6 Steps to Increased Fertility : An Integrated Medical and Mind/Body Program to Promote Conception

Book by Barbieri MD Robert L Domar PhD Alice D Loughlin M

STEP 1

Begin Making Healthy Lifestyle Changes Today

If you are thinking about getting pregnant, you can do many simple, effective things right now to improve your chances of conception, because lifestyle can have profound effects on the reproductive functions of women and men. This means that increasing your fertility potential is something that you both can do without outside help: you can adopt healthy ways of eating, you can eliminate habits that may diminish fertility, and you can make sure your weight is within the range that's conducive to starting a pregnancy.

Think of this as a wellness program: Like an athlete, you'll be training for optimal performance. Not only can you enhance your prospects for a pregnancy, but as healthy parents you will be better prepared for the physical work of raising a child. Here are some simple strategies to pursue right now.

Keep Your Exercise Moderate

Women and Exercise

Getting enough exercise is an important part of helping your body to function well. But some women do so much exercise that it can be counterproductive, especially as far as fertility is concerned. A Harvard study by Dr. Rose E. Frisch examined the health of over 5300 women who had been athletes in college and found that strenuous or elite-level exercise appeared to impair fertility, which was often demonstrated by a lack of menstruation and ovulation. The most obvious indication that you are exercising too much if you want to become pregnant is having light or irregular periods or none at all. Professional or dedicated women athletes who want to have a baby need to cut back to much less strenuous levels of exercise or stop their workout programs altogether.

For the woman who already is experiencing infertility, Dr. Alice Domar and her colleagues at the Harvard Mind/Body Program for Infertility recommend that although giving up all exercise can be difficult for a woman who is concerned about weight gain or is used to exercising vigorously, she stop all exercise for three months to make sure exercise isn't a factor. Even when menstruation and ovulation appear normal, exercise can cause a decrease in progesterone levels that might prevent an embryo from implanting. Dr. Domar has seen a number of pregnancies result when women stopped exercising. Stretching routines, yoga, and relaxed strolls (under two miles) are good tension reducers and can be useful substitutes for vigorous exercise. A yoga program should be supervised by someone familiar with the effects of infertility treatments on the body.

Drs. Kevin Loughlin and Robert Barbieri, however, feel that a simple reduction in the number of miles women (and men) run or bicycle or in the hours they spend working out is sufficient to overcome most exercise-related fertility problems. Since exercise can affect body fat and a person's body mass index (BMI), its effect on fertility is difficult to sort out.

LILLIAN'S STORY

In her job as a supervising chef at a well-known restaurant, Lillian was on her feet for eight to ten hours a day, with little opportunity to relax. "Our food had to be amazing, day after day, because we had a reputation to maintain. Something often goes wrong. It was exciting but demanding." In addition, Lillian ran for recreation and to keep fit. At five feet eight inches, she liked to keep her weight at 120 pounds. When she started attending the Mind/Body Program for Infertility, she had been trying to get pregnant for two years and the cause of her infertility couldn't be explained. She was thirty-three years old.

When she learned about the possible connection between too much exercise and infertility, Lillian slowed down. She gave up running and walked more slowly at work. As part of her effort to take life more easily, she also practiced the relaxation routines and meditation exercises taught in the program. "Overall, I became much calmer. For a month I gave up trying to get pregnant. I relaxed about everything, I didn't worry about when to have intercourse -- and I got pregnant in six weeks. It was entirely unplanned." She now has a less demanding job and takes care of her baby.

Men and Exercise

Men can work out more than women without adversely affecting their fertility, but many research studies have found that high levels of exercise and endurance training can lead to a decrease in testosterone levels, negatively affecting libido and sperm health. Furthermore, men who are extremely lean can also experience marked drops in their testosterone levels, and may lose their interest in sex and their ability to have erections. Long-distance runners and scullers trying to keep to a lighter weight are examples of men who may experience infertility because of a combination of high-level exercise and lean bodies with little fat. These effects can be reversed with a modest weight gain.

We also should mention that over fifty miles a week of bicycling on a hard, narrow seat may lead to impotence. Studies have shown that sitting for long periods on such a seat can flatten the artery that controls blood flow to the penis. This type of bicycle seat may also cause nerve damage. Impotence specialists recommend switching from a solid seat to a type that has an oval opening built into the saddle. Various seats are available at bike stores.

Eat Well

An important influence on fertility is attaining a level of good nourishment that permits your body to function as it should. Bad eating habits can reduce the reserves of nutrients necessary for reproductive hormone systems to work properly. Inadequate nutrition also may weaken your immune system to the point where any sickness might diminish your fertility. This isn't just a woman's issue; men who don't get enough of certain vitamins and minerals may have low sperm counts and low testosterone levels.

It's important to eat regular, adequate meals -- at least three a day -- and to choose foods that are rich in nutrients and low in fat. And we recommend that you have one or two nourishing snacks every day as well. Good snacks help you avoid the temptation to reach for empty-calorie foods high in fat and sugar.

Eat More Fruits and Vegetables

This is the time to heed nutritionists' advice about stepping up the number and variety of fruits and vegetables you eat every day -- currently the recommendation is five to eight servings per day. That may sound like a lot, but one serving can be as little as a couple tablespoons of raisins or a handful of fresh peas or grapes.

If you're not an enthusiastic vegetable/fruit eater and want to make each serving count the most, every week eat at least several dark green and orange/yellow vegetables such as Swiss chard, kale, sweet potatoes, and carrots, as well as red, orange, and yellow fruits. Deep-colored foods tend to have more nutrients. For instance, pink grapefruit has more nutritional value than white grapefruit, and watery-but-red watermelon is surprisingly nutritious.

GOOD HEALTH TIP

To make salads more nourishing, use lettuces such as romaine, Boston, or greenleaf (iceberg lettuce is not rich in vitamins) and include fresh spinach. Real time-savers are the lettuce mixes sold by most supermarkets. Because they contain a variety of greens, both flavor and vitamin content are better. For a change of pace that's quick, toss a leafy salad with a minimum of low-calorie dressing, and add several slices of ripe pear or mango to each serving. This looks elegant and tastes delicious.

A word about salad dressings: If you can wean your family from their favorite bottled dressings, it's cheaper and usually lower in fat and calories to mix a jar of your own. Do as Europeans do and toss the entire salad with just 1 or 2 tablespoons (or less) of dressing to barely coat the leaves so that the taste of the greens comes through.

Salad dressings taste better if they're made a day or two (or more) beforehand, well mixed, and stored in the refrigerator. Or mix your dressing right in the salad bowl as you start dinner preparations. Try crushing a garlic clove, then adding two parts olive oil, 1/4 teaspoon of Dijon mustard, one part wine or cider vinegar or lemon juice, a drizzle of honey, and pepper to taste. Letting the dressing warm up to room temperature 30 to 60 minutes before tossing it with the greens enhances its flavor.

Although vegetables provide much of the vitamins, minerals, and fiber you need, if you are a vegetarian and are trying to improve your fertility, be sure that you're getting enough protein. Women who are vegetarians may have fertility problems because they have skewed levels of reproductive hormones: they metabolize estrogen into inactive products more quickly, and have longer menstrual cycles than women who include meat in their diets. Moreover, you are much more likely not to menstruate if you are both a runner and a vegetarian.

GOOD HEALTH TIP

One of the easiest ways to get enough fruit and vegetables is to use them as between-meal snacks. Supermarkets sell packages of baby carrots, cherry tomatoes, and assortments of bite-size pieces of melon that are easy to pack along to the office or to nibble on while watching TV. You can spend a few minutes cutting up broccoli and cauliflower or else buy a small vegetable party platter from your supermarket and use it for salads and snacks all week. (To wash away insecticides and other possible contaminants, thoroughly wash all precut vegetables and salad greens in water, add a few drops of dish detergent, then rinse well, before eating.)

To make a good accompaniment for fresh and cooked vegetables, add fresh dill, other herbs, or garlic powder to plain yogurt. And simply adding fresh spinach or slices of fruit to salads dramatically increases their nutritive value.

Snacks Can Be Good for You

Don't be afraid to eat snacks between meals. Choose snacks that are low in fat and salt, taste good, and make you feel satisfied, so that you can override any yearnings for high-sugar, high-fat foods. Keep several on hand for those times when your energy is flagging or you have the greatest cravings for junk food. See the box that follows for ideas for between-meals foods.

To make a snack more satisfying, combine carbohydrate foods with protein foods. If you don't want to gain weight, check the portion size and calorie amount listed on the food label to help you determine how big a snack to eat.

Snacks are also more satisfying if you eat them slowly and mindfully. Be aware of how much you're eating, how full you feel, and how it tastes. Avoid eating while you're doing something else to lessen the risk of thoughtless munching. Serve yourself one portion and put the rest of the food away. When you're very hungry and preparing a meal, nibble on chunks of raw vegetables such as sweet red or green peppers, cucumbers, or celery instead of reaching for potato chips. A more nutritious substitute for chips are whole-grain crackers such as Wasa Crispbreads, Kavli, Finn Crisp, whole wheat matzos, and Whole Foods Baked Woven Wheats.

Food Supplements Help

In addition to eating a fruit- and vegetable-rich diet, both men and women should take a multivitamin/mineral supplement. Taking a single multivitamin/mineral tablet avoids the danger of taking too much of one vitamin or mineral. Megadoses of vitamins should be avoided, especially if they're fat soluble. Fat-soluble vitamins, such as vitamin A or vitamin D, are not readily excreted and can build up to toxic levels in your body, a particular concern if you're trying to get pregnant. This doesn't mean you should avoid these important vitamins, but just be sure not to take doses that are over the federal recommended daily allowance (RDA) without the advice of a nutritionist or doctor. RDAs are listed on the labels of vitamin bottles.

WARNING: LIMIT YOUR VITAMIN A

At any time it's wise not to take too much vitamin A, but this is especially important when you are expecting to have a child. A study of 22,000 women showed an apparent increase in the number of birth defects when pregnant women took over 10,000 international units (IU) of this vitamin. To be on the safe side, nutritionists recommend you choose a multivitamin that contains only 5000 IU of this vitamin. This allows you to also eat a lot of foods every day that are rich in this vitamin and in beta carotene, its precursor.

Folic Acid. A woman hoping to get pregnant should take a daily supplement that includes at least 400 micrograms (mcg) of folic acid. Folic acid is a synthetic form of folate (one of the B vitamins), and is now available in most multivitamin/mineral tablets and as a supplement in a few food products. Folic acid helps prevent anencephaly and spina bifida, birth defects of the brain and spinal cord, respectively. It's vital to have enough of this vitamin in your body before you conceive as well as afterward because such defects can occur within the first thirty days after the egg is fertilized. (It's also important, however, not to take more than 1000 mcg of folic acid unless your doctor or other health care provider clearly advises it.) Although you can get folate from foods, it is only half as available to the body as folic acid. The simplest approach may be to get the recommended minimum of 400 mcg every day in a multivitamin and think of the folate in foods as a bonus.

Calcium. During their reproductive years (and afterward) women also should consume about 1200 milligrams (mg) of calcium every day. To get that much, you will need to eat or drink at least three 8-ounce servings of dairy products, such as low-fat or nonfat yogurt and milk, or healthy fortified foods such as calcium-fortified orange juice. Read the product labels -- they list serving size and the amount of calcium per serving.

If you can't eat enough calcium-rich food every day, a good way to make sure you're getting enough of this important bone preserver is to take a supplement. Calcium carbonate, calcium lactate, calcium citrate, or calcium citrate malate all are good, readily digested supplements. They are best absorbed when taken with a meal in doses of 500 mg or less. If you can't take your supplement with meals, calcium citrate is the form most easily digested on its own. Check the labels to make sure the form you buy is low in lead. Calcium derived from bonemeal or oyster shells can contain higher levels of lead. At all ages, everyone, male and female, should consume at least 1000 mg of calcium every day.

Zinc. Men, too, may benefit from taking a daily multivitamin supplement, particularly one that contains the RDA of zinc, which some researchers found is associated with the production of healthy sperm. An adequate level of zinc in the body is needed for the testicles to function normally. A deficiency in this important mineral also may decrease libido and contribute to impotence, probably by reducing testosterone levels. Other studies have found that a lack of zinc can reduce sperm count; however, the benefit of oral zinc on male infertility is still uncertain.

Increase Your Body Fat

For a change, this is not a suggestion to lose weight, unless you are very overweight. Like too much exercise, being too thin can delay puberty or slow down or stop menstrual periods entirely. To be able to reproduce, you must store a minimum amount of body fat. Teenagers need to have a certain amount of body fat in order to start having periods. A decrease in body fat can cause menstruation to stop. Women whose body mass index is below 17 are more likely to find that their periods have become further apart, are light, or have stopped,...