By Vasiliki A. Moragianni, MD, MS, FACOG. Dr. Moragianni is an award-winning reproductive endocrinology and infertility specialist at Fertility SolutionsTM. She is passionate about providing individualized, state-of-the-art fertility care to individuals and couples who wish to build a family. She currently sees patients in Dedham, MA and Providence, RI.
So you are either new to the journey towards childbearing or you have already had several experiences, positive or negative, and are wondering, besides seeking professional help, is there anything that you and/or your partner should be doing to increase your chances of a healthy pregnancy? This is a topic often not given the attention it deserves. When it is discussed, the information tends to be confusing, overwhelming, and oftentimes controversial. What I will attempt to do in the next few paragraphs is debunk some of the myths and shed some light on the existing, albeit scarce at times, evidence.
And please keep in mind that since the goal of fertility treatment always is a healthy pregnancy, the following information applies when trying to achieve both natural and assisted conception.
Let us begin with some of the most commonly mentioned and studied factors: diet/supplements, caffeine, smoking, alcohol, and drugs. There is very little solid evidence to support any particular diet (vegetarian, vegan, low-fat) or supplement (anti-oxidants, herbal remedies) having a significant effect on fertility. That being said, you should make sure to mention any and all supplements (over the counter vitamins, Chinese herbs, “muscle enhancers”, “energy boosters”, etc.) that you and/or your partner are using to your physician so they can be carefully assessed on an individual basis. Also, all sexually active women not using contraception should be taking at least 400 mcg daily of a folic acid supplement. In terms of caffeine consumption, the general rule of thumb is that 1-2 cups of coffee daily before and during pregnancy do not decrease fertility or cause adverse outcomes. That is the equivalent of 250 grams of caffeine a day and the estimate of your use should include other sources of caffeine as well, such as decaffeinated coffee, chocolate, tea, colas, other sodas, energy water, alcoholic energy drinks, breath fresheners, etc.
It is now established that female and male, active and passive smokers take longer to achieve conception, either naturally or with treatment. They are also more likely to develop lung cancer, cervical cancer, bladder cancer, heart and lung disease, and osteoporosis. Female smokers reach menopause sooner and are more likely to have adverse obstetrical and neonatal outcomes. However difficult to initiate and maintain, smoking cessation is imperative for both you and anyone you might be a second-hand smoker to. The available treatment modalities are effective but they have to begin with education and willingness to change.
As long as alcohol consumption is limited to 1 drink daily there is no overwhelming evidence that it affects fertility. However, it is crucial that all consumption is discontinued as soon as pregnancy is achieved, since a safe alcohol level has not been established for pregnancy and its effects on fetal development can be detrimental and life-long. Finally, the use of marijuana should be avoided as it negatively affects both male and female fertility. The use of cocaine, heroin, and other recreational drugs has not yet been accurately studied due to reporting bias but should be discouraged given their known adverse effects on fetal development.
Another factor that has received a lot of attention, and for very good reasons, is weight. Both underweight and overweight patients have lower pregnancy rates. During both weight extremes the brain, through intricate hormonal mechanisms, signals the rest of the body to shuttle energy away from the reproductive system. This applies to women and men alike! Furthermore, overweight and obese women are more likely to have menstrual irregularities and be affected by polycystic ovary syndrome (PCOS), where hormonal aberrations lead to immature ovulation and a cascade of events hindering fertility. Since pregnancy is always accompanied by weight gain and since increased weight is positively correlated with several obstetrical and neonatal complications, the pre-pregnancy weight should be as close to the ideal body weight for height as possible. In addition, patients who are overweight or obese are much more likely to have other co-morbid conditions (such as high blood pressure, diabetes, high cholesterol, heart disease, etc.). These conditions might not have manifested themselves yet, mostly because our reproductive years are the younger years of our lives, but should be prevented as we strive for a healthy baby with healthy parents. Weight loss or gain for patients on either extreme of the spectrum is undeniably challenging. It is thus essential that as an individual you work with your reproductive endocrinologist, nutritionist, and/or therapist to begin addressing some of the underlying issues. Do not underestimate the power of any change. You do not have to begin with a 20 lb loss or gain; setting small and attainable goals is definitely more realistic.
Several studies have evaluated the effects of environmental exposures on fertility and pregnancy, with conflicting results. Here are the take-home points: Individuals consistently exposed to dry cleaning solvents, printing industry chemicals, lead, industrial microwaves, and high doses of bisphenol A, or those who mix and apply herbicides can likely experience a higher rate of infertility. However, all environmental exposures should be mentioned to your physician and discussed individually.
I purposefully left the discussion of stress for the end. This is because trying to achieve a healthy pregnancy can be in and of itself very stress-provoking, at the same time that we are asking patients to minimize stress in their lives. We know that extreme amounts of chronic stress lead to hormonal signals that can prevent procreation. But does day-to-day stress do the same? The answer remains unclear but anything that can be done to decrease stress can only be beneficial. There are several effective treatment options, and a lot of them are specifically geared towards fertility, so patients and providers should not hesitate to initiate discussion and evaluation.
We can safely conclude that maintaining a healthy body and a positive attitude during this whole process will only increase your chances at a healthy pregnancy. Please do not hesitate to seek medical attention for any of these issues.