Patient’s Factsheet – optimizing women’s fertility.

Weight

Ideally, aim to keep your weight between a BMI of 19 and 24 kg/m2 because a BMI outside these limits has been linked to subfertility, poor IVF outcomes, and miscarriages.

If you need to lose weight regular exercise (minimum 30 min of moderately intense exercise at least three times a week) and low calorie diet (1000 – 1200 kcal/day) is recommended.  However, low calorie diets are hard to implement and stick to.  The Fast Diet, which suggests two low calorie days per week, has been very successful for many of my patients.  Low-carb diets have been found to be very successful, especially for sufferers of PCOS, but also for anyone wanting to lose weight.

Please bear in mind though that losing weight while undergoing reproductive treatment is not recommended.

Smoking

Smoking or inhalation of second-hand smoke is harmful to fertility:

• smoking increases the risk of ectopic pregnancies
• smoking increases the risk of miscarriage
• smoking reduces IVF success rates
• smoking reduces the reproductive life span by one to four years
• smoking is linked to birth defects in the children of parents who smoke.

It is evidently essential to stop smoking and to avoid exposure to second had smoke.  Speak to your acupuncturist and/or family doctor if you need help with smoking cessation.

Alcohol

The research evidence on the effects of moderate alcohol intake and subfertility is at present mixed.  Some studies suggest a detrimental effect with just one unit of alcohol a week, other studies have found a detrimental link with intakes of 7 – 14 units, and some have found no detrimental association.  One large study found that women who consumed half to two units of alcohol a week conceived a little sooner compared with women who drank no alcohol.  Therefore, it is probably not detrimental to have the occasional glass of wine.  However, avoid binge drinking.  Avoid alcohol completely in pregnancy.  Speak to your acupuncturist and/or family doctor if you need help with reducing your alcohol intake.

 Caffeine.

Many authorities consider that drinking caffeinated drinks such as coffee, tea, cola may reduce fertility and be linked to miscarriage.  NICE currently say that the evidence doesn’t suggest this but I feel it would be wise here to err on the side of caution.  Either avoid caffeine entirely or limit yourself to 1 – 2 cups of caffeinated drinks a day.

Recreational drugs.

The use of recreational drugs is strongly linked to subfertility.  If using drugs, speak to your GP or acupuncturist who may be able to advise you on how to give up.  The information will be treated in a highly confidential manner.

 Prescription and over-the-counter medication.

These may affect your chances of conception and cause miscarriages or birth defects.  Always check with your doctor or pharmacist if your medication is safe to take when trying to conceive or during pregnancy.    Non-aspirin nonsteroidal anti-inflammatory medication such as diclofenac, naproxen, celecoxib, ibuprofen, or rofecoxib has been linked to increased risk of miscarriage, even in small dosages.  Therefore, avoid taking this medication.  Never discontinue taking your medication without first checking with the doctor who prescribed it for you.

Environmental toxins.

Exposure to environmental toxins may affect reproductive health, although more research is needed to know exactly what types of chemicals are detrimental.  In the meantime, minimize your exposure to as many toxins as possible.  For example:

• Delay house decoration and renovations until after reproductive treatment is completed.
• Minimize the use of plastic containers, plastic food wrapping, and canned foods.
• Ideally, organic food should be eaten and fruits and vegetables washed to reduce exposure to pesticides.
• Whenever possible, natural cosmetics and cleaning products should be used.
• When preparing fish, trimming the fat, removing or puncturing the skin, and not frying may help to reduce exposure to chemicals and metals.
• Reduce exposure to chemicals at work.  Consider changing your job if exposure is unavoidable.

Nutrition.

A Mediterranean-type diet (with a high intake of olive oil, vegetables, fish and legumes) has been shown to reduce the risk of subfertility and improve conception rates following IVF.  Consuming a high carbohydrate diet increases the risk of impaired fertility because it interferes with ovulation.  Seek specialist nutrition advice if you feel you need help with your nutrition.  Your acupuncturist may also suggest other foods beneficial in your case, based on your acupuncture diagnosis.

Supplements.

Advice in this section is provided for general information only.  Always seek specialist advice from a nutritionist regarding specific micronutrients.

• Folic acid: take 0.4 mg/day for 3 months before conception.  a higher dose of 5mg/day is recommended for women who have previously had a baby with a neural tube defect, women who take anti-epileptic medication, and diabetic women.  Women with hyperhomocystinaemia (elevated homocysteine) should also take a higher dose of folic acid together with vitamins B6 and B12.  Good sources of folic acid include dark green leafy vegetables, fruits, nuts, beans, peas, dairy, poultry, eggs, seafood and grains.  The best sources of B12 are beef liver and clams, fish, meat, poultry and dairy.  There is some evidence that it may be better to take folic acid in its natural form of folate.
• Vitamin D: women who are pregnant or lactating should take a minimum of 600IU of vitamin D per day, but may require an even higher dose of 1500 – 2000 IU per day.  Do not take more that 4000 IU without medical supervision.  Spend as much time in the sun as possible because sunlight hepls the body to make vitamin D.  Food sources of vitamin D include fish-liver oil, oily fish, egg yolks and mushrooms.  It can be a good idea to get your vitamin D levels tested.  This isn’t routinely available via the NHS but can be ordered via the Zita West clinic.
• Iodine: it is recommended that all women who are trying to conceive should take 250 μg of iodine supplement in addition to eating foods rich in iodine (cow’s milk, yoghurt, eggs, cheese, white fish, oily fish, shellfish, meat, poultry).  Ideally, iodine should be taken a few hours apart from iron supplements.  If you have a diagnosed thyroid disease or take thyroid medication, you must check with your doctor regarding iodine supplementation.
• Vitamin A:  too much vitamin A may be harmful in pregnancy.  Avoid taking supplements high in vitamin A or foods rich in vitamin A (e.g. crustaceans and liver) from ovulation (egg retrieval) to the beginning of your next menstrual cycle and throughout pregnancy.
• Vitamin E:  doses 400 – 500 IU/day have been shown to improve the endometrial lining.  Foods naturally rich in vitamin E include nuts and seeds, avocados and olive oil.
• Omega 3:  DHA and EPA are two types of omega-3 that have been shown to have a beneficial effect on reproductive health.  Ensure that you consume at least 200 – 300 mg of  DHA plus EPA per day.  The best source of omega-3 is oily fish (salmon, sardines, herring).  Some nutritionists believe you should avoid fish high in mercury (e.g. swordfish) but others reassure that the mercury is bound to selenium.  Alternatively take a good quality fish oil, but not cod liver oil which is high in vitamin A.  Omega-3 can thin your blood.  If you take blood thinning medication such as aspirin or heparin (Clexane) speak to your doctor or nutritionist before increasing your omega-3 intake.  Flax oil is not a good source of EPA & DHA.  Minimise your intake of refined vegetable oils such as sunflower or rapeseed oil as these are rich in omega-6 (which works in ‘opposition’ to omega-3).
• Selenium:  if you have a history of recurrent miscarriages, selenium supplements may help to reduce the risk of further pregnancy loss, especially if you have high thyroid antibody levels.  Speak to a nutritionist to see if your are deficient in selenium.
• Iron:  women of reproductive age are at high risk of iron deficiency anaemia.  Ensure that you eat iron rich foods (good-quality organic red meat, canned oysters, turkey, lentils, kidney beans) and take an iron supplement if needed.  Do get your levels checked by your doctor – it is harmful to have high levels of iron.

Exercise

If you are overweight intensive exercise is likely to significantly improve your fertility.  If your BMI is normal moderate exercise is adequate.  If you are underweight ensure that you don’t over-exercise because this may lead to subfertility.

Stress

If possible, reduce your stress levels.  Engage in stress-reducing activities such as hobbies, mindfulness meditation, yoga, tai chi, walking in nature etc.  If you find it difficult to manage your stress levels, speak to your acupuncturist, who may be able to help.

Sexual Intercourse

If you and your partner have not been diagnosed with complete sterility you should carry on trying to conceive naturally.

Daily or every other day intercourse is most likely to result in conception.  Timing intercourse to the fertile window is necessary.  The most reliable methods of ovulation detection are fertile mucus days or E3g-based ovulation detection kits.  Speak to your acupuncturist for more advice on this.  Intercourse should be fun with emphasis on foreplay, visual stimulation, and high and prolonged arousal.