Diet and lifestyle choices can have an enormous impact on fertility, conception and pregnancy outcomes. Each beneficial change that you make to improving either your diet or lifestyle is likely to have a positive impact on your fertility and help increase your chances of conceiving.

Often, in fact very often, I am quizzed about the latest ‘superfood’ or missing nutrient from our diet that is hailed the cure for our health problems, including fertility. Before considering ‘super foods’, ‘wonder nutrients’ and other nutritional elements tagged with remarkable attributes, the key areas of our diet that play the most significant roles should be in place first. In clinic, my first task is often, therefore, to explain that no one food, and no one nutrient, is likely to single-handedly restore health, fertility and vitality. In truth, single nutrient deficiencies are rare, and single nutrient cures are rarer. But don’t let that bother you, the combination of a variety of nutrients can be very powerful and enhance fertility and increase your likelihood of conception greatly!

To start, the first steps to enhancing  your fertility are to eat few processed foods, plenty of fresh fruit and vegetables, make healthy choices where possible and avoids the vices such as alcohol, smoking and too much caffeine. In terms of dietary changes, the best place to start is with the fundamentals; the role of energy, protein, fats and carbohydrates in fertility. That is not in any way to suggest that particular foods and nutrients are not of considerable importance for fertility and also conception, but it is true to say that you need to start at the beginning and build from there.  I absolutely agree, the macronutrients; energy, protein, fat and carbohydrates may seem a bit dull compared with the new and novel substances such as ‘inositol’ or ‘coenzyme Q10’ etc , but don’t be pulled in by novelty factor, your macro-nutrient intakes have a very significant effect on your fertility and almost certainly account for a far greater percentage of infertility problems than any single substance or nutrient.

Also, it’s worth remembering that the benefits of a healthy diet extend way beyond fertility. For example, a healthy diet will also help you achieve, and maintain, a healthy body weight, boost your immunity so that you are able to fight off infections quickly, as well as reduce your long term risk of falling ill with diseases such as cancer, diabetes and heart disease.

Whether you are male or female, if you are planning a baby, or having difficulty conceiving, nutritional advice will help to ensure that your body is as well prepared as it could be to ensure that you have every chance of conceiving and enjoying a healthy pregnancy.

My advice is to read through the ‘Essential Nutrition for Fertility and Conception Section’ below to help you both appreciate how dietary changes can improve fertility and support conception.

Personalised Food Analysis and Eating Plan

If you would like us to analyse your diet and provide you with a fully computerised and confidential evaluation of your nutritional intake, the quality of your diet and a breakdown of your intake of key nutrients that influence fertility and conception, please see my Dietary Analysis for Fertility and Conception for more information.

Essential Nutrition for Fertility and Conception

Energy Requirements for Fertility and Conception:

Energy balance is a key factor for fertility and weight abnormalities are estimated to be responsible for about 12% of infertility cases, so ensuring that you have a healthy weight is very important for fertility. Women with high or low body weights (more accurately body fat) can suffer from hormonal abnormalities that interfere with fertility. Correcting a weight abnormality usually corrects hormonal imbalances and fertility is restored. Such a fantastic endpoint must be well worth considering!

I don’t encourage anyone to become too focused on energy intakes because it can lead to unnecessary anxieties. As a rule, if you have a body weight that is stable and healthy (e.g. if you have a Body Mass Index within the ‘desirable’ range of between 22- 25), then calculating your energy requirements and starting to count calories isn’t at all necessary, and actually may just end up being more of an anxiety than anything else.

However, if your BMI is not within the ‘desirable’ range then it may be a good idea to calculate your energy requirements and compare what you need to what you are actually eating – you may be surprised!

If you need to lose weight because you have a BMI of more than 25, calculate your energy requirement and then aim to reduce your daily energy intake by 15% of your daily requirement. Try to reduce your energy intake by cutting out unnecessary fats, sugary foods and treats, such as sugary drinks, cake, crisps, chocolate and desserts, as these foods are generally low in vital nutrients and high in calories. Don’t cut down on your food intake too much as this type of ‘crash’ dieting can be very harmful and lead to nutritional deficiencies and metabolic changes which really won’t help with any fertility problems. Losing weight slowly, whilst eating a healthy, nutrient rich, low fat diet is by far the best way to lose weight whilst remaining healthy.

If you need to lose a lot of weight, try to lose the weight before you try to conceive. Not only does this avoid disappointment and stress, but it also ensures that you are eating a balanced, healthy diet with sufficient energy whilst trying to conceive and that then gives you the best chance of success. It is important to take an ante-natal supplement whilst trying to lose weight and also when you are trying to conceive, as it will safe guard against any nutritional short falls in your diet, as well as build up your nutrient reserves for pregnancy – perfect!

If you are underweight (e.g. you have a Body Mass Index of <21), then it is also useful to calculate your energy requirement and use that ‘ideal’ as your aim. If you find that you are eating considerably less calories than your estimated daily requirement, build up your food intake slowly until you are within 10% of your total daily energy requirement.

Try to correct any weight abnormalities alongside other positive changes to lifestyle factors that influence fertility, particularly starting a regular exercise regime if you are overweight, but also consider reducing stress, alcohol, and eliminating smoking.

Calculating Energy Requirements for Fertility and Conception

The steps below provide a simple method that can be used as a guide to calculate your daily energy requirements. You will need to know your height (metres).

1. Calculate your Basal Metabolic Rate (BMR). This is the amount of energy that your body requires in any one day to simply exist. The calculation of BMR does not include any physical exertion.BMI (female 18 – 29) years = 0.056 X Wt (Kg) + 2.898BMI (female 30 – 59) years = 0.034 X Wt (Kg) + 3.538
2. Using the table below, estimate your ‘Physical Activity Level’ (PAL), this is an indication of your daily activity level. If you are very sedentary your PAL will be about 1.2, if you are extremely active your PAL will be about 2.5 (be honest!)
   Adapted from: Department of Health Report 41: Dietary reference Values for Food and Energy and Nutrients for the United Kingdom. 1991 London: HMSO
3. If your PAL is less than 1.4 you should try to increase by adding a few more activities into your day. For example, if you are able to walk to work on a summers day then try to do so, or perhaps take the stairs rather than the lift. Adding lots of small activities can be quite effective.
4. And finally multiply your PAL by your BMR to find your average daily energy requirement.

Many food labels give a really good idea of how many calories they contain per portion. I am not suggesting that you weigh out your food each day and start counting calories from here on in, but it can often be a very useful exercise to do it for a few days. Sometimes making a note of what and how much you are eating in a day can help enormously with making us more conscious of what we are really eating. Common problems that can be highlighted by keeping a food diary for a few days, possibly up to a week, are:

• Abnormal portion sizes – too small or too big
• Coming to terms with what exactly you do and don’t eat – quite often people are shocked when they actually write down what they eat because they see how many crisps, cakes, and other snacks they are eating in a day. Because these foods are often eaten in a rush, maybe while going from one place to another, they can be easily overlooked.
• The quality of your diet also stares back at you when you write it down – are you eating 5 portions of fruit and vegetables in a day? Is there any fibre in your diet?

Protein Intakes for Fertility and Conception

When we were at school many of us remember those early science lessons when we were told that proteins were the building blocks of life – and they are. Every cell, every function and every piece of delicate genetic information within the body involves a protein in one form or another. They are therefore, essential for many aspects of fertility and conception.

Usually people in the UK eat plenty of protein, although some people, such as vegetarians, vegans, teenagers, frequent dieters and picky eaters are vulnerable to low intakes. Also, note that it is as important to eat ‘enough’ protein as it is to eat protein ‘regularly’ throughout the day. As a rough guide if you weigh between 60 and 75Kg then you need between 70 – 90g protein a day, depending on your ideal body weight. If you are underweight you should eat enough protein to meet the needs of your ‘ideal body weight’, rather than your actual weight. Your ideal body weight can be calculated by multiplying your ideal BMI (which will be between 22-25 depending on whether you are a large or small build) by your height squared (m²).

Good sources of protein include lean red meat, fish, chicken, pulses, nuts and seeds. The table below gives the protein content of some common foods at average portion sizes.

The Protein Content of Selected Foods.

Fat Intakes for Fertility and Conception

There are a few things to think about when we discuss ‘fats’. We not only need to consider how much fat we eat, but also which fats are better to eat and which should be limited?

In the UK, most of us generally eat too much fat; our average intake is about 33%, or a third of our total energy intake. A healthy diet should contain about 25% fat, which, for an average female, is about 550 kcal or 60-65g. For an average male a good guide would be about 70g fat a day.

Fat is vital for health, although some fats are far healthier than others. The table below explains the different sorts of fats and which foods contain these fats.

The Role of Omega-3 fatty acids in Fertility and Conception

In Western societies our typical intake of omega-6 PUFA is high and the ratio of the omega-6: omega-3 fatty acids in the UK is now thought to be greater than 10:1 and even as high as 25:1 in some adult diets. In comparison, many years ago the omega-6: omega-3 ratio dietary intake of primitive man was closer to 1:1.

There are three important omega-3 fatty acids; alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and two important omega-6 fatty acids; linoleic acid (LA) and arachidonic acid (AA).

Over the last 50 years or so we have seen the most dramatic changes in intakes of the two families of fatty acids. Our intakes of omega-6 fatty acids have gone up, to displace the saturated fats in our diet that were associated with heart disease, stroke and cancer. Unfortunately there has also been a corresponding decline in our intake of omega-3 fatty acids, mainly because in  the UK our main sources of these oils were from green leafy vegetables, diary produce and meat from cattle grazing on grass, and eggs produced from chicken which also fed on seeds and natural foods. The fall in popularity of green leafy vegetables, and changes in animal husbandry have resulted in a dramatic decline in our intakes of these omega-3 fatty acids.

Omega-3 fatty acids (omega-3 FA) are important in the prevention and treatment of various diseases, including both male and female infertility. The omega-6: omega-3 affects numerous male and female reproductive processes via a number of complex pathways involving prostaglandin synthesis, key enzyme expression involved in prostaglandin and steroid metabolism and cell membrane properties. While it is not at all important that anyone who is wanting to start a family understands all of these processes, it is important that I have got the point across that high quality omega-3 fatty acids are extremely important for all stages of reproduction including, female ovulation, male sperm count/motility and DNA, conception, embryo development, pregnancy outcome and child health.

In males, the fatty acid composition of the sperm membrane is thought to be a strong influence of fertility and fertile men have been found to have much higher sperm levels of omega-3 FAs as compared to infertile men. Patients with higher omega-6 fatty acids concentrations and lower omega-3 fatty acids concentrations were found to have lower overall sperm counts, sperm motility and sperm morphology.

Sperm generate low levels of reactive species in order to stimulate key events, such as sperm capacitation which is an essential process prior to fertilisation.  However, sperm have a limited capacity to protect themselves from free radicals and oxygen species and if the number of these highly reactive molecules becomes elevated for any reason, this will result in a state of oxidative stress characterized by damage to the sperm membrane and DNA. Oxidative stress in male DNA is associated with poor fertilization rates, impaired embryonic development, high levels of abortion and increased morbidity in the offspring, including childhood cancer.

The omega-6 or the omega-3 fatty acids are the precursors for the naturally occurring chemicals produced in sperm to carry out those necessary events that lead to fertilisation. Reactive species that are derived from omega-3 fatty acids are considerably less potent (anti-inflammatory) than those from omega-6 fatty acids. An omega-3 fatty acid supplement will lead to an increase in the less potent/reactive  family of reactive species, and as a result sperm could be exposed to less oxidative damage thus protecting sperm health and motility, and limiting DNA damage. In males who currently have low omega-3 fatty acid profiles, omega-3 supplementation, is likely to support sperm motility and quality, limit damage to sperm DNA, and increase the likelihood of conception as well as support embryo development.

In women, abnormal periods can be a result of an imbalance between ‘anti-inflammatory’, vasodilator eicosanoids derived from omega-3 FA and ‘pro-inflammatory’, vasoconstrictor eicosanoids derived from omega-6 FA. Increased intakes of omega-3 FA can reverse this condition by decreasing the amount of omega-6 FA in cell membranes. Similarly, omega-3 FA can facilitate pregnancy in women with infertility problems by increasing uterine blood flow. Supplementation with omega-3 FA during pregnancy has been found to lower the risk of premature birth and increase the length of pregnancy and birth weight. Furthermore, intake of omega-3 FA during pregnancy and breast feeding may facilitate the child’s brain development and there is also some evidence that supplementation with omega-3 FA might help to prevent pre-eclampsia, post-natal depression, menopausal problems, post-menopausal osteoporosis, and breast cancer.

The fetal brain grows rapidly during the third trimester of pregnancy, a process which requires DHA, as does the development of the retina. A high quality omega-3 supplement, with a high concentration of DHA, is particularly important at this time.

It is important to appreciate that the quality of an omega-3 FA supplement is very important. It should have an appropriate antioxidant content, and dioxin and polychlorinated biphenyls (PCBs) levels should be well below the established safe limit.

Juliet Wilson DHAPure Pregnancy for women, and DHAPure Conception for men are premium, pure and safe omega-3 supplements, with high concentrations of DHA, designed to provide you and your partners with peace of mind – all through fertility, conception, pregnancy and breastfeeding.

The Role of Carbohydrate for Fertility and Conception

• ‘Carbohydrate’ is a term that encompasses several categories of foods that are important for energy release including sugars, starch, soluble fibre and insoluble fibre.
• It’s important to eat a healthy mix of the different carbohydrates to help balance blood sugar levels and to maintain an even energy release.
• Carbohydrates that are high in simple sugars, such as glucose, are often termed as instant or quick release carbohydrates as they are rapidly absorbed and cause a rapid and often sharp rise in blood sugars. Foods that are high in simple sugars should be eaten in small amounts and where possible mixed with slow release carbohydrate to help avoid dramatic changes in energy levels.  Probably more importantly, foods that release sugars rapidly can exacerbate the metabolic problems associated abnormalities in glucose metabolism and insulin resistance that are related to some causes of infertility. These foods can also be related to increases in weight, energy swings and nutrient deficiencies.
• Fibre has an important role in health and it is important to eat 3-5 portions of fibre each day. There are two main types of fibre: soluble and insoluble. Soluble fibre is found mainly in oats, fruits and vegetables and is very important for gut health as it is fermented by the gut microflora to produce energy and nutrients that benefit the cells of our gut, thus keeping our digestive tract healthy. Insoluble fibre keeps us ‘regular’ as your Granny would say, although take care not to increase your insoluble fibre intake without also ensuring that you have enough fluid each day or just the opposite can happen. Avoiding constipation is really important as regular bowel movements ensure that waste products, toxic compounds and other elements are removed from the body regularly and efficiently without enabling them to hang around and cause any unwanted effects.
• The following table is based on ‘The Glycaemic Index of Foods’, which gives a useful indication of how quickly sugars from foods are absorbed. Try to choose foods that are have a low Glycaemic Index where possible; some moderate choices are fine, and just a few high Glycaemic Index foods. This table represents the Glycaemic Index of a few common foods and can be used as a simple guide to help you make your carbohydrate choices.

The Glycaemic Index of Foods

The Role of Antioxidants in Fertility and Conception

Antioxidants have been at the forefront of nutritional research for the last decade. Their role in human health and disease prevention is well documented and in recent years the understanding of antioxidants role in fertility and conception has also been recognised.

Every day tens of thousands of highly reactive molecules (reactive oxygen species, free radicals) are produced naturally within the body, and in a healthy balanced environment, these reactive molecules carry out important immune and functional tasks and the effect of these free radicals is limited by antioxidants. Ideally free radicals and antioxidants work in balance, but when the balance is disrupted towards an over-abundance of free radicals, oxidative stress occurs. Dramatic changes in the composition of our daily diets over the last 50 years, and that of our cattle as well, and general increases in exposure to environmental chemicals and stress, have caused such an imbalance between the highly reactive free radicals and antioxidants in our bodies and this can affect many aspects of our health, including many elements of male and female reproduction.

Antioxidants provide important protection against free radical damage. Vitamins C, E and A are the most well known antioxidants, although selenium, copper and many natural plant compounds also have antioxidant roles. Their role within the body is to protect delicate cell membranes, critical genetic material (DNA) and important enzymes and other functional systems within the body from the damage caused by free radicals. This is sometimes referred to as ‘oxidative’ damage.

Oxidative stress can influence the entire reproductive lifespan of a woman. In health, they are key signal molecules, but in excess they become pathological and can effect ooycyte (egg) maturation, fertilisation, embryo development and pregnancy.

It is more difficult to research the oxidative stress in the female; however the available evidence suggests that oxidative stress in the ovary, the source of oocytes and regulating hormones, is very likely to have a considerable impact on fertility, conception, including assisted fertility treatment and female reproduction.

A number of studies suggest that oxidative damage also has a major influence on male fertility. Sperm cells themselves produce the very free radical chemicals that can cause damage to the delicate membrane of sperm, as these chemicals also play a vital role in fertilisation. Too many free radicals can destroy sperm (or at least reduce motility), limit a sperm’s ability to fuse with the female oocyte (egg), and, by oxidative damage to DNA within the sperm, compromise the paternal genetic contribution to the embryo and potentially cause early pregnancy loss. Antioxidants offer the vital protection to neutralise these oxidative chemicals and limit any damage so that the sperm is able to swim on and continue with its purpose in life!

Vitamin C as an Antioxidant in Fertility and Conception

Further evidence that supports the vital role of antioxidants for fertility is that fertile men have been found to have much higher seminal vitamin C levels than infertile men.  Vitamin C is known to protect against damage to the sperm membrane and genetic material and deficiencies have been associated with reduced fertility or unexplained fertility in men. Studies suggest that vitamin C is directly associated with the degree of oxidative damage to human sperm DNA, and when supplemented, vitamin C deficient infertile men showed a significantly increased fertility.

Vitamin E as an Antioxidant in Fertility and Conception

Vitamin E is also important in its antioxidant role as it protects the delicate fats in the cell membrane of the sperm from damage and clinical trials have found that vitamin E supplementation increases fertilisation rates, possibly by reducing this reduction in oxidative damage.

Vitamin A as an Antioxidant in Fertility and Conception

Similarly, vitamin A, as Beta carotene, also has important antioxidant properties. Vitamin A also has a number of other key roles in reproduction including; aiding the production of sex hormones and a healthy libido, oocyte maturation, regulation of development, cellular growth and differentiation in the embryo after fertilisation.

Generally, a large section of the young adult population in the UK consumes insufficient quantities of antioxidant nutrients and evidence is highly persuasive that a diet rich in these nutrients and supported by supplements, will enhance both male and female fertility, increase conception and protect embryo development. Go ahead, eat an apple!

The Role of Zinc in Fertility and Conception

Zinc is required for healthy sperm production and is found in high concentrations in the male testes and prostate. In males, deficiency of zinc has been found to impair angiotensin converting enzyme (ACE) activity, which leads to depletion of the male hormone testosterone and a consequential inhibition of sperm production. Furthermore, zinc has an important role in sperm maturation and DNA synthesis and research has found fertile men to have significantly higher semen zinc concentrations than non-fertile.

In females, zinc is required for ovulation and a regular menstrual cycle and mild zinc deficiency has been associated with pregnancy complications. The role of zinc in DNA transcription is likely to make it a particularly important nutrient for embryo development.

Zinc also has antioxidant properties that counteract oxidative stress in both men and women.

The Role of Folic Acid in Fertility and Conception

Folate deficiency is common in the UK and rest of the developed world . Folate from food is relatively ineffective at increasing folate status compared to folic acid (the synthetic form of folate) in supplements and fortified foods, because folate is readily lost during cooking and also the absorption of folate in foods is quite low (40 – 70%).

Folic acid, or folate, is essential for cell division because of its critical role in DNA synthesis. Ensuring that you have good folate status is really important before conception as low folate status is associated with increased risk of miscarriage, pre-term and low birth weight babies, as well as the well established association of folic acid supplementation and the prevention of Neural Tube Defects.

Folic acid has been found to have antioxidant properties and is thought to protect cell membranes and DNA from oxidative damage.  Men with high folate intakes have fewer abnormal sperm, higher sperm counts and sperm motility. In females folate is important for oocyte (egg) quality, maturation, embryo implantation and fetal growth and organ development.

The Role of Selenium in Fertility and Conception

Selenium is an essential trace element and a deficiency has been linked to reproductive problems. Selenium also has an important role in the body as an antioxidant and is part of a group of enzymes involved in thyroid hormone function. In sperm, selenium is found in part of the tail (known as the mitochondrial capsule midpiece) and a deficiency in selenium has been associated with reduced sperm motility and breakages in tail midsection, which results in loss of motility, as well as reduced sperm production.

Selenium may also reduce the risk of miscarriage.

The Role of Carnitine in Fertility and Conception

Carnitine is produced in the liver from two amino acids, methionine and lysine, and is therefore not an essential nutrient in the diet.  The role of carnitine is to transport fatty acids to the mitochondria in the cell, where they are converted into ‘energy’. This process and the role of carnitine is particularly important in sperm where energy requirements for motility are high.

A low concentration of carnitine in sperm may lead to decreased fatty acids conversion into energy, and therefore decreased sperm motility. More research is necessary to be certain of how many males are likely to be vulnerable to sub-normal carnitine levels, especially as the liver is able to synthesise carnitine. However, the synthesis of carnitine is dependent on other nutrients, including vitamin C, iron and vitamin B6, and it is important to ensure that a healthy, balanced diet is consumed daily to support carnitine synthesis.

Selective males, particularly those who have poor nutrient intake or restrictive dietary practices, should try to make sensible dietary changes to support carnitine synthesis and consider dietary analysis and nutritional consultation to ensure all other nutrients are consumed, and to discuss the suitability of supplementation.

The Role of Arginine in Fertility and Conception

In men, arginine is found in very high concentrations in sperm and is thought to be essential for sperm motility and preparation of the sperm for fertilisation. In some studies supplementation has been shown to increase both sperm count and motility in infertile men.  In women, arginine supplementation may improve ovarian response in assisted reproduction patients. However, results from other studies have not confirmed these findings and others have found supplementation of arginine to be detrimental to fertility.

At this time I do not recommend supplementation with Arginine.

The Role of Co-enzyme Q10 in Fertility and Conception

Co-enzyme Q10, also known as ubiquinone, is present in seminal fluid where it is known to have has two important functions in sperm; energy production and antioxidant characteristics.  As an antioxidant, it protects the outer membrane and DNA of the sperm from damage and in its role in mitochondrial energy production, it enhances sperm motility. Supplementation with Co-enzyme Q10 has been associated with an increased fertilisation rate, increased sperm count and motility and may be a useful treatment in male infertility.

It is not recommended that carnitine is routinely supplemented.

The Role of Vitamin B12 in Fertility and Conception

Vitamin B12 is important for cellular replication, especially DNA synthesis. Deficiencies are associated with decreased sperm count and motility and supplementation with B12 has shown increased sperm production in men with a low sperm count. In females, vitamin B12 is necessary for ovulation and vitamin B12 deficiency is associated with pernicious anaemia which has been found to be a cause of infertility.

References

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Battaglia C., Regnani G., Marsella T., Facchinetti F., Volpe  A ( 2002) Adjuvant L-arginine in controlled ovarian hyperstimuation: a double blind randomised study. Human Reproduction 17(3): 659 – 65

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Safarinejad MR, Hosseini SY, Dadkhah F, Asgari MA.(2009) Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr. 29(1):100-5

Saldeen P, Saldeen T. (2004) Women and omega-3 Fatty acids. Obstet Gynecol Surv. 59(10):722-30

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