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A Healthy Lifestyle

IMPORTANCE OF HEALTHY LIFESTYLE FOR REPRODUCTION
HEALTHY LIVING AND REPRODUCTION
Extremes in weight, either too thin or too heavy seem to impact on a woman’s fertility (BMI greater than 35 or less than 19), and weight loss in obese women has been shown to improve fertility. Maintaining an optimal weight will require a combination of regular exercise and proper dietary choices. According to the Canada Food Guide and Dietary Guidelines for Americans, a healthy eating plan includes an emphasis on:

• Fruits, vegetables, whole grains and fat-free or low-fat milk and milk products.
• Lean meats, poultry, fish, beans, eggs, and nuts
• Low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
• Stay within your daily caloric needs

There is little scientific evidence that specific diets improve fertility, however diets high in seafood are associated with high mercury levels and reduced fertility. We do recommend that all women take folic acid supplementation as outlined below.

FOLIC ACID
Scientific data confirms that folic acid (FA), a common B vitamin, reduces the risk of serious defects of the central nervous system of the developing fetus called neural tube defects (NTDs). These conditions include anencephaly, a condition where large portions of the brain, skull and scalp are absent; and spina bifida, which results in malformations of the spinal cord due to a portion of the spinal canal failing to close properly.

The use of FA supplementation, between 0.4 mg and 1.0 mg, has been shown to reduce the risk of problems by 50%. It is recommended that those women who are wishing to become pregnant start taking the supplement during the 2 to 3 months preceding any attempt at conception, and to continue throughout pregnancy. The recommendation from the Society of Obstetricians and Gynecologists of Canada (SOGC) is that women with pregnancies at high-risk for NTDs require increased dietary intake of folate-rich foods (dark green vegetables and pasta) and 5 mg of FA daily. Risk factors include epilepsy, insulin-dependent diabetes, obesity with BMI>35 kg/m2, family history of NTD, and belonging to a high-risk ethnic group (e.g. Sikh).

ALCOHOL AND REPRODUCTION
Alcohol and Fertility

The impact of alcohol consumption on fertility has not been clearly established but some large study surveys suggest that moderate use (up to 2 drinks per day) may actually improve fertility, particularly the drinking of wine.

Alcohol and Pregnancy

Simply stated, there is no safe amount of alcohol use in pregnancy, or safe time to use it while you are pregnant, or potentially pregnant. All types appear to be equally harmful, including wine and beer. Alcohol quickly passes into the fetus via the placenta and is associated with miscarriage, stillbirth, and a range of physical, intellectual and physical disabilities in the child called fetal alcohol spectrum disorders (FASDs). FASDs may include:

• Abnormal facial feature such as a smooth ridge between nose and upper lip
• Small head
• Short, small child
• Poor coordination
• Hyperactivity and attention deficit
• Poor memory
• Learning difficulties, particularly with mathematics
• Speech and language delay
• Low IQ
• Poor judgment and reasoning
• Sleep and sucking difficulty as an infant
• Visual and hearing impairment
• Organ problems, including heart, kidney and bone

Alcohol use early in pregnancy (first 3 months) can cause facial abnormalities. Since the brain and body develop throughout pregnancy, alcohol use at any time can cause growth and neurologic problems.

Advisory on Alcohol Use in Pregnancy

MEDICATIONS IN PREGNANCY
It is important that you review all medication use with your PCRM medical team. This includes prescriptions, over-the-counter medications, as well as dietary or herbal products. Please be aware that little is known about the effects of most medications in pregnancy, because pregnant women are often excluded from safety studies for new pharmaceuticals. In fact, fewer than 1 in 10 medications approved by the Food and Drug Administration in the United States have been adequately studied for birth defect risk.

Certain medications have well know effects on the unborn child (eg. Thalidomide (Thalamid®) and isotretinoin (Accutane®). There are a number of online resources to help guide you in the use of medications, however there are a number of factors to consider before using. These include the dose, timing in pregnancy, the condition being treated and other medications that you use.

IMPORTANT LINKS
Mother Risk
The Organization of Teratology Information Specialists (OTIS)
LactMed
Treating for Two – Center for Disease Control and Prevention

SMOKING AND REPRODUCTION
Despite well documented and recognized health risks, over 25% of reproductive age Canadians smoke cigarettes. In addition to the harmful effects of tobacco on general health, many studies have demonstrated the detrimental effects of smoking on both a man and woman’s fertility, and during pregnancy. Cigarette smoking by either partner delays the time to natural conception with the delay proportional to the amount smoked. Second-hand smoke also reduces fecundity in women with an effect only slightly less than that of active smokers. As such, if a woman’s partner smokes this will adversely affect her fertility.

Effects on the Ovary

Various chemicals inhaled in cigarette smoke are toxic to the ovarian follicle (the functional unit containing the egg). Menopause, which marks the complete loss of ovarian function, occurs almost four years earlier in smokers. Women who start smoking during adolescence are three times more likely to have menopause before the age of 40, over ten years earlier than average.

Effects on Sperm

Virtually all common measures of sperm quality have been shown to be reduced in smokers. Sperm counts are reduced by about 25%, the ability of sperm to move (motility) is significantly reduced, and the numbers of abnormally shaped sperm are increased. Laboratory measures of a sperm’s ability to penetrate and fertilize the egg are also reduced.

Effects on Pregnancy

Reactive by-products of cigarette smoke bind and alter genetic material within both sperm and eggs. Resulting mutations can be passed on to the embryo and increase the risk of early pregnancy loss. Tobacco also contains nicotine, carbon monoxide, and cyanide which are all chemicals that deprive the growing fetus of vital blood and oxygen. Most studies show a clear connection between smoking and miscarriage.

Impact of Smoking on In Vitro Fertilization (IVF)

Compared to women who do not use tobacco, smokers have only about one half the chance of pregnancy with an IVF cycle. Several toxins present in tobacco smoke have been isolated in high levels within the fluid of the ovarian follicles of smokers. Compared to nonsmokers, women who smoke have fewer eggs produced and require more stimulation medication. Some insurance companies in the U.S. will not pay for IVF in smokers, and require urine testing as proof of non-smoking status.

Given all the detrimental effects of smoking on reproduction, smoking cessation is a powerful first step to improve the chances of conception and having a healthy pregnancy. More information available through Health Canada: Tobacco Use

CAFFEINE
Moderate caffeine use (up to 3 cups of coffee/day) appears to have no negative effects on fertility, pregnancy, or the risk of birth defects. Greater than 3 cups per day in pregnancy has been associated with miscarriage and greater than 5 cups per day may decrease fertility.

SUMMARY OF OUR RECOMMENDATION BEFORE STARTING TREATMENT/PREGNANCY:
• Maintain a healthy weight with a combination of exercise and proper eating habits
• Folic acid supplementation starting at least 3 months prior to conception
• Moderate your alcohol use prior to pregnancy (up to 2 drinks per day)
• NO alcohol use during pregnancy
• Report any medication use, or chronic exposure to environmental and workplace toxins with your physician
• NO smoking before or during pregnancy
• Moderate your caffeine intake (up to 3 cups per day before and during pregnancy)
• Control and chronic medical conditions and ensure that a plan is in place for pregnancy
• Ensure that your immunizations are up-to-date

“THE EASIEST METHOD TO IMPROVE THE OUTCOMES FOR PREGNANCY AND CHILD IS KEEPING MOM HEALTHY.”
DR. JEFF ROBERTS

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