Are there any lifestyle changes that my partner and I can make in preparation to getting pregnant or starting the IVF process?
The answer is YES. It is now apparent that several lifestyle factors can influence fertility. Therefore, it is important to attend these issues from the beginning of your planning to conceive, and even more as treatments become more complex, particularly with IVF.
It is estimated that 38% of adult women in the United States are obese (versus 34% of adult men). Female obesity has a negative effect on spontaneous and assisted conception rates. It also increases miscarriage, premature labor, stillbirth, perinatal risks such as gestational diabetes and hypertension, need for operative delivery, and other complications such as wound infection and thromboembolism.
There are complex mechanisms whereby over-weight and obesity reduce female fertility. Notably, oxidative stress, inflammation, and insulin resistance are common mediators of those effects. Obesity is also a prominent aggravating factor in the development of polycystic ovarian syndrome (PCOS).
On the other hand, male obesity can be associated with hypogonadism, risk of diabetes and cardiovascular disease, sexual dysfunction, and abnormal semen analysis, contributing to infertility.
Over-weight and obese individuals usually have a very unhealthy diet, and most are sedentary. Regular exercise can reduce oxidative stress and markedly improves insulin sensitivity. In a published observational study, obese women who regularly exercised had an over three-fold higher success rate with IVF compared with those who were sedentary. A prudent diet, which is associated with achieving pregnancy with IVF, contains more antioxidants, is anti-inflammatory, and is associated with decreased circulating markers of inflammation, which in turn improves insulin sensitivity.
A healthy diet and regular exercise are lifestyle changes that over time are likely to result in gradual, progressive, and sustained weight loss and improved overall health. Diets resulting in short-term weight loss are usually followed by regain of the weight. As such, we should encourage positive lifestyle changes over 3–6 months before and during and after IVF rather, than requiring a marked weight loss, which lacks evidence of efficacy and may be harmful.
In another recent IVF-ICSI study, a “health conscious–low processed” dietary pattern characterized by high intakes of fruits, vegetables, fish, and whole grains and low intakes of snacks, meats, and mayonnaise, was positively correlated with red blood cell folate. But a “Mediterranean” dietary pattern with high intakes of vegetable oils, vegetables, fish, and legumes and low intakes of snacks, was not only positively correlated with red blood cell folate, and levels of vitamin B6 in blood and follicular fluid, but significantly, high adherence by the couple to this diet increased the probability of pregnancy!
Summary and recommendations
- Planning ahead: be aware of the impact of delaying fertility: fertility decreases with age, both female and male.
- Time intercourse around ovulation days. Check ovulatory status with easy-to-use urinary tests.
- Modify poor personal habits: as I tell my patients: if your right hand is working towards increasing fertility, do not let your left hand work the opposite way. Stop smoking, stop alcohol intake, avoid excessive caffeine (coffee-regular tea), exercise moderately, and switch your dietary habits as appropriate.
- A reasonable recommendation of diet and supplements would be: a healthy diet with fruits (especially berries), and vegetables (especially cooked), low red meat and no trans-fats (doughnuts, French pastries, or fried foods). Olive oil, avocados and nuts are good. You can add supplements such as omega 3 fatty acids (EPAS/DHA), and vitamins (folic acid, vitamin C and E -anti-oxidants).
For further information please call Sher Fertility Institute New York at (646) 792-7476.