Lifestyle and fertility
If you are trying to conceive or undergoing fertility treatments, what you eat and are exposed to matters. During your attempts at conception, I want to optimize the chance for success by controlling all variables that you can. These are some lifestyle modifications that may have an impact on your success.
BPA: bisphenol A.
BPA is an endocrine disruptor and interferes with estrogen, testosterone and thyroid hormone action. BPA is now largely out of some plastics but being replaced with other bisphenols which are not regulated. BPA exposure is associated with poor egg quality, lower embryo development, and lower pregnancy rates.
Used in plastics, vinyl, cleaning products, nail polishes, fragrance
Most studied is DEHP which is high in food packaging and processing. DEHP is associated with lower egg and embryo quality due to oxidative stress. Women who underwent IVF and had higher DEHP exposure had fewer eggs retrieved and a lower live birth rate.
PFCs: perflourinated chemicals
PFCs are widely used in consumer goods including food packaging, paper wraps, firefighting foams, pesticides, textiles, and Teflon. PFCs are long acting and passed on through the placenta in pregnancy. PFCs have been associated with increased time to pregnancy and alteration of steroid hormone metabolism.
Avoid all plastic food and beverage containers
Don’t use microwavable plastics or packaged products
Avoid canned goods (look for box packaging, especially tomatoes)
Don’t touch paper thermal receipts (go electronic if possible, wash hands after touching)
Use stainless steel or glass drinkware
Limit processed foods – cook at home (food packaging and processing is bad)
Limit consumption of processed and fast food
Change out plastics, especially those exposed to heat (coffee maker, plastic coffee cups, don’t put plastics in the dishwasher or microwave)
Limit fragrance in products and don’t wear perfume
Look for phthalate free and formaldehyde free nail polish
Don’t use teflon or non-stick cookware, look for stainless steel and cast iron
Limit pesticide exposure, wash food and buy organic (especially for food products without a protective outer layer)
Carbohydrates are not overall bad type matter. High insulin levels impact normal hormone function in the ovaries and may impact egg quality (increased chromosome abnormalities). For example, diabetics have a higher chance of chromosome abnormalities and a higher risk of miscarriage. Refined, simple carbohydrates have been associated with an increase ovulatory infertility in the Nurses’ Health Study. And in a small IVF study, in women without blood sugar problems or diabetes, who failed their first cycle of IVF, when asked to eat fewer simple carbohydrates, they had improved embryo quality and pregnancy rates.
And sugar itself is in the form of soda is bad. Just one soda a day has been associated with lower live brith rate with IVF and decreased natural fertility.
Whole grains also have been shown to have antioxidant and anti-inflammatory properties which can result in beneficial impacts on glucose metabolism and have been associated with improved live birth rates. Carbohydrates are important for how our body functions and an important component of the dietary process for most people.
A note, fruit does have natural sugar, but it also has fiber which helps change how sugar is absorbed and helps stabilize blood sugar levels and prevent insulin spikes. Fruit is good, eat fruit.
And what about gluten itself – certainly if you have celiac disease we know that gluten is not processed well, will cause inflammation, and is associated with decreased pregnancy rates and increased miscarriage rates. Celiac disease is an autoimmune disease and so on the autoimmune spectrum it has potential other associations with inflammatory and autoimmune disease like thyroid disease, endometriosis, and possible causes of recurrent pregnancy loss. My recommendation is for patients with these conditions to avoid dairy and gluten as there is some concern that gluten and dairy can contribute to inflammation in women with sensitivity to gluten – even without full celiac disease.
Plant based eating and protein:
It appears that plant based eating improves reproductive outcomes.
Protein: Ovulation is essential for reproduction, and for every serving of vegetable based protein over animal based protein there was an improvement in ovulation and pregnancy rates. surviving increased vegetable protein intake improves ovulatory patterns. Similarly, in an evaluation of IVF parameters and dietary intake embryo development and clinical pregnancy rates were lower in in vitro fertilization cycles decreased with increase in red meat consumption and in weight loss dieting. This is further evidence that both red meat and having a negative energy balance (such as ketosis) are not healthy conception environments. It is worth noting that animal foods are high in AGE or advanced glycosylation end products (AGE) and these AGE end products cause cellular damage. There is evidence that AGE accumulation is correlated with poor egg and embryo development and lower pregnancy rates
Omega 3 fatty acids: Evidence suggests that diets higher in omega 3 polyunsaturated fatty acids and lower in trans fats are associated with both shorter time to pregnancy, improved ovulation, and improved outcomes with fertility treatments. Omega-3s are high in fish and fish oil products, and can be found in flax, walnuts and chia. Importantly, studies evaluating fish consumption result in inconsistent results. Fish can be an excellent source of omega-3 polyunsaturated fatty acids although fish consumption also poses risk for environmental exposure, especially methyl mercury. If eating fish, recommend limiting to 2-3 servings per week. Alternatively, fish oil or algae based supplements are sufficient sources of omega 3 fatty acids.
Dairy: Evaluations of dairy intake have resulted in inconsistent impacts on reproductive outcomes. Total dairy intake has not been associated with decreased fertility; however 2 large cohort studies have revealed negative associations between dairy intake and fecundability. It has been shown that if you are eating dairy, full fat products are better than low fats. This is likely due to the processing and removal of fat but replacement with other hormones and substances to keep the consistency.
Soy: There is concern that soy based protein intake may impair normal endocrine estrogen dependent pathways. However, no correlation has been seen between soy intake and fecundity in prospective studies. Further, in patients undergoing fertility treatments, improvements in reproductive outcomes, including live birth rate in IVF were seen in women with higher soy intake. The concern that soy modifies hormone production negatively as a phytoestrogen has not been shown in any study, and I support the use of soy.
As female reproduction is a hormone dependent and sensitive process, it is hypothesized that increased consumption of animal based proteins (meat, dairy, eggs) may increase exposure to endocrine disrupting chemicals, steroid hormones, and growth hormones. It appears that greater adherence to healthy diet patterns, including emphasis on whole grains, fruits, vegetables, and olive oil, may result in improved health and also improvement in fecundity. A recent evaluation revealed that the “fertility diet” that included higher intake of supplemental folic acid, vitamin B12, vitamin D, low rather than high pesticide residue produce, whole grains, dairy, soy foods, and seafood rather than other meats had higher probability of live birth even with IVF [Gaskins AJOG 2019].
And for those interested in being fully plant based, there is no evidence of maternal or fetal harm from vegan diets. The lack of randomized studies prevents us from distinguishing the effects of diet from confounding factors. With this said, veganism id considered safe with appropriate supplementation (folic acid, vitamin B12, vitamin D)
Vitamin B12: Vitamin B-12 is in animal products and fortified foods (such as some brands of soymilk, breakfast cereals, and nutritional yeast) or supplements. Unless fortified, no plant food contains significant amounts of active vitamin B-12. Foods such as sea vegetables and spirulina may contain vitamin B-12 analogs; neither these nor fermented soy products can be counted on as reliable sources of active vitamin B-12. Lacto-ovo-vegetarians can get adequate vitamin B-12 from dairy foods and eggs if these foods are consumed regularly. B12 is important in nervous system function and prevention of anemia. Recommend at least a 3 mcg supplement daily for vegans.
Omega 3 Fatty Acids:Important for brain and eye development. Can be found in fish, fish oil, flax, algae, walnuts. Recommend all supplement due to dietary limitations.
Vitamin D: Vitamin D is important in calcium absorption and in bone, muscle, and cell health. Vitamin D decreases inflammation and has been associated with improved reproductive outcomes. Vitamin D is likely important in endometrial receptivity with improved live birth rates and clinical pregnancy rates with higher vitamin D levels. Foods that are fortified with vitamin D include cow’s milk, some brands of soymilk and rice milk, and some breakfast cereals and margarines. If sun exposure and intake of fortified foods are insufficient, vitamin D supplements are recommended. Most need at least 1000 IU Vitamin D3 daily. I often recommend 2000 IU daily if not checking and monitoring vitamin D levels and trying to conceive.
Folate: Folate Is essential for cell division and deficiencies can lead to anemia and in pregnancy is associated with neural tube defects, preterm birth, intrauterine growth restriction. Folate is found in leafy greens, as well as broccoli, asparagus, brussel sprouts, avocado and beans. Folate is fortified in grains, but even with this, many reproductive aged women are deficient. At least 400 mcg daily is recommended, with some fertility improvements seen with higher levels (800 mcg). Some women will benefit from methylated folate, and many supplements are not in this form. I recommend 800 mcg of methylated folic acid for my patient trying to conceive.
Additional supplements with some potential benefit:
Coq10:Coenzyme Q10 is important in mitochondria function and may be beneficial for older women or those with low ovarian reserve. I recommend 200mg per day of ubiquinol.
DHEA:Dehydroepiandrosterone (DHEA) is produced from the adrenal glands. Research is conflicting, but a supplement may benefit women who are older or have low ovarian reserve, if so I recommend 25 mg per day.
Limit sugar, no soda, limit processed, refined carbohydrates
Encourage legumes, nuts, seeds, vegetables, whole grains like quinoa, wild rice, brown rice, steel oats, buckwheat
Diet high in organic fruits and vegetables
Plant based protein sources over animal based protein sources
Soy is not harmful
Limit fish to 2-3 servings per week if consumed
Limit dairy, but if consumed choose full fat over low fast options
Supplement with folic acid, vitamin D, and vitamin D12, and omega-3 fatty acids
A whole food, plant based diet is nor harmful in pregnancy
Consider CoQ10 and DHEA if older or if you have low ovarian reserve
The Veggie MD - Plant Based Started Guide