Want to improve your fertility? Start with lifestyle modifications
Infertility has been described as a devastating life crisis for couples, which can cause physical, mental and financial stress. Based on Canadian statistics from 2013, infertility affects roughly 16% of couples in the population. Our system is designed to react to sub-fertility or infertility, not being proactive about fertility. This information below, is from a couple of articles I wrote for Physiopedia, titled “Fertility” and “Can Physiotherapists Play a Role in Fertility?”
Lifestyle Factors Affecting Fertility
TOBACCO USE
has been associated with infertility, particularly if the female partner is using tobacco (1).
WEIGHT
increasing obesity is associated with decreasing spontaneous pregnancy rates and increased time to pregnancy (2)(3).
increased weight in both males and females has a negative impact on fertility (4)(5).
a prospective cohort study found that every 5 kg body weight increase is associated with a current duration of pregnancy attempt increased by 5% (6).
weight loss is advised for females with an elevated BMI because weight reduction aids in spontaneous conception in some studies and reduces the need for fertility treatment (7)(8).
the risk of unsuccessful in vitro fertilization (IVF) increases with increasing BMI and may be related to poor oocyte (egg) quality, ovarian function, endometrial quality, or a combination of these factors (9).
EXERCISE
vigorous exercises may have an adverse effect on fertility on females with a BMI <25 kg/m2, however, exercise has a positive effect on fertility with females who are overweight (10).
ALCOHOL INTAKE
moderate alcohol intake (<2 drinks/day, 1 drink = 10g of ethanol) in females and males does not appear to affect fertility (11)(12)
Abstinence at conception is recommended, because a safe level of pre-natal alcohol consumption has not been established
DIET
A couple of reputable resources for nutrition:
CAFFIENE
caffiene intake less than 200mg/day in both females and males does not seem to affect fertility (11).
STRESS
in a meta-analysis a small but significant negative associations were found between stress, distress and reduced pregnancy chances with assisted reproductive technology (13).
Fertility, Exercise, and Stress Management
The ultimate goal is to aid you in reaching your fertility goals and it is important that we are proactive regarding the breadth of issues that could affect fertility outcomes. Exercise, stress management, and weight management can play an important role in fertility. Exercise is a relatively inexpensive addition to “usual care” and can improve the outcomes of “natural” fertility and assisted fertilization.
In addition, exercise may aid in the mental health of clients during this challenging time. This can be a very stressful time, and techniques such as mindfulness meditation, deep breathing, guided imagery, and yoga can be promoted for stress management.
A physiotherapist can advise you and help to create a program to aid in your fertility journey.
A recent pilot study highlighting the potential effect of exercise on fertility:
A study conducted by Kiel et al. (2018), examined the effect of high-intensity interval training (HIIT) on women undergoing assisted fertilization through a pilot randomized control trial. Eighteen woman with a body mass index of over 25.0 kg/m2 were split into two groups: the control group “usual care” (n=10) and the intervention group “HIIT” (n=8). The first outcome measure was “ongoing pregnancy” and the second was “insulin sensitivity, reproductive hormones, oxygen uptake, and body composition.” The study concluded that HIIT significantly improved insulin sensitivity, VO2 peak, and abdominal fat. Furthermore, fertility outcomes may increase by improving insulin sensitivity and the regulating the hypothalamic-pituitary-adrenal axis, central obesity, as well as, cardiovascular fitness (7)(14).
Exercise therapy may be beneficial, however, this must be prescribed with caution in some cases as there may be an increased risk of ovarian torsion (15). The risk of ovarian torsion increases with the presence of an ovarian mass and increased ovarian size, and individuals actively going through assisted fertility therapy (ie. in vitro fertilization), which stimulates the ovaries, increasing their size (16)(17).
References:
1 5. Hughes EG, Lamont DA, Beecroft ML, Wilson DM, Brennan BG, Rice SC. Randomized trial of a “stage-of-change” oriented smoking cessation intervention in infertile and pregnant women. Fertility and sterility. 2000 Sep 1;74(3):498-503.
2 6. van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Burggraaff JM, Oosterhuis GJ, Bossuyt PM, van der Veen F, Mol BW. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Human reproduction. 2007 Dec 11;23(2):324-8.
3 7. Gesink Law DC, Maclehose RF, Longnecker MP. Obesity and time to pregnancy. Human Reproduction. 2006 Nov 9;22(2):414-20.
4 8. Ramlau-Hansen CH, Thulstrup AM, Nohr EA, Bonde JP, Sørensen TI, Olsen J. Subfecundity in overweight and obese couples. Human reproduction. 2007 Mar 7;22(6):1634-7.
5 9. Nguyen RH, Wilcox AJ, Skjærven R, Baird DD. Men's body mass index and infertility. Human Reproduction. 2007 Jul 17;22(9):2488-93.
6 10. Gaskins AJ, Rich-Edwards JW, Missmer SA, Rosner B, Chavarro JE. Association of fecundity with changes in adult female weight. Obstetrics and gynecology. 2015 Oct;126(4):850.
7 11. Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, Moholdt T. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ open sport & exercise medicine. 2018 Jul 1;4(1):e000387.
8 12. Özcan Dağ Z, Dilbaz B. Impact of obesity on infertility in women. Journal of the Turkish-German Gynecological Association. 2015 Jun 1;16(2).
9 13. Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reproductive biomedicine online. 2011 Oct 1;23(4):421-39.
10 14. Wise LA, Rothman KJ, Mikkelsen EM, Sørensen HT, Riis AH, Hatch EE. A prospective cohort study of physical activity and time to pregnancy. Fertility and sterility. 2012 May 1;97(5):1136-42.
11 15. Abadia L, Chiu YH, Williams PL, Toth TL, Souter I, Hauser R, Chavarro JE, Gaskins AJ, EARTH Study Team. The association between pre-treatment maternal alcohol and caffeine intake and outcomes of assisted reproduction in a prospectively followed cohort. Human Reproduction. 2017 Aug 8;32(9):1846-54.
12 16. Eggert J, Theobald H, Engfeldt P. Effects of alcohol consumption on female fertility during an 18-year period. Fertility and sterility. 2004 Feb 1;81(2):379-83.
13 17. Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R. Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis. Human reproduction. 2011 Aug 1;26(10):2763-76.
14. Hakimi O, Cameron LC. Effect of exercise on ovulation: a systematic review. Sports Medicine. 2017 Aug 1;47(8):1555-67.
15. Littman ED, Rydfors J, Milki AA. Exercise‐induced ovarian torsion in the cycle following gonadotrophin therapy: Case report. Human Reproduction. 2003 Aug 1;18(8):1641-2.
16. Varras M, Tsikini A, Polyzos D, Samara CH, Hadjopoulos G, Akrivis CH. Uterine adnexal torsion: pathologic and gray-scale ultrasonographic findings. Clinical and experimental obstetrics & gynecology. 2004;31(1):34-8.
17. Houry D, Abbott JT. Ovarian torsion: a fifteen-year review. Annals of emergency medicine. 2001 Aug 1;38(2):156-9.
