At our center, we have long held that your circadian rhythm–how your biology responds to the day-night cycle–impacts your fertility. This is one of the many reasons we focus on optimizing vitamin D levels, melatonin (when necessary) and paying careful attention to our embryo transfer schedules. In case your fertility center hasn’t figured out how important that this is, check out the following recent study on miscarriage risk associated with time shifts. https://consumer.healthday.com/infertility-information-22/infertility-news-412/daylight-savings-time-may-lower-chances-of-ivf-success-for-some-study-719514.html
Fertility treatment is stressful. Worse still, there is evidence that stress can reduce your chances of achieving a successful pregnancy. For both of these reasons we’re aggressively seeking ways to help our patients reduce their stress. Here is another excellent study demonstrating the incorporating a yoga practice into the lead-in time to fertility treatment is one effective strategy. Smile, breathe and read on: https://www.mdlinx.com/obstetrics-gynecology/medical-news-article/2015/02/18/infertility-in-vitro-fertilization-stress-yoga/5919631/
There is a global obesity epidemic. More than one BILLION adults are projected to be obese by 2025. Obesity is a major risk factor for the development of medical conditions such as diabetes and cardiovascular disease, as well as numerous types of cancers. Obesity, in either male or female partners, is associated with a decrease in the ability to become pregnant. Obese women are not only at an increased risk of having trouble conceiving, they are also at risk of: needing medications to conceive, being less responsive to fertility treatments, losing pregnancies to miscarriage, having children with birth defects, as well as having complications during pregnancy such as high blood pressure and diabetes.
Many people use artificial sweeteners or “diet” drinks as a substitute for whole ingredients with the hope of cutting calories. A recent study suggests that this may be a bad idea. This group followed people for 10+ years and found that people that used low-calorie sweeteners had a higher body mass index (BMI), larger waist circumference, and were more likely to be obese. This paper suggests that using low-calorie sweeteners may not be effective means of weight control, and might even lead to harm.
When I review studies like this, I think it’s important to note that these studies are NOT designed to prove that artificial sweeteners CAUSE obesity; rather, they show an ASSOCIATION at a population level. For me, as a physician and mom, this association is reason enough to be cautious about the use of artificial sweeteners. For others, especially die-hard Diet Coke drinkers, they might want more proof before changing their diet habits.
There is no easy solution for weight loss; diet drinks probably aren’t going to help. If you are overweight or obese, don’t lose hope. Even a modest weight loss (10-15% body weight) can enhance your natural fertility. It will take hard work through diet and lifestyle changes. Avoid sugary snacks and drinks in general. Consider using natural sweeteners like stevia (Dr. Greene’s favorite!) or honey (my favorite!) instead of artificial ingredients. Your selection in which sweetener you use, is likely going to depend on what is most important to you including considerations like why you are using a sweetener, why you are looking for artificial sweeteners (cutting calories), and taste. Please be an informed consumer and make sure that you know why you are making the choices that you make. Taking care of yourselves will help prepare you for a healthy pregnancy and prepare you to be healthy parents.
One of the first research projects I did on the impact that lifestyle can have on fertility showed that women exposed to a handful of common chemicals classified as EDCs (endocrine disrupting chemicals) go through menopause earlier than women who have less exposure. It gained a lot of media attention because several of the toxic chemicals I found in my study are common in makeup products. A more recent study highlighted the continued importance of addressing this issue in women’s health and prompted this post.
This group evaluated the top beauty brands for each type of makeup and found 1322 ingredients. They then went on to summarize the evidence suggesting the association between each of these chemicals and menopause. Most of the chemicals they found are absorbed through the skin, meaning that all these chemicals are entering our bodies each day. Although the group admits there aren’t enough studies to show a direct link between cosmetics use and menopause, I think it’s enough to have me question what I’m being exposed to on a daily basis and how it’s going to impact my health.
Even though you may be far from menopause, I think it is still important for you to consider how chemicals that you’re exposed to can be impacting your ovaries. Women who go through menopause early are likely to have a shorter fertility window, meaning that they may use up their eggs at a faster rate than someone else their age. In the fertility world, this can translate to women who respond less to medications or are less successful with their use of assisted reproductive technology compared to others their age.
As a woman, as a mother, and as a fertility specialist, my first response to learning how many chemicals we are exposed to daily was disbelief: Why aren’t we protected as consumers from these potentially toxic chemicals? Why are they still exposing people to these toxic chemicals? Although the Food and Drug Administration monitors the chemicals that go into food and drugs, cosmetics are not subjected to the same regulation. Here are a few things that we can do to protect ourselves by limiting the numbers of chemicals we are exposed to daily.
Take home points:
- Women are exposed to 1000s of toxic environmental chemicals each day.
- Some of the chemicals found in makeup have been linked to health problems, including earlier menopause
- Physicians and patients need to do a better job learning about the risks to their health so that they can make more informed choices in selecting their personal care products
- What you can do:
- Limit the number of personal care products you use. For example, try to limit to one type of shampoo to minimize the exposure to multiple chemicals.
- Avoid any personal care items that have fragrances or scents.
- Read labels and support companies that disclose what their ingredients are and support their efforts to remove those that are not necessary or are suspected to be unsafe.
- Be an informed consumer: know what you are being exposed to. Here is a list of great resources.
The impact of lifestyle upon male fertility is very difficult to study and therefore rarely gets much scrutiny. In previous posts, I have referenced studies on how healthy sleep and melatonin levels impact egg quality. Now we have a new study that found that men that sleep less than 6 hours per night or more than 9 hours per night seem less fertile than those within the 6 to 9 hour time range. Although further research would be needed to confirm the validity of this study, it could be that sleep is impacting your ability to conceive with your partner.
Writing about nutritional choices is tricky. One author recently compared our dietary choices as being like our own personalized religion. We’re all born into certain dietary patterns. Then as we grow, we either accept or modify these choices based upon our own belief as well as our own personal preference. Unfortunately today, many of the fad diets are like dietary cults—people not only want to make their own choice but they encourage others to embrace their decision as well. Unfortunately, most of these popularized diets are based upon scientific rhetoric. They often use encouraging language and small bits of science (often taken out of context) to try to create a compelling message. They want you to join them. As a scientist and a as a physician, I find this troubling because it often has a negative impact upon the care of my patients. For example, let’s consider gluten.
Gluten is a combination of proteins found in wheat, barley, rye, oats and various other grains. It has become a very prominent part of our diet because these proteins help dough to rise and retain their shape in baked goods. Although gluten has been vilified by some recent nutritional gurus; many foods that contain these proteins have major health benefits. These whole grain foods are attributed with a lower risk of developing obesity, diabetes, heart disease and various types of cancer. It is estimated that about 1-2% of us may have a true allergy or autoimmune disease (Celiac disease) as a reaction to these proteins. So let’s consider the possible health benefit for the other 98% of the population.
Gluten is also a prebiotic. Prebiotics are the nutrients necessary to help the healthy bacteria thrive within your body. A common reason that many people today are taking probiotics is because their diet is not providing these healthy bacteria the nutrients that they need to survive. However, taking a probiotic is not sustainable without feeding these healthy bacteria so they can thrive. There is also evidence that gluten can be an immune booster.
Natural Killer cells (NK cells) are part of your body’s immune system. Despite their ominous sounding name, they serve a sort of security role. They are responsible for identifying and eliminating dangerous invaders like virus infected cells and potential tumor cells—they keep you healthy. Ironically, they also serve a critical role in promoting pregnancy. When functioning properly, they enhance the ability of an embryo to implant and thrive. New studies are now demonstrating that gluten can actually facilitate healthy NK cell activity. Whatever the reason, there is convincing evidence that gluten containing whole grains are associated with higher pregnancy rates in patients that are trying to conceive.
Patients undergoing IVF provide a unique opportunity to study interventions in a closely monitored setting. Recently, the impact of eating whole grains was investigated at Harvard University as part of the Environment and Reproductive Health (EARTH) study. In this study they were tracking whole grain content by following the diets of women going through IVF treatment. They found that women that were eating more whole grains had a higher pregnancy rate and a higher live birth rate (53% vs. 35%) than those eating little or no whole grains. In fact, at least one serving per day of a whole grain food was able to boost the odds of success by about 33%. Another recent study that was looking at comprehensive dietary patterns and success during Advanced Reproductive Treatment (ART) found that women eating whole grain cereals had about a 30% greater chance of fertilization and early embryo development and an almost a 60% greater chance of becoming pregnant. Finally when researchers measured the urine for a marker of whole grain food consumption in a healthy population of fertile women they found that those eating more gluten containing foods took fewer months to conceive naturally. Taken together, it seems that we should encourage women that are not truly allergic to gluten to eat more whole grain as part of their fertility boosting diet.
We’re all frightened by what we don’t understand. Many infectious diseases feed in to that fear. Consider for example the recent media frenzy over Ebola Virus; then again over Bird Flu and then more recently over Chikungunya—all of which have died down without the nightmare scenarios coming to fruition. Now we’re focusing on Zika virus. This is admittedly scary due to its possible link to birth defects in babies born in Brazil. So let’s review what we know, what we don’t know AND what we can do in the meantime.
Recently the Society of Maternal-Fetal-Medicine held a special session to review this important topic and provide updated advice and guidance for women’s healthcare specialists in the USA. Zika is a virus transmitted by mosquitos. Those developing a symptomatic infection during pregnancy may be at high risk of having a child with a birth defect known as microcephaly. Although this link has not yet been definitively established it is recommended that we provide very close surveillance of any suspected cases while additional information is gathered. Although this sounds scary here are some of the key facts to keep in mind:
- Only 1 in 5 people bitten by an infected mosquito is likely to develop an infection
- Those infected have pretty specific symptoms including sore joints, a rash and conjunctivitis (red, swollen areas around the eyes)
- The infection will appear within one or two weeks of the mosquito bite
- The current test available is nonspecific and can create concerns due to false-positive results (a positive test due to a related virus that has not been linked with birth defects)
- The Center for Disease Control and Prevention is monitoring places in the world known to have active Zika transmission for travelers and advising those that are pregnant or planning pregnancy to avoid traveling to those locations
- Meanwhile, alternate causes of the fetal malformations are being investigated including a possible link to an insecticide widely used to control mosquitos in the area of Brazil most heavily effected by fetal microcephaly
Clearly we need to learn more about the Zika virus. In the meantime, here is some practical advice for patients that want to become pregnant:
- If possible avoid traveling to areas effected by Zika for at least one month prior to starting fertility treatment
- During mosquito season (as well as while traveling to effected areas) consider the following protective steps
- Wear long sleeves when possible and stay in air conditioned facilities (rather than using open windows for cooling
- Use insect repellants to reduce the risk of mosquito bites. Here are two that are among the safest (and least toxic) for women trying to conceive:
- If you live in an area with a high rate of Zika virus exposure, consider undergoing fertility treatment and freezing the embryos for delayed embryo transfer–a process known as embryo banking.
- If you develop the symptoms of rash, joint pain and red eyes, contact your healthcare provider to discussed current recommendations on testing.
- Stay informed. If you subscribe to this blog, I will do my best to remain current on this topic.
For the latest updated information from the CDC on this emerging problem, check out the following link: http://www.cdc.gov/zika/
Latest Update 02/29/2016: “It’s entirely possible there’s something else going on in Brazil — something unique to the population or environment in which transmission takes place.” – Dr. Anthony Fauci, Direct of National Institute for Allergy and Infectious disease