beta-carotene and lutein as well as minerals such as selenium, zinc, and copper. Folate and zinc have antioxidant properties that affect both male and female fertility (20-25).
There are several ways scientists measure foods’ antioxidant activity. According to the USDA, a food’s antioxidant measurement doesn’t necessarily translate into antioxidant action in the body (26); however, in the last few years, there have been more than 25 publications dealing with dietary antioxidants and their possible health benefits (27). The following foods are considered some of the richest in antioxidant capacity and should be included in your “before baby” diet and beyond (28, 29).
• Vegetables: spinach, chile peppers, green and black olives, mushrooms, asparagus, arugula, radicchio, beets, broccoli, artichokes, and red peppers
• Spices: clove, allspice, mint, sage, thyme, nutmeg, rosemary, saffron, tarragon, oregano, ginger, cinnamon, natural cacao
• Beverages: pomegranate, grape, prune, and cranberry juices (Espresso, coffee, and black and green teas also contain antioxidants but should be consumed in moderation.)
Nutrition and Lifestyle Reign
Clearly, nutrition and lifestyle play a critical role in fertility. The information presented here is just a small glimpse into how important diet is—not only in the odds of conceiving but also in carrying a pregnancy to term and having a child who thrives. Before going through the expense and emotional roller coaster of fertility treatments, it’s wise for a woman who’s trying to conceive to work on improving her diet and that of her partner first. RDs are the perfect source of information for this highly motivated population.
In Health and Happiness,
Kelly Harrington, MS, RDN
Registered Dietitian Nutritionist for Healthy Goods
Article courtesy of Today’s Dietitian.
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