Likely the most frequently asked question from our patients is this: “What can I do to improve my chances in my fertility treatments?” The honest answer usually is that “there really isn't much to be done.”
Going through fertility treatments is, of course, a very stressful process. Not surprisingly, patients want to do whatever is possible to improve their chances. CHR welcomes this attitude because it demonstrates motivation, which in turn promises discipline in executing the required treatments and, if there is one thing every patient can do to help her chances, it is correct execution and timing of treatment schedules. As IVF cycles involve self-injecting correct doses of fertility medications at the right time, patients play a hugely important role in the success of prescribed treatments.
The desire to maximize chances, however, also sometimes leads to self-prescribing, i.e., the habit of reading something on the Internet (or elsewhere) and deciding to add it to treatments recommended by physicians. While most over-the-counter products, likely, are relatively harmless, some are not. Those that are not, are often not dangerous per se, but may either interfere with diagnostics (i.e., lab test results) or may interact with other supplements and/or prescription drugs that are important for a treatment cycle. Therefore, CHR strongly recommends to patient under fertility treatments to stay away from self-prescribing!
For women who concomitantly are under the care of physicians in other medical specialties, it is also important to remember that those physicians must be informed about intent to conceive, whether spontaneously or via fertility treatments. Some medical problems require changes in therapy for women who are on the verge of conceiving, with chronic hypertension being a good example, where women often must change their medication regimen quite radically.
The answer is no, you don't need to get on any particular "fertility diet," if your regular diet is well tolerated and does not give you gastro-intestinal distress symptoms, like heartburn, gas or cramps. If, on the other hand, bread makes you run to the bathroom or gives you excessive gas and cramps every time you touch it, you may be gluten-sensitive, maybe even have celiac disease. In such a case, trying a gluten-free diet as a withdrawal test may not be a bad idea. If you notice immediate improvements, you may, indeed, be gluten-sensitive (or have celiac disease) and staying off gluten-containing foods may help, because every time your body is exposed to gluten, inflammation flares up in your body.
We do not like inflammation in women who are trying to conceive because the immune system of women with active inflammation does not reprogram itself as well toward the new pregnancy as it should. That, in turn, can increase difficulties for embryos to implant and, if they do implant, can increase miscarriage risks.
Definitely yes! Smoking decreases fertility in women and men but much more so in women. Smoking also affects the pregnancy and results in lower birth weights for offspring. The time when a woman is trying to conceive and/or is pregnant is very clearly not a time to smoke.
CHR recommends against recreational use of marijuana during fertility treatments and during pregnancy. There is increasing evidence that offspring of mothers who use marijuana during pregnancy may be adversely affected.
If we count alcohol as a recreational drug, then CHR does not object to a glass of wine here and there, while trying to conceive. As we noted before in these pages, if such social alcohol consumption adversely affected pregnancy potential and/or offspring, many countries where drinking wine is a national habit, would demonstrate obvious consequences. That countries like France, Italy, Spain and others do not demonstrate such effects, contrary to many proponents with rather scary messages, suggests that mild social consumption of alcohol during periods of fertility treatments is safe. Once pregnancy is established, CHR, however, supports absolute abstinence in view of reports in the medical literature that even minimal amounts of alcohol have been associated with the so-called fetal alcohol syndrome. CHR, of course, also objects to use of other recreational drugs during infertility treatments and in pregnancy.
When trying to get pregnant is, in principle, not the right time to change your life’s routine. Fertility treatments create enough stress on their own; changing one’s daily routine only adds to that, and the potential weight loss over a few short weeks to months is not worth the effort.
Weight loss can be helpful in truly obese patients but, when such a strategy is pursued, CHR usually recommends interrupting fertility treatments, so that patients can concentrate on weight loss and exercise during that time period. Once a couple returns to treatment, they should be able to concentrate on their fertility treatments.
Use of such a strategy is, of course, also dependent on the female’s age. As long as they don’t suffer from premature ovarian aging (POA), in younger patients, treatment delays of six months or even of a full year, may be worth the effort. However, if patients are older, the loss in fertility chances from waiting may outweigh the benefits of the weight loss, and in such cases CHR usually proceeds with treatments without attempting prior weight loss.
That coffee consumption is harmful to infertility treatments is, once again, one of those widely distributed messages for which there is really no credible evidence in the scientific literature. Countries with strong coffee cultures, like Italy, Spain, Austria and the Latin American countries are, again, “natural experiments” that strongly contradict this widely claimed association. What also often goes unmentioned is that a cup of tea frequently contains just as much, and in some cases even more, caffeine than a cup of coffee and countries with strong tea cultures, like Russia and the UK, also have not reported any associated adverse effects on their populations’ fertility from drinking tea. In summary, coffee in moderation is perfectly fine while going through fertility treatments.
Definitely yes! Here, too, the principle applies that women who go through fertility treatments should stick to their regular habits. Those who regularly exercise should continue doing so. Once pregnant, and if the pregnancy progresses normally, recommendations are to decrease length and intensity of exercises by ca. 20% in each trimester of pregnancy.
In following the recommendations not to change behavioral patterns while trying to conceive, this is also not necessarily the best time to start exercising. A much better strategy appears to be to wait until after the delivery to start paying for a new gym membership.
This is actually a surprisingly frequent question from patients in all socioeconomic groups. Unless there is a clear medical reason for stopping work, we usually strongly recommend against stopping working simply because of infertility treatments. The reason is, again, that radical changes in daily routine often increase, rather than decrease, stress levels.
How much stress a patient is exposed to and how well or poorly a patient deals with stress is, of course, very difficult to assess. Studies on the effects of stress on fertility treatment outcomes are, therefore, sparse. A very recently published study concluded that there was no obvious evidence that stress impacted fertility treatments, but the authors assessed stress by levels of stress hormones in their patients’ bloods, and that is not necessarily a great tool to assess all psychological stress.
That stress, per se, does not cause infertility, is throughout history quite well established because even the most stressful situations, like wars, famines and even rape, result in pregnancies. At the same time, stressful situations are associated with lower birth rates, and war as well as famines are again good examples for significant declines in birth rates. Indeed, even economic recessions affect birth rates to significant degrees, as declining birth rates in the U.S. and elsewhere after the 2008 recession again demonstrated. Whether declining birth rates in such circumstances reflect only conscious choices or may to a degree also reflect declining fecundity (ability to conceive spontaneously) is unclear. But what can be stated with considerable certainty is that, while stress, of course, should be avoided, there is no good evidence that it affects fertility treatments to significant degrees.
CHR is neutral when it comes to use of acupuncture. Whether the procedure affects pregnancy chances with fertility treatments like IVF has remained controversial and a large recently published study, indeed, suggested that there was no outcome benefit observable with IVF. Acupuncture is, however, also alleged to reduce stress, and that, of course, cannot hurt. A good number of CHR patients, indeed, use acupuncture for various reasons and CHR is grateful to acupuncturists who are serving those patients.
Only one word of caution: As already noted above, CHR is concerned with utilization of Chinese herbs, while patients are in infertility treatments, and usually recommends to patients to discontinue their use. Our recommendations around fertility supplements are found here.
This is a part of the September 2018 CHR VOICE.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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