Lifestyle and Fertility
There are some lifestyle changes you should consider, which will improve your chances of conceiving and having a healthy baby.
Folic acid and multivitamins
There is good evidence that folic acid reduces the chances of having a baby with spina bifida (when the spine does not develop normally). The recommended dose is 0.8mg of folic acid daily for two months before conceiving and until 12 weeks of pregnancy. The major folic acid supplements in the New Zealand market include Elevit and Blackmores (Blackmores Pregnancy and Breast Feeding Gold, and Blackmores Conceive Well). Folic acid supplements that contain general multivitamins may also reduce the chances of cardiac, urinary and cleft lip abnormalities in babies. Vitamin A formulations should be avoided as they are linked with birth defects.
Cigarettes have a huge impact on fertility. Women who smoke are only 60% as likely to conceive as non-smokers and smoking is also associated with miscarriage, small babies and earlier menopause. Smoking appears to speed up the reproductive clock sometimes by up to 10 years. Men who smoke have lower sperm counts and more malformed sperm than non-smokers and are more likely to have children who develop childhood cancer. Smoking marijuana is also thought to have a detrimental influence on sperm. The good news is that smoking-induced damage to fertility may be reversible. Sperm take around 72 days to fully form, so if you give up smoking at least three months before trying to conceive, sperm quality should improve.
Women should not smoke for at least three months before trying to conceive, as this is how long it takes for an egg to grow and mature. Nicotine patches may cause the same problems as smoking so should also be avoided.
Give up alcohol
Most people are aware of the detrimental effects that alcohol can have on a pregnancy, by causing fetal alcohol syndrome. However, moderate drinking whilst trying to conceive also reduces fertility. Research has shown that women drinking five units or less a week are twice as likely to conceive as women drinking 10 or more units. If there is a safe level of alcohol in pregnancy, it is not known, so it is better not to drink at all as soon as you know you are pregnant, preferably before.
Alcohol also affects testicular and sexual functioning in men, so large amounts of alcohol should be avoided. The current recommendation is that men should drink less than 20 units of alcohol per week. One unit of alcohol is defined as 8g of ethanol and is equivalent to a small can of beer or a small glass of wine (125ml).
Drink less caffeine
Caffeine intake can affect fertility in women, as it is associated with a longer time to conceive and also reduced chances of becoming pregnant on an IVF programme. More than six cups of coffee a day may also be linked with miscarriage. Caffeine is not only contained in coffee but also in a variety of other products such as tea, cola, energy drinks, some frozen desserts and chocolate; so be aware of your overall caffeine intake. Male fertility does not appear to be affected by caffeine.
Avoid sexually transmitted infections (STI’s)
The rates of STI’s are increasing in New Zealand. Often, these infections cause few, if any, symptoms, so the damage they cause can go unnoticed until a couple tries to conceive. For example, there is approximately a 10% chance of one episode of chlamydia (a sexually transmitted bacterial infection) causing infertility in women.
The damage caused by STI’s includes blocked Fallopian tubes, pelvic pain, ectopic pregnancy as well as male infertility. Condoms should be used in all new sexual relationships to avoid risk of infection.
Maintain a healthy body weight
Being overweight or underweight can reduce fertility, so it is important to keep your body weight within the normal healthy range. Body Mass Index (BMI) is an indication of your body weight and can be calculated by dividing weight (in kgs) by height (in m2). You should aim for a BMI of between 20 and 25, as this will optimise your chances of conception.
Even in these modern times, nature knows best. If a woman’s BMI falls below 19, the body senses famine and ovulation is switched off to prevent the risk of having a baby with malnutrition. Excessive exercise can reduce body fat and increase muscle mass to a point where periods cease for the same reason. Risk of miscarriage is also increased in women with a low BMI.
Being overweight (BMI>30) can reduce fertility by 50%. Pregnancy in overweight women is often associated with problems such as maternal diabetes, high blood pressure, big babies and increased risk of caesarean section.
The good news is, however, that as soon as you get back on track with your body weight, ovulation and fertility quickly return to normal. Even a minimal weight loss (less than 5% of body weight) can make a difference, therefore advice with weight and its management is an important part of fertility treatment.
In men, being slightly overweight may also reduce sperm count, so men should also make an effort to keep their BMI within the normal range.
You can check your BMI with our online calculator here.
Couples experiencing infertility definitely experience considerable stress, but whether stress causes infertility is a much debated issue, but one effect it can have is to interrupt a normal sex life resulting in less frequent sex. Extreme stress can switch off ovulation completely, however, cognitive therapy can help to reduce stress and has been shown to restart ovulation.
There is also some evidence that women who are clinically depressed when they start an IVF cycle are less likely to conceive. So our take home message is to look after yourself and your relationship by managing stress and seeking help if needed.
What should you eat?
The current dietary advice is to eat a healthy balanced diet with lots of fresh fruit and vegetables. There are no wonder foods that will boost fertility, however there are some foods you could eat more of and others to be avoided. For men, there are a number of studies suggesting that antioxidants such as vitamin C and E, along with zinc and selenium may reduce DNA damage in sperm. Foods rich in antioxidants are good for both prospective parents, and include:
- all types of berries
- fruits such as grapes, oranges, plums, pineapple, dates, kiwifruit, mandarins
- dried fruit such as apricots and prunes
- vegetables such as red cabbage, peppers, parsley, artichokes, Brussels sprouts, tomatoes, spinach; brightly coloured vegetables are particularly rich in antioxidants
- legumes such as broad beans, groundnuts, soybeans
- cereals such as barley, millet, oats and corn
- nuts and seeds such as walnuts, brazil nuts, sunflower seeds
- garlic and ginger
- dark chocolate
For women, there are some foods that should not be eaten frequently, such as some fish which may be high in mercury. The highest levels of mercury are found in shark, swordfish and marlin, with much lower levels in tuna.
A recent study also found that a diet containing high levels of ‘transfats’ doubled the chances of infertility in women. Transfats are formed when liquid oils are chemically treated to increases their shelf life (hydrogenation) and are present in a wide variety of foods, particularly in snack foods, biscuits and some takeaways.
Although an ‘organic’ diet is a healthy option, there is no evidence that it improves fertility.
There is a surprising lack of data on the effect of exercise on fertility. However, moderate exercise is always a healthy option and should be encouraged. Excessive exercise may not be so beneficial, as it may switch off ovulation resulting in irregular or absent periods. Cutting back to moderate exercise may restore the normal menstrual cycle and hence fertility. We do not fully understand why ovulation ceases with regular strenuous exercise or a low body weight, but it may be explained by the complex interactions between body fat, brain chemicals and ovaries. Moderation is the key to exercise when trying to conceive. For men, even less is known about the effects of exercise and sperm. Male obesity is associated with lower sperm counts so again moderate exercise is the healthy and most beneficial approach.
What about medication?
It is wise to check with your doctor regarding any medication that you are both on, as there may be a better alternative while you are planning a pregnancy. For example, women taking medication for epilepsy or depression should discuss options with a medical practitioner. There are also some drugs which you may have taken in the past that may impact on fertility, particularly chemotherapy drugs.