

By: Kathryn C. Calhoun, MD, ACRM

Trying to conceive, and undergoing fertility evaluation and treatments, can be stressful and expensive. There are many ways to ensure that you are optimizing your fertility outside of the fertility doctor’s office. This will help to secure the maximum benefit from your treatment cycles.

How to Increase Your Fertility

Body Weight

It is widely accepted that pregnancy rates are lower in women who are obese or very thin. Much of this effect is due to irregular periods (anovulation) resulting from weight changes, but women with regular periods may also have more difficulty conceiving at the extremes of weight. Additionally, there can be increased problems during pregnancy for mothers who are not at an ideal weight. Men who are obese may also have problems with sperm and testosterone production.

Your doctor can help you identify your ideal body weight for pregnancy and, together, you can determine a timeline to achieve this weight safely.

Fertility and Diet

A diet may be part of a program to help you achieve a higher or lower body weight prior to conception. A nutritionist can be helpful in recommending daily calorie goals to achieve desired weight loss/gain; you can also calculate this number using resources available on the internet.

There is no convincing evidence that any particular type of diet (i.e. vegetarian, antioxidant-rich, low-fat) can improve fertility in women, apart from helping them to achieve an ideal weight. For women who are pursuing weight loss, the most important factor in a successful diet is that it be a sustainable plan, i.e. one that you can continue for life.

There is also no evidence that any particular diet can reliably affect infant gender.

Exercise

The American Heart Association and the American Congress for Obstetricians/Gynecologists recommend moderate activity for 45 minutes per day on most, if not all, days. This recommendation includes pregnant women with no specific contraindications to exercise.

Regular exercise has well-proven benefits for cardiovascular health; it appears that it may also reduce pregnancy complications such as gestational diabetes and high blood pressure.

Regular exercise during the conception/pre-pregnancy period also seems to be safe for women with no specific contraindications to exercise. There is some data that women who are more active in the year prior to fertility treatment are more likely to conceive. Conclusions are less clear for vigorous sports and elite athletes.

Each woman should check with her doctor about specific activity recommendations during fertility treatment, In Vitro Fertilization (IVF), and pregnancy.

Sexual Practices

Couples attempting conception should plan to have intercourse every 1-2 days during the “fertile window,” which refers to the 7 day period ending on the day of ovulation. There is no evidence that sexual position or prolonged bed rest after intercourse affect pregnancy rates.

There is no documented relationship between female orgasm and fertility.

A study of the use of sexual lubricants by couples attempting conception reported that use of lubricants did not affect pregnancy rates. Some sexual lubricants affect the motility of sperm in the laboratory, but it is unclear how they affect sperm motility when applied in the small quantities that are used in real life. Mineral oil, canola oil and hydroxyethylcellulose based lubricants do not affect sperm motility in the laboratory.

Sexually-transmitted diseases, such as gonorrhea or chlamydia, can often go undetected and may affect a woman’s fallopian tubes. A current gonorrhea or chlamydia infection can impact a man’s semen quality. It is important to share relevant history and current symptoms with your doctor.

Click here for more information on sexual practices and fertility.

Alcohol

Studies are mixed about the effect of alcohol on female fertility, but high levels of consumption (> 2 drinks/day) are best avoided during conception due to the well-documented harmful effects on fetal development.

Alcohol consumption appears to have no effect on male fertility.

Tobacco

Women who smoke are more likely to be infertile and to go through menopause at an earlier age. Smoking also increases the risk of ectopic (tubal) pregnancy and miscarriage. Exposure to first-hand or second-hand smoke reduces the chance of conception in an IVF cycle.

Men who smoke have poorer semen analysis scores, though the exact impact on male fertility is unclear.

Cigarette smoke is best avoided in pregnancy, due to associations with fetal growth.

Recreational drug use

It is difficult to know the effects of illegal drugs, though some studies have shown decreased fertility with marijuana use.

It is best to avoid drug use during conception/pregnancy because of the well-documented harmful effects on fetal development.

Prescription and over-the-counter (OTC) drugs

You should share all regular and occasional medications and supplements with your doctor. Even products that claim to be “all-natural”, “organic” or “bio-identical” can affect your reproductive health.

Caffeine

Daily intake of 300mg or less has not been shown to affect fertility or miscarriage rates. A table of common drinks/foods and their caffeine content is provided for reference – energy drinks are probably best avoided in the conception/pregnancy period due to their higher caffeine content and other additives.

Name Amount Caffeine (mg) Coffee 8oz 100-200 Tea 8oz 40-120 Coke (regular or diet) 12oz 35-50 Mountain Dew 12oz 50 Hershey Bar 1 small bar 10

Artificial Sweeteners

There is no consistent evidence that use of aspartame (Nutrasweet), sucralose (Splenda), or stevioside (Stevia) by pregnant women increases the risk of birth defects.

Saccharin (Sweet 'N Low) is eliminated more slowly by the fetus, and was associated with fetal bladder issues in one animal study so many clinicians recommend avoiding saccharin during pregnancy.

The American Academy of Pediatrics (AAP) Committee on Nutrition and the FDA and the Council on Scientific Affairs (CSA) of the American Medical Association (AMA) concluded that aspartame is safe for both the pregnant mother and developing baby, but recommend moderate doses.

The Acceptable Daily Intake (ADI) for aspartame is 50 mg/kg/day (Diet Coke contains 131 mg aspartame per 355 mL can and one packet of Equal contains 33 mg of aspartame.)

There are no recommendations for artificial sweetener use during conception/fertility treatments.

Stress and Fertility

The effect of both psychosocial and physical stress on fertility cannot be underestimated. Reduction of stress during conception has beneficial effects on pregnancy rates and outcomes. Methods to reduce stress are unique to each woman/couple, but should be an important part of any conception/pregnancy plan.

Massages are generally safe in conception/pregnancy, though the masseuse/masseur should be made aware of fertility treatment/pregnancy. Attention must be paid to proper hydration before and after the massage.

Although it is difficult to study acupuncture in a randomized controlled trial, many studies have reported benefits of acupuncture treatment on the outcomes of fertility treatment.

Environmental toxins

Information continues to build regarding pollutants and toxins and reproductive health. Care should be taken to avoid chemicals used in certain industries (dry cleaning, printing), pesticides and heavy metals. Exposure to radiation (including industrial microwaves) should also be limited.

Heat/saunas

Sauna bathing does not affect female fertility, and can be safe during uncomplicated pregnancy. Literature is inconclusive regarding the effects of recreational heat (saunas, laptop computers) on male fertility.

For more information or to schedule an appointment with Dr. Calhoun please call 678.841.1089 or click here.