What’s in a Prenatal Vitamin?

What?

  • FOLATE aka FOLIC ACID (most important)
  • Iodine
  • +/- Iron (this can also be supplemented separately as needed, such as for anemia)

Why?

  • Folate reduces risk of neural tube defects (birth defects), such as spina bifida
  • Iodine optimizes thyroid health and fetal brain development

When?

  • Optimal to start about 3 months prior to conception
  • Take 1 serving (number varies by vitamin) daily

How much?

  • At least 400 mcg folate per day, but individual needs may be higher
  • 150 mcg per day of iodine

Where?

  • Any pharmacy or grocery store, or available online

Other ingredients?

  • Limited evidence for other ingredients, but they are usually not harmful.
  • It is important to avoid excessive quantities, such as for Vitamin A or B vitamins.

Which are legitimate products?

  • Prenatal vitamins can be given as a prescription from your doctor
  • Prescription brands are FDA-regulated
  • Direct-to-consumer (aka over-the-counter, or OTC) brands are not as strictly regulated
  • If you buy it OTC, check for the following certification standards:
    • Look for NSF (National Sanitation Foundation) certified
    • Or look for USP (United States Pharmacopeia) verified

Introducing Dr. Chiang!

Greetings to the Enhancing Fertility Blog community! I am happy to be joining the Conceptions team and looking forward to connecting with everyone via this blog. I recently relocated from Alabama to my husband’s home state of Colorado. My areas of interest are infertility, ovulation induction, intrauterine insemination, IVF, fertility preservation, and recurrent pregnancy loss.

I enjoy working with patients on building their families, particularly problem-solving and navigating the challenges of health and life. Deciding to pursue fertility, defer fertility, or choose fertility preservation can be a complicated decision, and it is a topic almost everyone comes across in their lifetime. It requires patients to consider many factors, including their health assessment, emotional reserve, and financial status. I love being the doctor people can trust for guidance with that decision.

I joined Conceptions because the practice stands out to me as a local, ethical, privately held Colorado business model. The dedication is to professionalism and doing right by our patients in the long run, not to corporate shareholders. We focus on the people we care for. We empower patients to make personalized decisions that nurture physical and mental wellbeing on the road to having a baby.

You can follow my Instagram @jasmineleechiang

More on pesticides

images-4

Thank you for the excellent feedback from our last string of posts: “Top 10 ways to minimize your exposure to toxic chemicals in our environment.”

One of the tips that was covered in this list is to eat lots of fruits and veggies. I recommended eating a variety and to choose organic selectively by using tools such as EWGs “Clean 15” and “Dirty 12.”

Human fertility rates are declining. Although this was thought to be due to lifestyle changes and societal changes, could our environment be playing a role? Could environmental contaminants like pesticides in our food be contributing to infertility?

This study in China showed that women with high levels of organophosphate or pyrethroids exposure (common pesticides) took longer to conceive and were more likely to have infertility than couples that had lower levels of exposure.

What you can do:

  • Wash your produce for at least 20 seconds to minimize your exposure to pesticides.
  • Eat organic when you can and strategically by utilizing resources like EWG’s dirty list: certain items are worth the money of switching to organic (“Dirty 12”) more than other produce (“Clean 15”)

Doing IVF? Avoid artificial sweeteners

For decades, infertility patients have been told to avoid caffeine consumption when trying to conceive and during fertility treatments. As we have previously reviewed, moderate caffeine consumption is ok, and could even help! New data is showing us that what you put in your coffee, could be more dangerous than the caffeine itself

We have previously discussed this topic: You are what you drinkThis study looked at couples doing IVF and found that women who drank beverages with artificial sweeteners had lower pregnancy rates than women who did not consume these beverages. Similarly, any type of soft drink consumption (regular vs diet) was associated with worse outcomes: poor embryo development in the lab and lower pregnancy rates.

If you are doing IVF, avoid using artificial sweeteners or consuming soft drinks in order to optimize your chances of success.

Take home points:

  • Men and women should avoid sugary drinks when trying to conceive, but particularly if they are using IVF
  • Using artificial sweeteners is not necessarily a safe alternative to sugary drinks
  • If you can’t completely eliminate sugary drinks, consider limiting your intake to <1 beverage a day.

Caution about Sunscreen Use

KZANmsH8RR2GSuXI5cNy_spray sunscreen

If your family is anything like ours, sunscreen is a routine part of our daily lives. Sunscreens protect our skin from sunlight using mineral or chemical filters. Mineral sunscreens use zinc oxide or titanium dioxide. Most sunscreens use chemical filters that contain active ingredients such as oxybenzone. Studies have demonstrated that these chemical filters mimic hormones and can act as endocrine disrupting chemicals.

 

Sunscreen exposure increases our exposure to chemical filters, such as oxybenzone. Oxybenzone use is widespread throughout the US. It is detected in nearly every American.

 

The reproductive system is sensitive to environmental factors. Early pregnancy is a particularly vulnerable time for endocrine disruption. Exposures when trying to conceive can impact the likelihood of conceiving as well as the health of the pregnancy.

 

Oxybenzone exposure and exposure to related compounds is associated with male infertility  and poorer reproductive success in men undergoing fertility treatments. Similarly, men with greater exposure to a similar compound found in sunscreen had poorer sperm quality and took longer to conceive. Female exposures to oxybenzone and related chemicals have been linked to increased risk of endometriosis and problems with ovulation. These chemicals have also been associated with oxidative stress and inflammation in pregnancy.

 

The good news is that we can be informed consumers and change our exposure.

This is a great resource of safer sunscreen alternatives.

 

 

Take home points

  • Avoid sunscreens with chemical filters, particularly oxybenzone
  • Use mineral sunscreens when possible when trying to conceive

Depression in Dads

DepressedDadITN

The stress related to a diagnosis of infertility parallels what is experienced with a cancer diagnosis or grief of the loss of a loved one. We all recognize that stress has a negative impact on our health and can impact fertility. However, most of what we know has been from studies based on the female partner.  New research demonstrates that the stress of infertility on male partners should be considered as well.

 

Nearly 50% of men seeking IVF reported symptoms of depression. 50%! This study found that although major depression is more common in female partners than in male partners, it can still have a significant impact on fertility success. Couples in which the male partner had major depression were 60% less likely to conceive and have a live birth than those in which the male partner did not have depression.

 

Although this study shows an association between male depression and decreased likelihood of success with fertility treatments, it leaves many questions about whether one causes the other unanswered. What this study does a great job at, however, is demonstrating the need for us to focus on the health of all our families prior to conception.

 

Take Home Points:

  • Infertility and the associated treatments are a major life stressor.
  • Depression during fertility treatments can be common, in both female and male partners
  • Untreated depression in men may decrease fertility
  • Talk to your REI and primary care doctor if you think depression is impacting your life

Fast food is bad for fertility

48507384-fast-food-and-unhealthy-eating-concept-close-up-of-hamburger-or-cheeseburger-deep-fried-squid-rings-.jpg

Does anyone else remember when we first started realizing that fast food was unhealthy? I personally remember watching the documentary “Super Size Me”and being shocked; I think we all suspected that fast food wasn’t as healthy as a home-cooked meal, but few of us realized just how dangerous this food could be for our health. Documentaries like “Super Size Me” revealed the negative impact of fast food on health: significant physical and psychological negative impacts were found with regular fast food consumption. Worse yet, this documentary showed how corporations encourage poor nutrition through marketing in order to benefits its own profits.

 

New research now shows that fast food is particularly harmful when trying to conceive. In this study, the nutrition habits of couples trying to conceive were watched. What they found was that couples that ate the most fast food and the least fruits & vegetables took longer to conceive and were more likely to have infertility. This study also found that the effect was dose-dependent: couples that ate the most fast food (>4 times/week) had the highest risk of infertility.

 

Take home points:

  • There are many reasons why you shouldn’t eat fast food. Your fertility is one of them.
  • Limit or altogether avoid fast food while trying to conceive
  • Try to eat diets full of fruits & vegetables to enhance your natural fertility

Doing an IVF cycle? A Mediterranean diet can help!

istock000068258379large

Couples often ask me: “What else can we do to make this IVF cycle successful?” The first answer, is to pick the right lab. I’m fortunate to work with an amazing group of embryologists so I encourage my patients to consider the next step: using your diet and lifestyle to stack the odds in your favor. As we have discussed before in the blog, what you eat and what you do can absolutely impact your fertility and overall health. New research demonstrates that your diet, in particular, can impact your success with IVF.

 

As many of my patients know, I encourage a plant-based diet to enhance your fertility naturally. The problem with many of these studies that we have previously reviewed is that people who eat a plant-based diet are more likely to be thin and the following question emerges: “Is diet really impacting your fertility or does this have to do with your weight?” A new study helps us address this question.

 

In this study, women who had a normal weight (BMI < 30 kg/m2) underwent IVF in Greece. Women who ate a Mediterranean diet were more likely to get pregnant and bring home a healthy child compared to women who did not eat a Mediterranean diet. Women who ate better were almost 3 times as likely to bring home a child than women who did not eat a Mediterranean diet! The results suggest that dietary modifications may help increase the chances of a successful pregnancy and delivering a live baby for women undergoing IVF treatment.

 

What this study doesn’t answer, however, is when these dietary changes need to be implemented in order to have the full benefits on your fertility. My advice is simple: the sooner the better. The healthier you are when you start an IVF cycle, the more likely you are to get the full benefits of diet on your fertility. However, if you have a time crunch with regards to your fertility, with diagnoses such as diminished ovarian reserve, it may not be in your best interest to delay starting treatment. Talk to your doctor for more information about what the best next steps are for you.

 

Take home points:

  • Your diet can impact your chance of having success with IVF
  • Consider implementing a Mediterranean diet
  • Talk to your doctor for more information to help select the best diet for your goals

You are what you drink- continued

We have previously discussed in this blog the impact of the beverages we drink on fertility.The old saying of “You are what you eat” couldn’t be more true- what you eat absolutely impacts how we feel and our overall health.

sugary-drinks

New research is adding to this old saying- what you drink may be just as important as what you eat, when it comes to fertility. Similarly, we also discussed that the beverages you consume now can impact the health of your future children: women that drank beverages with low-calorie sweeteners are more likely to have obese children.

New research adds to these concerns. In this large study, the dietary habits of men and women were evaluated while they tried to conceive. Drinking sugary beverages was associated with decreased fertility for both men and women. Similarly, participants who had consumed the most sugary drinks (>7 servings/week) were found to have the lowest odds of fertility for both men and women.

This study looked at what couples drank during an IVF cycle and monitored their outcomes. They found that couples that drank more sugary drinks like soda did worse in IVF, when compared to couples who don’t drink sugary drinks: fewer eggs and fewer good quality embryos.

Take home points:

  • Men and women should avoid sugary drinks when trying to conceive, but particularly if they are using IVF
  • Using artificial sweeteners is not necessarily a safe alternative to sugary drinks
  • If you can’t completely eliminate sugary drinks, consider limiting your intake to <1 beverage a day.

Is going low carb dangerous?

At the initial patient visit, I try to learn about any special dietary restrictions my patients may have. A common diet is going “low carb” in an effort to lose weight. Emerging research, however, suggests that this could be dangerous when trying to conceive.

Folic acid is a vitamin that reduces the risk of having a child with a problem with it’s spinal cord, known as a neural tube defect. Folic acid is added to many common meals, like cereal, in order to fortify the food. Women who intentionally avoid carbohydrates, thereby consuming fewer fortified foods, may not have adequate dietary intake of folic acid.

This study found that women eating low carb had significantly lower dietary intake of folic acid. Women eating low carb were 30% more likely to have an infant with a severe neural tube defect such as anencephaly or spina bifida.

What you should do:

  • Talk to your doctor about any special diets you have before trying to conceive
  • Women should take a daily prenatal vitamin in addition to having a well-balanced diet while trying to conceive