According to the World Health Organization (WHO), infertility is a disease of the reproductive system that is defined by the failure to achieve a clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse. Infertility affects up to one in seven couples in the UK.1 It is imperative that health care professionals (HCPs), including dietitians, understand the importance of optimizing fertility and pregnancy outcomes to support preconception health as well as promote future health outcomes for parents and their children.
Hippocrates advocated for special diets for both men and women to improve fertility. This text is saying that male infertility is a problem for one-third of couples and that both partners play an equal role in conception and fertility. This means that both partners should have a healthy diet and be as nutritious as possible before conception.3
The increasing understanding of the role of nutrition in maintaining good health before conception is evident in the increased number of academic papers written on the topic, as well as the increased media and social media attention. A series of papers published in The Lancet in 20184 suggest context-specific interventions for preconception health. This text provides details on how healthcare professionals can help improve nutrition for both parents and their children before and after birth. Recommendations include supplementing and fortifying food to improve long-term outcomes for mother and child.
The purpose of this article is to provide an overview of the current evidence around specific nutrients and dietary factors that can impact fertility and to offer guidance on how best to incorporate this information into dietetic practice. Some practical tips that dietitians can give to their patients who are trying to conceive or are in the process of planning a pregnancy.
Eat Food That Are Rich In:
Fats
Eating a diet high in monounsaturated fat may improve fertility rates for women, according to some evidence.5 Additionally, higher intakes of full-fat dairy, plant proteins, non-haem iron, and monounsaturated fats have been linked with lower rates of ovulation infertility (OI).6 Observational research suggests that low-fat dairy may have a negative impact on female fertility, but this is not backed up across the academic literature. The current literature does not have a clear consensus on how fat intake affects fertility. Therefore, it is advisable to be cautious when suggesting diet changes based on this idea. There is a lack of clarity in the literature on this topic, which shows that more large-scale, well-designed RCTs are needed before any definitive recommendations can be made.
A diet rich in anti-inflammatory omega-3 fatty acids has been shown to improve sperm health, quality and motility for men, whereas a diet high in saturated and trans fats adversely affects sperm quality.
Protein
Plant-based proteins may improve ovulatory infertility, according to some evidence. It is suggested that consuming more plant proteins and fewer animal proteins may have a positive effect. An observational study that looked at 18,550 women found that those who ate more plant protein had a 50% reduced risk of OI. There is a growing societal and environmental interest in plant-based eating, and the observed health benefits, implications for fertility outcomes, and potential links with reduced childhood obesity are frequently discussed within clinical practice.7 A systematic review9 found that whilst poorly planned vegan and vegetarian diets carry an increased risk of vitamin and mineral deficiencies, there are potential benefits from a well-planned, whole food, plant-based diet and no known risks to fetal or maternal health with appropriate planning.
Vitamin D
10 Vitamin D may be important for fertility, with receptors located in the ovaries, placenta, and endometrium, as well as in testicles and sperm, according to accumulating data. A recent meta-analysis concluded that adequate serum vitamin D levels are associated with more positive pregnancy tests, clinical pregnancies, and live births in women undergoing artificial reproductive technology (ART). There is no association between vitamin D status and the likelihood of miscarrying, according to current literature. However, more research needs to be done in this area, specifically in the form of randomized controlled trials, in order to better understand the connection between the two.
In men, a lack of Vitamin D has been linked in observational studies to low testosterone levels in the blood, as well as poor semen quality. This includes a reduced number of sperm, as well as reduced movement and abnormal shape. However, RCTs have not shown improvements following supplementation.12
Iron
Iron deficiency is the most common nutritional deficiency worldwide. A woman’s risk of having a baby with a birth defect increases if she becomes pregnant before she is well-nourished or if she has had multiple pregnancies. It is important that men and women have their iron levels checked before they conceive, as a deficiency in either sex can cause fertility issues, including abnormal sperm production, reduced libido, sperm damage from oxidation, and OI.13 Some research suggests that the kind of iron consumed matters, and data from the Nurses’ Health Study II shows that women who consume more non-haem iron are at a lower risk for OI.5
Zinc and folate
There is a documented link between folate deficiency in women and the increased risk of neural tube defects. The recommended daily supplement for women who are trying to conceive is 400mcg of folic acid. Women who are at an increased risk of having a pregnancy affected by neural tube defects may benefit from a higher dose of 5mg.JUMP Folate is also important for male fertility as it is needed for the synthesis of DNA in sperm.
Zinc is important for both male and female fertility; in men, it is necessary for sperm production and motility, while in women, it aids in hormone balance and ovulation.16 Good sources of dietary zinc include whole grains, nuts, seeds (particularly sesame seeds), beans, oysters, and lean red meat. Since men lose zinc every time they ejaculate, they need slightly more of it than women do (9.5mg vs 7mg). Men should be encouraged to consume adequate amounts of zinc from food sources every day.
Lifestyle Tips
Achieve or maintain a healthy body weight.
Weight is not the only factor that determines health and fertility. A healthy weight may be beneficial for fertility by supporting healthy ovarian function, hormone levels, and menstrual cycles.
Get active.
There is no doubt that there are health benefits to being physically active on a regular basis. You may not know this, but it can also help support fertility.
Regular physical activity supports healthy cholesterol levels and a healthy weight, both of which are important fertility factors. Working out can also do wonders for your mental well-being and stress levels – two things that can impact fertility.
Most experts would say that moderate exercise is good while trying to conceive; this could include walking, cycling, water aerobics or hiking. The goal is to be physically active for 30-60 minutes each day, most days of the week.
Take a high-quality preconception prenatal vitamin.
If you are trying to conceive, you should start taking a good preconception prenatal vitamin. Shady Grove Fertility notes that a woman’s nutrient needs differ when she is trying to conceive as opposed to when she is pregnant.
A vitamin taken before conception should include a full range of nutrients, such as folate, choline, iodine, iron, and vitamin D.
Folate and choline are important nutrients for the development of the baby’s brain and nervous system. It is also essential to maintain a healthy Vitamin D level for fertility and a healthy pregnancy.
Consider other preconception supplements.
If you are a certain age or have a certain health history, taking extra nutrients with your prenatal vitamins may help create healthy eggs and a healthy pregnancy.
Coenzyme Q10 (CoQ10)
If you are concerned about your CoQ10 levels, taking a supplement may be a good idea. CoQ10 is important for energy production in the body’s cells, including egg cells.
As you age, your cells produce less CoQ10, which reduces their efficiency in producing energy. Egg cells are the largest cells in the human body and require a lot of energy to develop properly.
To maintain healthy egg quality, it is important to support fertility as you age. Research has found that a diet rich in CoQ10 can help promote healthy egg quality and a healthy pregnancy. Consuming foods that are rich in CoQ10, such as organ meats, salmon, tuna, chicken, beef, canola and soybean oil, and pistachio nuts, is a good option.
Inositol
Inositol is a nutrient that is similar to B vitamins and is naturally found in whole grains, beans, nuts, and fruits.
Studies have found that inositols may help to regulate blood sugar levels, improve menstrual regularity, and support ovarian function in women.
Inositol has been shown to improve egg quality and can be helpful for women struggling to conceive.
There are many different forms of inositol. There are two types of inositol that have been shown to be beneficial in research studies: Myo-inositol and D-chiro-inositol.
Limit caffeine and alcohol.
Both caffeine and alcohol may affect your fertility.
Caffeine
Caffeine is a stimulant that is commonly found in coffee, tea, chocolate, soda, and energy drinks. It is important for women to limit their caffeine intake before getting pregnant. Does drinking coffee impact fertility?
The answer to the question is yes, but it is dependent on the amount of caffeine being consumed. A recent study has shown that consuming just 200mg of caffeine a day can reduce your chances of conception and increase the risk of miscarrying.
Other studies have found that caffeine increases the amount of time it takes to get pregnant.
If you’re used to having caffeine every day, you can still drink a small cup of coffee or cappuccino. You should only consume 200 mg of caffeine or less when you are trying to get pregnant.
Alcohol
The jury is still out on whether or not drinking alcohol delays the amount of time it takes to get pregnant, as the research on the matter is mixed.
A study that was done recently in Denmark showed that alcohol had no effect on fertility for women trying to conceive naturally. The study included over 6000 women.
According to research summarized by Shady Grove Fertility, alcohol has a negative impact on women who are trying to conceive. Fertility decreases slightly in women who have up to 5 drinks per week, compared to women who did not drink, and falls further in those who have over 10 drinks per week.
A different study showed that women who drank more than 6 drinks a week were 18% less likely to get pregnant.
The takeaway is that you should reduce your intake of alcohol when trying to get pregnant. It is especially important to keep communication open with your healthcare team if you are working on getting pregnant. If you might be pregnant, do not drink.
Stop smoking.
If you want to conceive, you should stop smoking. If you smoke, it negatively impacts not only your health but also your fertility. Smoking cigarettes can lengthen the amount of time it takes to get pregnant. If you are pregnant and you smoke, it increases your risk of having a miscarriage and your baby having birth defects.
If you want to quit smoking, see your healthcare provider or look at the American Cancer Society’s guide to quitting.
Reduce stress.
The connection between stress and fertility isn’t entirely clear. Pregnancy is more likely to occur during months when couples feel relaxed and less likely during months when they feel more anxious.
Some women who were not successful in getting pregnant before have found that practicing stress management techniques has helped them. There is some evidence to suggest that acupuncture, massage therapy, exercise, meditation, and deep breathing techniques may be effective in reducing stress levels.
Get enough sleep.
More than a third of Americans do not get enough sleep, according to the Centers for Disease Control.
It is important that you get enough sleep for your health, fertility, and healthy pregnancy.
During sleep, our bodies are working to repair and restore themselves. Getting enough sleep is necessary for repairing cells, regulating hormones, and many other body processes.
Sleep regulation is important for the hormones involved in ovulation and reproduction, such as leptin, progesterone, estrogen, luteinizing hormone, and follicle-stimulating hormone. If you want to maintain healthy ovarian function and menstruation, you need to get enough sleep. The goal is to sleep seven to nine hours every night.
Seek medical care for untreated conditions.
Some medical conditions can reduce your fertility or make it more difficult to get pregnant. You should visit a gynecologist or primary care physician for a physical before attempting to get pregnant. If you have a previously undiagnosed condition, getting treatment can improve your fertility and help you prepare for pregnancy.
Summary
To sum up, eat a nutritious diet before pregnancy, exercise regularly, think about taking a high-quality vitamin supplement specifically for preconception as well as other fertility supplements, and change other aspects of your lifestyle that will help you achieve your goal of getting pregnant. You should try to eat healthy foods and exercise regularly.
