Periconception, lifestyle and fertility

The reproductive health of a couple is the single most significant determinant of the health and well-being of their children.

A sub-optimal environment inside the uterus predisposes an individual to diseases in adulthood, including obesity, heart disease, diabetes and stroke.

Maternal reproductive disorders such as PCOS, obesity, endometriosis, sexually transmitted infections and ovulation disorders influence periconception events and alter endometrial receptivity.Altered embryo development or insufficient maternal support can lead to later miscarriage or abnormal placental development resulting in pre-eclampsia, fetal growth restriction or preterm delivery.

FACTORS THAT AFFECT FERTILITY

Weight, exercise & nutrition:

The prevalence of overweight young couples of reproductive age is steadily increasing.

Obesity has been linked to male fertility because of lifestyle changes, internal hormonal environment alterations and sperm genetic factors.

Female obesity has been shown to be associated with poor pregnancy outcomes, congenital abnormalities, cesarean delivery, preeclampsia, gestational diabetes, fetal macrosomia and stillbirth.

Physical activity improves:

• Cardiovascular risk factors.

• Hormonal profile.

• Decreases the abdominal fat.

• Decreases blood glucose, blood lipids and insulin resistance .

• Improves the menstrual cyclicity, ovulation, and fertility.

• It is also recommended to advise overweight and obese women to lose weight before ART use.

Vitamins:

Women in the reproductive age group must take up to 500mcg of folate in the periconception period and 5mg in high-risk women.

Consider consuming vitamin D and getting adequate sunlight exposure.

All women who are pregnant, breastfeeding, or considering pregnancy should take an iodine supplement of 150 μ g each day.

Antioxidants: Increase the intake of fruits and vegetables in the diet.

Alcohol

Even low alcohol consumption during early pregnancy increases the risk of spontaneous abortion. It is, therefore, better to avoid alcohol during the periconception period.

Caffeine

High consumption of caffeine may be associated with impaired fecundity. Try to keep this below 200–300 mg per day (less than two cups of coffee per day).

Fish consumption

Certain types of fish that are high in mercury should be avoided, while a high-polyunsaturated diet, as given by fish, is desirable.

Smoking

Smoking negatively affects the outcomes of in vitro fertilization (IVF) cycles. Active and Passive Smoking can affect all stages of reproduction. Sperm studies have shown increased oxidative stress, a lower sperm count, and abnormal sperm fertilizing capacity.

Illicit drugs

Drugs like Marijuana, Cocaine, heroin and methadone increase female infertility and significantly affect sperm function and form. Anabolic steroids can reduce testicular sperm production.

Stress

Psychosocial stress is associated with negative reproductive outcomes. However, appropriate counselling and lifestyle adjustments may ameliorate these effects.

Sexually transmitted diseases: Both partners should seek advice regarding detecting and treating any reproductive tract infection.

Occupational factors

Dysregulation of the biological clock as in shift work, prolonged working hours, lifting, standing, and heavy physical workload, and exposures to endocrine disrupting chemicals such as bisphenol A, phthalates, insecticides, and other potentially dangerous products may adversely affect outcomes of reproductive interventions.

PRE-PREGNANCY PREPARATION

l Folic acid supplementation.

l Dietary modifications.

l Active weight loss programs.

l Smoking cessation.

l Avoiding alcohol and drug use.

l Treating STIs.

l Avoiding environmental pollutants and occupational hazards.

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