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Lifestyle changes: maximising fertility

Sometimes simple lifestyle changes are all you need to increase your chance of getting pregnant, These can make a big difference to your wellbeing and the way in which important hormones regulate your fertility. This checklist will help ensure you and your partner are both in peak form.

Review your diet

You can’t eat your way to getting pregnant, but maintaining a balanced diet and a healthy weight can make a difference. Both obese and underweight women take longer to conceive.¹ Obesity is associated with menstrual dysfunction, decreased fertility and increased risk of miscarriage.² In men, obesity is associated with abnormal semen parameters and may also adversely affect fertility.²

Start by eating more fresh fruit and vegetables:

You’ll naturally consume fewer calories
You’ll increase your intake of the nutrients your body needs

A body weight above or below average can affect fertility. A large study looking at more that 2,000 pregnant women established that time to pregnancy was 4 times longer for underweight women (BMI<19 kg/m2) and 2 times longer for overweight women (BMI>25 kg/m2) in comparison to women with a normal weight.¹

If you’re on a diet to lose weight, talk to your doctor about finding one that’s not too stringent. Losing weight is a worthwhile goal. But a severe diet may also impair your fertility. If you have an eating disorder such as anorexia, bulimia or compulsive eating, speak to your doctor. These conditions can affect your chances of conceiving.

Moderate consumption of caffeine should not create difficulties getting pregnant. However, women consuming seven or more cups of tea or coffee a day are more likely to experience fertility problems.¹

Finally, go easy on drugs. While the effect of moderate alcohol consumption on fertility is unclear, there is evidence that high levels of alcohol consumption reduce fertility in both women³ and men¹. Women who smoke are significantly more likely to have problems conceiving.⁴ It is recommended that women trying to conceive try to stop smoking or reduce their smoking to less than 10 cigarettes per day.⁵ The use of marijuana is also associated with reduced fertility in women.¹

Take a deep breath and relax

It’s typical to feel under pressure or anxious about your chances of becoming pregnant. The key is to manage your emotions before they take control and you begin to feel overwhelmed. Stress can affect ovulation⁶ and of course, libido. It can rob your body of nutrients, weaken your immune system, cause stomach problems and lead to depression. For all that, there’s not much actual evidence that stress directly causes infertility, except in rare cases.⁶

Here are some ideas to get you started. It may seem paradoxical, but you need to put some effort into learning to relax!

Begin a yoga or Tai Chi course, take up meditation or explore your spirituality. Ask your doctor about specific relaxation techniques, such as deep breathing or creative visualisation.
Get out! Pull some weeds from your garden, go to a movie, or meet with friends for a cup of tea somewhere new. It matters less what you do, than the fact that you do it - away from familiar surroundings.
Start a journal. Writing down your thoughts and feelings can help you understand them and figure out why you're feeling stressed.
Get involved. Take a class, or become a volunteer. There's nothing like helping others to make you forget your own problems for a while.
Have a massage. It's a way to reward yourself and ease tension at the same time.

Think about seeing a counsellor, if you find yourself thinking about fertility issues constantly, feeling down for more than a couple of weeks, or frequently ‘out of sorts’ with your partner. Your doctor will be able to suggest someone who deals in fertility stress issues.

Get a good night’s sleep

Sleep on its own won’t eliminate stress, but a lack of sleep can certainly make it worse. Here are 10 tips for quality nights:

Avoid alcohol before bedtime. It can unsettle your sleep.
Limit what goes on in bed to sex and sleep. Find somewhere else to watch TV, eat, read, or sort out your accounts!
Exercise regularly - but not within three hours of bedtime.
Try to go to bed at a regular time.
Avoid heavy meals close to bedtime.
Cut back on caffeine and nicotine, which are both stimulants, and avoid altogether within three hours of bedtime.
If you don't fall asleep within 15 minutes of going to bed, get up and do something relaxing. When you're sleepy, try again.
Drink less fluid before going to bed.
Develop a relaxing bedtime ritual – for example, a hot bath accompanied by soothing music.
Try not to obsess about not sleeping. It only makes matters worse. Some sleep experts suggest hiding the clock!

Think about seeing a counsellor, if you find yourself thinking about fertility issues constantly, feeling down for more than a couple of weeks, or frequently ‘out of sorts’ with your partner. Your doctor will be able to suggest someone who deals in fertility stress issues.

Begin a fitness programme

Exercise helps reduce body fat and increase libido, which can make a big difference to a couple’s chances of conception. Moderate, regular exercise burns excess fat, boosting fertility, heart health and energy levels.

If either of you don’t exercise regularly, it’s time to start. Thirty minutes a day of gentle exercise, 4-5 times a week can reduce fat levels. But don’t get carried away! Excessive vigorous exercise can impair fertility too.

Getting started

You and your partner needn’t be daunted by the prospect of starting an exercise routine. You can begin by making a few simple changes to your regular routine. Here are five ideas to get you started:

Walk or cycle to places you would normally drive.
Park or get off the bus a little further away from your destination.
Take the stairs instead of the lift.
Go dancing.
Take a walk during your lunch break.

Take a hike

Becoming fit needn’t involve joining an expensive gym. Walking is a terrific way to begin a fitness routine – and it floods the body with natural endorphins or chemicals released by the brain, which make us feel good.

Start gradually and over several weeks, begin walking faster, going further and walking for longer periods of time.

Rethink your bedroom routine

Generally speaking, sexual positions don’t make a big difference to achieving pregnancy.⁴ But if you are having problems, every bit of advice helps!

The aim is to deliver the maximum amount of sperm to the entrance of the cervix. Avoid having sex in positions where sperm could leak from the vagina, for example while sitting or standing.

Some commercially available water-based lubricants and petroleum jelly have been found to affect sperm motility.⁴ Ask your doctor about lubricants that can be used safely while trying to conceive.

Some research also suggests that the contractions that accompany the female orgasm may help carry sperm further into the cervix, yet there is no known relationship between orgasm and fertility.⁴

Many couples do try some tricks hoping that they make a difference. This is perfectly fine, as long as they make your sex life more fun and do not introduce unnecessary stress! The most important thing is that you and your partner feel comfortable and sex does not become a chore.

One last thought

Be wary of blame. Pregnancy is a result of a complex combination of factors and events. So if you can, avoid finding fault with yourself or your partner. Instead, view this as an opportunity to increase your odds of conceiving while improving your health.

^{1. Hassan MA, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril 2004 ;81; 384-92. 2. Obesity and reproduction: and educational bulletin. Fertil Steril 2008; 90:S21-9. 3. Eggert J et al. Effects of alcohol consumption on female fertility during an 18-year period. Fertil Steril 2004;81:379-383. 4. Optimizing Natural Fertility. Fertil Steril 2008; 90:S1-6. 5. Bolumar F et al. Smoking Reduces Fecundity: A European Multicenter Study on Infertility and Subfecundity. Am J Epidemiol 1996; 143:578-87. 6. Stress and Infertility. Patient Fact Sheet. ASRM http://www.asrm.org/Patients/FactSheets/Stress-Fact.pdf 2008}

Vagina

The muscular opening through which sperm travels in order to reach an egg. The vagina also serves as a passage for menstrual flow and secretions, which may assist or obstruct sperm in their journey to fertilizing an egg.

Varicocele

The presence of varicose veins around the testicles caused by poor circulation. The increase in blood leads to a rise in the temperature in the testicles. This causes abnormal testosterone levels, which hinder the production of sperm.

Vas deferens

A long curving tube that forms part of the sperm storage and transport system.

Scrotum

The pouch of skin below the penis, which holds the testicles or testes.

Semen

The fluid released by the penis during orgasm, which helps transport sperm manufactured in the testicles.

Seminal vesicles

Two pouches located behind the male bladder, which produce part of the seminal fluid used to transport and nourish sperm.

Sperm or spermatozoa

The gamete or reproductive cell that that carries the male’s genetic information to the female‘s egg.

Sperm count

The number of sperm contained in an ejaculate. Also called sperm concentration and given as the number of sperm per millilitre. Also see Azoospermia and Oligospermia.

Sperm motility

The percentage of all moving sperm in a semen sample.

Sterility

An irreversible condition that prevents conception.

Subfertility

A condition affecting couples who have already conceived, or have had an abortion, or have produced a first child but are now experiencing difficulty in adding to their family. Also see infertility or primary infertility.

Obstetrician/Gynaecologist

A doctor who delivers babies and specialises in the treatment of female reproductive organs.

Oestrogen

A hormone that stimulates secondary female sexual characteristics and controls the course of the menstrual cycle. Oestrogen is also produced in low quantities in males.

Oligospermia

A condition when a sperm sample contains less than 20 million spermatozoa per ejaculate. Many medical conditions reduce sperm concentration. The effects may be temporary or permanent. See also Azoospermia.

Outpatient

A Person undergoing a clinical procedure that does not require admission to hospital.

Ovarian failure

The failure of the ovary to respond to hormonal stimulation from the pituitary gland because of damage to or malformation of the ovary, or a chronic disease such as autoimmune disease or ageing process.

Ovarian follicle

The structure in which eggs are nurtured to maturation. Although in general only one egg is released at a time, somewhere between 10 and 20 follicles begin the process of maturation monthly. The excess ovarian follicles are reabsorbed before ovulation occurs.

Ovulation

The release of the matured egg or ovum from the ovarian follicle.

Ovum

A matured egg.

Ovulation Induction (OI)

Medical treatment carried out to initiate ovulation.

Ovarian Hyper Stimulation Syndrome

A condition characterised by enlargement of the ovaries, fluid-retention and weight gain. May occur when the ovaries are over-stimulated during assisted reproduction.

Ovaries, Ovary

Almond-sized organ(s) located on either side of the uterus, which produce and release mature egg cells and the hormones oestrogen and progesterone.

Manual palpation

A physical examination for any genital abnormalities or any other physical signs that might be associated with conception difficulties.

Myoma

A benign tumour in the uterus consisting of muscle tissue. Myomas are often the cause of persistent infertility or miscarriage.

Micromanipulation

A variety of techniques performed in a laboratory with microscopic guidance, such as Intracytoplasmic Sperm Injection (ICSI).

Menopause

Typically diagnosed 12 months after a woman’s last menstrual cycle. Natural menopause occurs when the ovaries begin decreasing their production of the sex hormones oestrogen and progesterone and marks the end of a woman’s fertility. See premature menopause.

Menstruation or menses

Shedding of the uterine lining by bleeding. In the absence of pregnancy, this normally occurs about once every 28 days.

Miscarriage

Spontaneous loss of a viable embryo or foetus from the uterus.

Motility

The ability of sperm to swim or move. Poor motility means sperm have less chance reaching and fertilizing the egg.

Multiple pregnancy

A pregnancy with two or more foetuses.

Mumps

A viral disease of the parotid (salivary) glands. Contraction of the virus after puberty may damage sperm-producing cells in the testicles. In most cases, only one testicle is affected. Some men could suffer permanent sterility.

Hepatitis

A disease characterised by inflammation of the liver arising from various causes including a range of viruses (i.e. A, B, C, E).

Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome

A disease of the human immune system caused by the HIV virus, which can be contracted through sexual contact.

Hormonal imbalance

An abnormal hormonal balance, which may arise for example, from a deficiency or excess of oestrogen or progesterone.

Hormones

Chemical messengers produced by the body that transmit instructions from one organ to another.

Human Chorionic Gonadotrophin

A hormone released by the placenta after implantation that keeps the corpus luteum producing estradiol and progesterone, and thus preventing menstruation. The hormone is also given via injection to trigger ovulation after some fertility treatments. In men, it is used to stimulate testosterone production.

Human menopausal gonadotrophin

Natural compounds found in the urine of postmenopausal women. Once extracted and sterilised, hMG is given to women to stimulate ovulation.

Hysteroscopy

A visual examination of the uterus via the vagina using a telescopic instrument, to identify any malformations in the uterus lining, the presence of myomas, fibroid growths or damage to the fallopian tubes. If necessary, minor surgery may be performed at the same time without the need for a large incision.

Hypogonadotrophic Hypogonadism

Impaired activity of the hypothalamus or pituitary glands resulting in below-average function of the ovaries or testicles and low in low production of the hormones Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), Oestrogen, Progesterone and Testosterone, which are necessary for reproduction.

Hypothalamus

The gland at the base of the brain that controls the release of hormones from the pituitary glands.

Cervical mucus

A natural lubricant produced by the female body that aids the transportation of sperm and helps protect against infection.

Cervix

The cervix or neck of the uterus is the lower, narrow portion of the uterus where it joins with the top end of the vagina.

Chlamydia

A sexually-transmitted infection, which may be asymptomatic or cause genital inflammation and discharge, pelvic pain and fever. Untreated, chlamydia can lead to Pelvic Inflammatory Disease (PID) and fertility problems.

Chromosomes

Structures found in the nucleus of cells that contain genes and carry heredity information, such as eye colour, blood type and vulnerability to disease. Humans have 23 pairs of chromosomes. One set of 23 chromosomes is inherited from the biological mother via her egg and the other from the biological father, via his sperm. Each sperm cell contains either male or female sex chromosomes. As such, it determines the gender of the foetus. Genetic abnormalities occur when an individual is born missing a chromosome or has more copies of a chromosomal pair.

Clomiphene citrate

A prescription drug used to bring on ovulation. It comes as a tablet and is often used as an initial treatment for women with ovulation problems. Clomiphene citrate induces ovulation in 80% of women who have trouble ovulating on their own.

Conception

The moment of fertilization when the sperm meets and penetrates the egg.

Congenital abnormalities

Physical abnormalities present at birth.

Corpus luteum

A hormone-secreting mass within the ovary that forms from the remains of a follicle each time an egg is released. The hormones it produces prepare the uterus for embryo implantation. If pregnancy does not occur, the mass is shed during menstruation.

Cryopreservation

A technique used to store human tissue at very low temperatures. Embryos that are not used in an ART cycle may be preserved in this way for future use. Also known as “Freezing”.

Cryptorchidism

A condition usually detected at birth or childhood whereby the testicles fail to descend. When a male foetus develops in the uterus, his testicles normally form inside his abdomen and descend into the scrotum shortly before birth. Undescended testicles usually descend themselves by the sixth month of life, but are unlikely to descend after this period of their own accord.