Your Health – Fertility Maintenance

As little girls, many of us spent a lot of time playing mommy. Once we reached adolescence, any time spent thinking about motherhood was dedicated to criticizing our own mother’s parenting skills. When we became sexually active, thoughts of motherhood were dedicated to how best to avoid it and, for many of you, avoiding pregnancy right now may still be one of your highest priorities. But for those who are considering “trying” at some point in time, whether in the next month, in 5 years, or if you have discarded birth control and are trying already, there are a number of choices you can make to maintain or increase your fertility.

Risk Factors

Smoking is listed first because it is probably the most crucial. Research shows that women who smoke are less fertile than nonsmokers.¹ Women who smoke go through menopause significantly earlier than nonsmokers and smoking adversely affects eggs in the ovaries. Since we were born with all of the eggs we will ever have (unlike men who literally produce millions of sperm every day), everything we are exposed to has the potential to harm our eggs. Since we don’t know exactly how many cigarettes it takes to harm an egg, it makes sense to start the quitting process sooner rather than later.

Recent research shows that caffeine consumption is linked to both infertility as well as first trimester miscarriage.2 Caffeine can decrease the chances of getting pregnant each month and if you get pregnant during a month where you drank a lot of caffeine, you may be more likely to subsequently miscarry.

However, prior consumption of caffeine has not been linked to these problems. Thus, if attempting to conceive is not on your horizon right now, caffeine consumption is not an issue. If you do plan on trying within the next few months, it is probably a good idea to examine your caffeine consumption. Coffee is the big culprit; tea, soda, and chocolate all have much less caffeine than coffee. The nonhome-brewed coffees tend to have the greatest amounts of caffeine.

Several years ago, two studies were released that showed basically the same thing—the more alcohol a woman drinks on a weekly basis, the longer it takes her to get pregnant.³ The amount refers to how much you drink during the week while trying to conceive, not how much you drank years or months before trying. Thus, a woman who drank 10 alcoholic beverages per week took significantly longer to conceive than a woman who drank six alcoholic beverages per week. So if you are planning on trying in the near future, you should start monitoring your alcohol consumption and taper down when you do start trying. And, of course, avoid alcohol completely once you are pregnant.

Avoiding Extremes

Body weight can impact fertility as well as the health of the pregnancy. In general, both extremes should be avoided. Women with very high or low body weights tend to have irregular or absent menstrual cycles and even if they menstruate regularly, can experience fertility problems. The recommendations for a normal body mass index (BMI) range are 20-25. The BMI measures the ratio of weight-to-height through a formula that divides a person’s body weight in kilograms by the square of her height in meters. Falling above or below these may increase your risk of infertility.

If you are below or above the suggested BMI range, research has shown that gaining or losing a relatively small amount of weight can put you into the “fertile range.”⁴ Research shows that underweight women who gain an average of 8 pounds have excellent subsequent pregnancy rates and overweight women who lose 12 to 14 pounds also have a much better chance of conceiving.⁵

The Stress Factor

Can stress cause infertility? It depends on the definition of stress. If you define stress as anxiety, there is minimal research on any connection. Highly anxious women may take longer to conceive and one study suggested that anxious women may have a higher rate of miscarriage, however, the scientific evidence is not very compelling.⁶ If you define stress as depressive symptoms, however, the evidence is stronger. Research shows that women with a history of depression are twice as likely to subsequently experience infertility as women without such a history.⁷ In addition, depressed women may have abnormal production of the hormones necessary for reproduction and tend to have lower success rates from infertility treatment.

If you have a history of depression, be sure to mention this to your obstetrician/gynecologist when you go in for your preconception physical. If you suspect or wonder if you may be depressed now, ask your primary care physician to screen you for depression, see a local mental health professional, or go to one of the major websites that contain depression screening questions.

Keep Moving

Exercise is probably the best strategy to promote your mental and physical health. It decreases the risk of cardiovascular disease, several different types of cancer, and osteoporosis, as well as leads to decreases in anxiety and depression. Whether or not exercise has any impact on fertility is unclear. If you are not currently trying to conceive and you have no medical condition that precludes exercise, I would recommend that you brainstorm on ways to increase the amount of exercise in your daily life.

If you are currently trying to conceive, have normal regular menstrual cycles, and no medical condition that is of concern to your obstetrician, there is probably no reason to stop exercising. However, if you currently have a moderate or vigorous exercise routine and have irregular cycles, you may want to stop exercising for a few months to see if your cycles return to a regular pattern. In addition, if you are a regular exerciser and have been trying to conceive for more than 6 months with no luck, you might want to cut back the intensity of your workouts for a few months to see if exercise might be contributing to a fertility problem. I tell my patients who are trying to conceive to keep their heart rate below 110 beats per minute.

The Alternative Path

Alternative health has hit the US by storm, and more and more Americans are trying some sort of alternative product or service. However, there is very little research to support either the efficacy or the safety of many of these approaches.

In terms of vitamins and minerals, unless you have been told by a physician or registered dietician that you need special supplements, you should only take either a prenatal vitamin or a multivitamin plus folic acid on a daily basis. There are a number of vitamins that are not water-soluble and may harm a developing baby, especially vitamin A. Regarding minerals, you need to be taking in an adequate amount of calcium, either through diet or supplement (calcium carbonate and calcium citrate are considered to be the safest).

Herbs are tricky. One study showed that three out of four herbs tested decreased the fertilizability of eggs and sperm and other research indicates that some herbs can cause birth defects.⁸ With other holistic health services, acupuncture appears to be safe and, in one study, increased the efficacy of infertility treatment.⁹ However, most of the others are untested. The best advice is to use caution with alternative products and discuss any you are considering with your obstetrician/gynecologist.

Don’t Panic

The human body is amazing; although the process of reproduction is amazingly complex, most people have no problem getting pregnant. Approximately 85% of women will conceive within 1 year of trying.¹⁰

The general rule of thumb is to try on your own for 12 months if you are under 35, and for 6 months if you are over 35 or have issues in your medical history (or your partner’s) that may make you more likely to have an infertility problem, eg, a history of a ruptured appendix, endometriosis, irregular menstrual cycles, undescended testicles. At that point, you should seek out an appointment with an infertility specialist. The key is when you do start to try to assume that you are fertile and not to worry about it.

References

1. Bolumar F, Olsen J, Boldsen J. Smoking reduces fecundity a European multicenter study on infertility and subfecundity. The European Study Group on Infertility and Subfecundity. Am J Epidemiol. 1996;143(6):578-587.
2. Buck GM, Sever LE, Batt RE, Mendola P. Life-style factors and female infertility. Epidemiology. 1997;8(4):435-441.
3. Jensen TK, Hjollund NH, Henriksen TB, et al. Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy. BMJ. 1998;317(7157):505-510.
4. Bates GW, Bates SR, Whitworth NS. Reproductive failure in women who practice weight control. Fertil Steril. 1982;37(3):373-378.
5. Clark AM, Ledger W, Galletly C, et al. Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod. 1995;10(10):2705-2712.
6. Demyttenaere K, Nijs P, Steeno O, Koninckx PR, Evers-Kiebooms G. Anxiety and conception rates in donor insemination. J Psychosom Obstet Gynaecol. 1988;8:175-181.
7. Lapane KL, Zierler S, Lasater TM, Stein M, Barbour MM, Hume AL. Is a history of depressive symptoms associated with an increased risk of infertility in women? Psychosom Med. 1995;57(6):509-516.
8. Ondrizek RR, Chan PJ, Patton WC, King A. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril. 1999;71(3):517-522.
9. Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002;78(6):1149-1153.
10. American Society of Reproductive Medicine. Available at: asrm.org. Accessed January 23, 2003.

Websites Offering Depression Screening

• American Psychiatric Association: www.psych.org
• American Psychological Association: www.apa.org
• American Society of Reproductive Medicine: www.asrm.org