Lifestyle Changes to Improve Fertility

Smoking
If either partner smokes, you must stop. Smoking has been shown in numerous studies to affect fertility in both men and women. Infertility is much higher in couples if either partner smokes. In men, smoking affects sperm production and function. In women, it affects the eggs resulting in poorer egg quality and makes the eggs more difficult to fertilize by the sperm. Women who smoke go through menopause earlier than women who don’t smoke. Studies have shown that in vitro fertilization success rates are significantly lower in couples that smoke.

Alcohol
Studies have shown that alcohol affects sperm production and function. We recommend that couples limit their alcohol intake. Recommendations are less than three to four drinks per week. Alcohol can lead to birth defects if consumed during pregnancy. Women should not drink alcohol if they think they may be pregnant or are trying to become pregnant.

Caffeine
No studies have linked caffeine to infertility although it is generally thought that greater than 250 mg/day can delay conception. One cup of coffee contains approximately 115 mg of caffeine. Caffeine consumption significantly increases the risk of miscarriage. Three cups of coffee daily increases the risk of miscarriage by two-fold.

Illegal drugs
Marijuana, cocaine and other drugs lead to infertility in both men and women. Drugs can also lead to birth defects. Stop using any drugs before attempting to conceive. Do not use any illegal or non-prescribed drugs during pregnancy.

Environmental exposures
Exposures to chemicals in the dry cleaning and printing industries, heavy metals (lead, mercury), herbicides, fungicides, pesticides, paint, oil and fuels can increase the risk of infertility and miscarriage. Avoid exposure to these substances and wear protective clothing when exposure cannot be avoided (e.g., pants, long sleeves, gloves, masks).

Prescription medications, over-the-counter medications and herbal supplements
Women should talk to their doctor about any medications they are taking. Some medications lead to birth defects and should be stopped before conception including Accutane, seizure medications, some antibiotics, some psychiatric medications, and Ibuprofen (Motrin, Advil) should be avoided around ovulation time. These medications may interfere with ovulation in some women. You can use Tylenol for discomfort anytime of the cycle and it will not affect fertility. Some herbal supplements have animal gland extracts (pituitary extracts). Do not take these drugs. Other supplements may have estrogen like actions in the body (e.g., saw palmetto, primrose oil, black cohash, chasteberry, dong quaii, St. John’s wort, and ginseng, which is often contaminated with lead). Both men and women should avoid these products.

Men should also discuss medications they are taking. Some prescription medications and over-the-counter medications can affect sperm production and function. These include: testosterone, DHEAS, DHEA, Androstenedione, other body building steroid hormones, Pepcid, Benadryl, Spironolactone (Aldactone), cimetidine (Tagamet), prostate cancer medications (Flutamide, Nilutamide), Ketoconazole (Nizoral), Digoxin (Lanoxin), and chemotherapy. Other medications may lead to decreased libido or erectile dysfunction including antidepressant medications and agents to prevent hair loss e.g., Propecia.

Exposure to heat
Some studies have shown that frequent exposure to hot tubs, saunas, etc., can decrease sperm production in men. With regard to undergarment selection in men, no studies have shown that boxers have any advantage over briefs, although it is common myth to avoid briefs when trying to conceive.

Dryness with intercourse
Avoid K-Y jelly, Astroglide or other agents for lubrication with intercourse (these agents can adversely affect sperm function). An agent that has shown to be better for sperm function is called Pre-Seed. It can be found at most local drug stores.

Timing of intercourse
Long periods of abstinence will decrease sperm motility. The sperm count may be higher, however, there will be a higher number of nonfunctional sperm. Intercourse every other day around the time of ovulation is generally adequate for most couples. Some couples may benefit from longer periods of abstinence (i.e. three days). Please discuss this issue with the staff if you are concerned.

Prenatal screening
Prenatal screening is available for some inherited and acquired conditions.

1. Cystic fibrosis (CF) is a disease that leads to problems with growth and severe lung disease in children. One of 25 Caucasians is a carrier. A screening test (blood test) is available that looks for the most common causes of CF. Both the male and female must be carriers for a child to be affected. The chance of having a baby with CF is one in 2,500 in the Caucasian population. We can screen the female and if testing is negative, the chance of being a carrier of CF is much lower. However it is not zero, as this is a screening test, and not all the gene mutations associated with CF have been identified.
2. Rubella is a virus. Most Americans are immunized to rubella in the form of an MMR (Measles, Mumps, Rubella) in childhood. Many college students are also immunized. Pregnant women who are not immune to Rubella can become infected. Rubella may result in deafness and other problems in the baby. We can check to determine if you are immune to rubella with a blood test. If you are not immune, you should receive a vaccine and delay conception for one month.
3. Sickle cell anemia is a disease that affects African American patients. Please request testing if you are concerned (blood test).
4. Patients of Eastern European Jewish descent may want to consider testing (blood test) for cystic fibrosis, Tay-Sachs disease, Canavan disease, and familial dysautonomia. These are inherited diseases that have a higher incidence in the Ashkenazi Jewish population.

Exercise
Moderate exercise is good for everyone. Thirty minutes three to four times weekly is adequate. Strenuous exercise can affect fertility. Runners who are training at 20 miles a week will likely experience decreased fertility or other athletes who are competitively training may see an impact on their menstrual function and fertility.

Weight
Weight affects fertility. Women who have a body mass index (BMI) less than 20 or greater than 25 will experience decreased fertility. A BMI of less than 20 is considered underweight. A BMI of between 20 and 25 is considered normal. A BMI greater than 25 is considered overweight. A BMI greater than 30 is considered obese. Sixty-two percent of American women are overweight and 33 percent are obese. You can talk to our staff to determine your body mass index. Women with an increased BMI do have an increased risk of miscarriage and increased risks during pregnancy including gestational diabetes, hypertension, preeclampsia, large for gestational age infants and cesarean delivery. We can refer you to a nutritionist and help you get started in an exercise program to improve your overall health. This will also increase the likelihood of conception and result in a healthier pregnancy and healthier baby.

Nutrition
It is important to eat healthy when trying to conceive and to continue eating healthy during pregnancy. It is important to eat five to eight servings a day of fruits and vegetables. Choose whole grain foods i.e. wheat bread instead of white bread, whole-wheat pasta instead of regular pasta, brown rice instead of white rice. Choose lean meats like chicken and turkey when possible. Monitor portion size and avoid highly processed foods including pre-made TV dinners, chips, crackers and cookies. If you would like a referral to a nutritionist please ask.

Holistic therapy options
Some studies have shown improvement in fertility with patients who elect to use holistic therapy including massage therapy, acupuncture and relaxation therapy in addition to their fertility treatments. We do work with practitioners in these areas and can direct you to additional treatment if you are interested. Please ask if you are interested in a referral.

General health
It is important to have a normal Pap test and physical exam. Female patients over the age of 35 should consider having a mammogram prior to conception. Women over the age of 40 should definitely have a mammogram prior to conception. You can schedule these with your regular doctor.