Couple cooking together in kitchen

Preconception

Optimal nutrition to maximize fertility

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Infertility is a problem that affects at least 186 million people worldwide[1]. An estimated 15.5 percent of women in the United States experience infertility caused by different conditions, exposures and behaviors[2]. Medical advances in infertility treatment such as In-Vitro Fertilization (IVF) have increased our interest in understanding all of the factors that affect fertility.

Nutritional status has been found to play an important role in male and female fertility alongside pre-existing ovulation problems, spermatogenesis, presence of disease, age, weight and certain lifestyle choices, including smoking, alcohol, stress and lack of sleep. Couples who smoke and drink excessive amounts of alcohol significantly reduce their chances of conception[3].

Before fertilization even occurs the sperm and the egg need to exist within a healthy and well-nourished parent environment[4]. Nutritional deficiencies in pregnancy can also contribute to risk factors around miscarriage and birth defects so the emphasis on nutritional optimization is essential.

Healthy Fats

There are several dietary changes that women and men alike can make to boost their fertility.  Studies have shown that the most fertile women eat a nutritionally balanced diet free of trans-fats and sugars[5] (including high fructose drinks and alcohol), consume more vegetable protein and maintain an optimal weight[6]. Weight has been shown to be a key factor in optimizing fertility. Women who are underweight are at risk of anovulation (cessation of ovulation) and, in overweight women, fertility decreases by five percent for each unit increase in the Body Mass Index (BMI) exceeding 29.[7]  In men, Andersen et al[8] found that a higher BMI led to a decrease in sperm docosahexaenoic acid (DHA), the major polyunsaturated fatty acid (PUFA) found in spermatozoa. Conversely, they found that a higher sperm DHA was associated with a higher sperm count, increased sperm motility and normal morphology8.

Studies have shown that adopting a Mediterranean diet can improve a person’s chances of conceiving[9], enhance fetal health and reduce the risk of preterm birth[10]. Increasing evidence also shows that an increased ratio of omega-3 to omega-6 fatty acids in the diet may also improve reproductive success as well as improve general health.[11] The importance of dietary omega-3 sources in male fertility was highlighted by Esmaeli et al’s[12] study, which found that sperm DHA levels were sensitive to dietary intake of omega-3s – with improvements in all sperm parameters after four weeks of increased dietary intake.

Vitamins and Minerals

In addition to making dietary adjustments, men and women are advised to ensure they are taking the Recommended Daily Allowance (RDA) of multi-vitamins and minerals. These essential micronutrients should be prescribed if the physician deems necessary[13].

Vitamins E and C are antioxidants and therefore may reduce damage to sperm from free radicals and also aid female fertility[14] [15] with vitamin E appearing to have a beneficial effect on the uterine endometrium and ovulation induction.  Vitamin D deficiency seems to be linked to infertility[16] and supplementation during pregnancy is now universally recommended in the U.K.  Supplementation is also beneficial in improving neonatal well-being and can be useful as a preventative measure for pre-eclampsia[17].

Research also shows that in addition to reducing the risk of the development of neural tube defects, an increase in folic acid intake may enhance male fertility[18] by reducing the risk of sperm abnormalities. Micronutrients, such as B6, B12, lipoic acid, selenium, zinc, omega-3s are all important in supporting normal spermatogenesis.

A diet containing Coenzyme Q10 may help to increase sperm motility (ability to move spontaneously) in males[19] and increase fertility in ageing females[20].

Male Fertility

While infertility research is mainly focused on female health, much more attention is being paid recently to male fertility and semen health. As previously shared, sperm quality is significantly affected by lifestyle factors and nutrition so an optimal diet is also essential for men.

The role of soy in the diet is controversial. Research shows that the isoflavones contained in soy mimic natural estrogen and can act as an endocrine disruptor[21]. Comprehensive research on soy and its links with fertility is still lacking, so couples trying to conceive are advised to avoid soy products.

A recent study has shown that there is increasing evidence linking male infertility to exposure to endocrine disrupting chemicals[22] and that exposure could start as early as conception. Opting for organic foods, reducing plastic and canned foods in everyday life and washing hands regularly are a few ways to decrease your exposure[23].

Stress and Fertility

When the body is under acute stress, cortisol levels rise and compromise the body’s immunity. A weakened immune system can affect fertility.  A study conducted by the National Institute of Health[24] has shown that women who have higher levels of alpha-amylase (an enzyme produced when the body is stressed) found it more difficult to conceive. Stress also affects male fertility by lowering the quality of sperm and semen.[25] Both men and women need to manage stress effectively to increase the likelihood of conception.

Sleep deprivation can have detrimental effects on the body, including the menstrual cycle, so a good night’s rest enhances fertility. Research suggests that lack of sleep causes abnormal hormonal rhythms that are linked to infertility[26].

Optimizing nutrition is a fundamental starting point for maximizing fertility[27]. The most important advice for couples trying to conceive is to maintain a well-balanced diet focused on increasing protein intake from vegetables, optimizing vitamin intake (especially D, E and C) and ensuring that the diet contains sufficient iron, fiber and other useful micronutrients such as omega-3s, Coenzyme Q10 and folic acid. Eating organic when possible to reduce chemical exposure and opting for a Mediterranean diet is also recommended.

Lifestyle and nutrition play a fundamental role in maximizing fertility. They are among the most promising strategies for improving fertility for both men and women.

 

References:   info

[1] Inhorn, M.C. and Patrizio, P., 2015. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Human reproduction update, p.dmv016.

http://humupd.oxfordjournals.org/content/early/2015/03/22/humupd.dmv016.short

[2] Thoma, M.E., McLain, A.C., Louis, J.F., King, R.B., Trumble, A.C., Sundaram, R. and Louis, G.M.B., 2013. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertility and sterility, 99(5), pp.1324-1331. http://journals.sagepub.com/doi/pdf/10.1177/1559827616641386

[3] National Collaborating Centre for Women’s and Children’s Health (UK, 2013. Fertility: assessment and treatment for people with fertility problems. London: Royal College of Obstetricians & Gynaecologists; 2013 Feb. (NICE Clinical Guidelines, No. 156.) 5, Initial advice to people concerned about delays in conception.

[4] House, S.H., 2009. Schoolchildren, maternal nutrition and generating healthy brains: the importance of lifecycle education for fertility, health and peace. Nutrition and health, 20(1), pp.51-76.

[5] Chavarro, J.E., Rich-Edwards, J.W., Rosner, B.A. and Willett, W.C., 2007. Dietary fatty acid intakes and the risk of ovulatory infertility. The American journal of clinical nutrition, 85(1), pp.231-237. http://ajcn.nutrition.org/content/85/1/231.short

[6] Chavarro, J.E., Rich-Edwards, J.W., Rosner, B.A. and Willett, W.C., 2007. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology, 110(5), pp.1050-1058. http://journals.lww.com/greenjournal/Abstract/2007/11000/Diet_and_Lifestyle_in_the_Prevention_of_Ovulatory.17.aspx

[7] Hassan, MA: Killick, SR Negative lifestyle is associated with a significant reduction in fecundity. Fertil. Sterile. 2004, 81, p384-392

[8] Andersen,J.M., Ronning, P.O., Henning,H., Bekken,S.D., Haugen,T.B. and Witzak,O.  Fatty acid composition of spermatozoa is associated with semen quality. Andrology, 2016,4, pp.857-865

[9] Vujkovic, M., de Vries, J.H., Lindemans, J., Macklon, N.S., van der Spek, P.J., Steegers, E.A. and Steegers-Theunissen, R.P., 2010. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertility and sterility, 94(6), pp.2096-2101.

http://www.sciencedirect.com/science/article/pii/S0015028209043386

[10] Khoury, J., Haugen, G., Tonstad, S., Frøslie, K.F. and Henriksen, T., 2007. Effect of a cholesterol-lowering diet during pregnancy on maternal and fetal Doppler velocimetry: the CARRDIP study. American journal of obstetrics and gynecology, 196(6), pp.549-e1. http://www.sciencedirect.com/science/article/pii/S0002937807000889

[11] Fontana, R. and Torre, S.D., 2016. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients, 8(2), p.87.

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[12] Esmaeli, V, Shahverdi,A. H., Moghadasian, M. H. and Alizadeh, A. R. Dietary Fatty Acids affect semen quality: a review. Andrology, 2015,3, pp.450-461.

[13] Sfakianaki, A.K., 2013. Prenatal vitamins: A review of the literature on benefits and risks of various nutrient supplements.

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[14] Salas-Huetos, Bullo M, Salas-Salvado., Hum Reprod. Update 2017 Mar 10: pp.-19

[15] Cicek, N,Eryilmaz, O.G., Sarikaya, E., Suleman, E., Gerec, Y., The  Journal Assist Reprod. Genet 2012, April; 29(4)pp.325-328

[16] Dabrowski, F. A., Grzechocinksa, B., Wielgos, M., The Role of Vitamin D in Reproductive Health-a Trojan Horse or Golden Fleece? Nutrients, 2015. May 29: 7(6) pp.139-53

[17] Bodnar, L.M., Catov, J.M., Simhan, H.N., Holick, M.F., Powers, R.W. and Roberts, J.M., 2007. Maternal vitamin D deficiency increases the risk of preeclampsia. The Journal of Clinical Endocrinology & Metabolism, 92(9), pp.3517-3522. http://press.endocrine.org/doi/abs/10.1210/jc.2007-0718#sthash.bj9VKriM.dpuf

[18] Green, N.S., 2002. Folic acid supplementation and prevention of birth defects. The Journal of nutrition, 132(8), pp.2356S-2360S. http://jn.nutrition.org/content/132/8/2356S.full.pdf+html

[19] Talevi, R., Barbato, V., Fiorentino, I., Braun, S., Longobardi, S. and Gualtieri, R., 2013. Protective effects of in vitro treatment with zinc, d-aspartate and coenzyme q10 on human sperm motility, lipid peroxidation and DNA fragmentation. Reproductive Biology and Endocrinology, 11(1), p.1.

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[20] Ben‐Meir, A., Burstein, E., Borrego‐Alvarez, A., Chong, J., Wong, E., Yavorska, T., Naranian, T., Chi, M., Wang, Y., Bentov, Y. and Alexis, J., 2015. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging cell, 14(5), pp.887-895. http://onlinelibrary.wiley.com/doi/10.1111/acel.12368/full

[21] Nardi, J., Moras, P.B., Koeppe, C., Dallegrave, E., Leal, M.B. and Rossato-Grando, L.G., 2016. TITLE: Prepubertal subchronic exposure to soy milk and glyphosate leads to endocrine disruption. Food and Chemical Toxicology. http://www.sciencedirect.com/science/article/pii/S0278691516304896

[22] Juul, A., Almstrup, K., Andersson, A.M., Jensen, T.K., Jørgensen, N., Main, K.M., Rajpert-De Meyts, E., Toppari, J. and Skakkebæk, N.E., 2014. Possible fetal determinants of male infertility. Nature Reviews Endocrinology, 10(9), pp.553-562.

[23] Zissu, A. (2016) 9 Ways to Avoid Hormone-Disrupting Chemicals: Endocrine disruptors like BPA and phthalates lurk in everything from cleaning products to fragrances, The Natural Resources Defense Council. https://www.nrdc.org/stories/9-ways-avoid-hormone-disrupting-chemicals

[24] Louis, G.M.B., Lum, K.J., Sundaram, R., Chen, Z., Kim, S., Lynch, C.D., Schisterman, E.F. and Pyper, C., 2011. Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertility and sterility, 95(7), pp.2184-2189. http://www.sciencedirect.com/science/article/pii/S0015028210010319

[25] Gollenberg AL, Liu F, Brazil C, Drobnis EZ, Guzick D, Overstreet JW, Redmon JB, Sparks A, Wang C, Swan SH (2010) Semen quality in fertile men in relation to psychosocial stress. Fertil Steril, 93 pp.1104-1111.

[26] Kloss, J.D., Perlis, M.L., Zamzow, J.A., Culnan, E.J. and Gracia, C.R., 2015. Sleep, sleep disturbance, and fertility in women. Sleep medicine reviews, 22, pp.78-87. http://www.sciencedirect.com/science/article/pii/S108707921400104X

[27] Fontana, R. and Torre, S.D., 2016. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients, 8(2), p.87.

http://www.mdpi.com/2072-6643/8/2/87/htm