Reproductive Health

How does lifestyle affect a woman’s fertility?

What are the lifestyle factors that could affect female reproductive potential?

More and more scientific studies show that the health of an individual is closely related to his lifestyle and the most recent evidence shows that lifestyle is of fundamental importance especially for one’s reproductive health.

Here are some tips from Dr. Gemma Fabozzi, Embryologist and Nutritionist of the B-Woman Center for Women’s Health, for those looking for a spontaneous pregnancy or through assisted fertilization, in the light of the latest scientific evidence published in the literature.

Physical activity: yes but without exaggerating

Moderate physical activity seems to be related to higher pregnancy rates especially in overweight women, on the contrary, excessive physical activity seems to be counterproductive.

In fact, women who train daily by practicing sports that require special efforts have an increased risk of infertility of 2.3–3 times (1). This can be due to multiple factors.

First of all, excessive physical activity generates an energy deficiency necessary for the maintenance of ovarian function, which is why in most cases there is an interruption of the menstrual cycle (1).

Secondly, there is an increase in cortisol, also called stress hormone, which could play a role in the etiopathogenesis of sub-fertility by acting on the hypothalamic-pituitary-adrenal axis (2).

Tip: Choose a moderate activity such as Yoga, perfect not only to tone the muscles, improve body elasticity and posture, but also to improve blood circulation, oxygenation of organs and promote their function and detoxification. And remember: physical activity is not synonymous with sports. To maintain our psychophysical well-being you do not necessarily have to go to the gym, just take the car a little less and stop using the elevator walking every day for at least 1 hour on foot without tiring our body and subjecting it to unnecessary stress.

Limit the consumption of coffee and caffeine

Caffeine is a central nervous system stimulant and its consumption has been shown to affect reproductive health by affecting the levels of circulating hormones. For example, it has been shown by several studies that excessive caffeine intake is related to low circulating estrogen levels (3-6), a phenomenon that may be due to the fact that caffeine and estradiol are both metabolized by the liver enzyme CYP1A293,94, but also by the fact that those who consume more caffeine have increased levels of a protein that binds sex hormones called SHBG (sex hormone building protein) which carries them in an inactive form in the bloodstream (7-9).

Furthermore, it has been reported by two different meta-analysis studies that high preconception caffeine consumption is associated with a small but significant increased risk of miscarriage (SAB) (10, 11).

Tip: Limit your daily caffeine consumption to 200mg, which is 2 coffees per day, as recommended by the European Food Safety Authority (EFSA) for women who wish to conceive (12). But be careful! Caffeine is not only present in coffee but also in many beverages such as tea and carbonated soft drinks, but also in some foods of industrial origin and some drugs.

Quit smoking

Several epidemiological studies have shown that smoking has a harmful impact on women’s fertility both in the case of spontaneous conception and through assisted fertilization, highlighting that in smokers the incidence of infertility is greater and the time required for conception is increased compared to non-smokers (13).

Smoking has also been shown to be associated with increased miscarriage, both in spontaneous and assisted conception (14-16), and ectopic pregnancy (17,18).

Smoking also appears to adversely affect endometrial receptivity. In fact, it has been reported in the literature that even in the case of assisted reproduction with egg donation, smoking patients have lower pregnancy rates than non-smokers (19) and that women smokers have a lower endometrial thickness than non-smokers on the day of embryo transfer (20).

Finally, it has been shown that smoking can accelerate the loss of reproductive function in women by anticipating menopause by 1-4 years (21-24).

Advice: As also recommended by the American Society for Reproductive Medicine, women trying to become pregnant should absolutely stop smoking and try to avoid exposure to secondhand smoke as it is now proven that even non-smokers, if excessively exposed to smoke , can have reproductive consequences comparable to those of smokers. (25). This, not only to be more likely to conceive and carry the pregnancy to term and protect the mother’s health, but also to protect the future health of the baby. In fact, it has been demonstrated that quitting smoking before and during pregnancy would greatly reduce therisk of cot death (SIDS)of the baby (26).

Stop drinking alcohol

It has already been widely demonstrated that maternal alcohol consumption during pregnancy can have negative effects on the child, especially on brain development. But what seems to emerge from the latest studies is that the intake of alcohol in the pre-conception period seems to have a negative effect on fertility. In fact, alcohol can interfere with the functioning of the glands that regulate the production of sex hormones and can cause reduced fertility in both men and women.

For example, it has been shown that women who consume alcohol immediately before starting (and during) assisted reproduction treatment have an increased risk of miscarriage and a reduced likelihood of becoming pregnant, despite a relatively low alcohol intake. low (average of 6.1 and 7.1 g/d, respectively) (27).

Furthermore, it has been observed that women who consume more than 50 g of alcohol per week have lower E2 levels and lower fertilization rates (28). NB. A small glass of wine (125 ml) contains an average of 12 g of alcohol.

Advice: Since there is no safe level of alcohol consumption, women seeking to conceive should cautiously abstain from alcohol.

Check your weight

Many studies show that both overweight (BMI 25–29.9) and underweight (BMI<19) women have a similar risk of infertility (29).

OVERWEIGHT: it has been demonstrated that overweight women have lower pregnancy and live birth rates than women of normal weight (30-35) and that, in particular, frankly obese women (BMI>30) have a risk of ovulatory problems more than twice as large (36, 37).

UNDERWEIGHT: Underweight women (BMI <19 kg/m2) have been shown to spend four times longer than women of normal weight. Notably, underweight women take an average of 29 months to conceive compared with 6.8 months in women of normal weight [37, 38]. This happens because when there is an energy shortage, our body exploits the few resources it has to keep our vital organs functioning, to the detriment of the organs assigned to other functions such as the reproductive ones (fountain). This is the reason why, in conditions of energy deficit and fat mass, ovarian function fails.

Tip: Getting back into shape helps fertility. If you are overweight or underweight, avoid do-it-yourself diets which risk creating worse damage. Consult an expert nutritionist to find your ideal weight before starting the search for a pregnancy, either spontaneously or through assisted procreation. It will help you regulate your menstrual cycles and improve your reproductive chances

Pay attention to nutrition

More and more scientific studies show how nutrition can influence the time needed to achieve pregnancy, both naturally and through assisted reproduction. With regard to fertility in general, it has been reported that nutrition can decrease the risk of infertility due to ovulatory problems (39).

The correlation between the Mediterranean diet and fertility has also been demonstrated, as women who have this type of diet show less difficulty in achieving pregnancy (40) while those who eat “fast food” junk foods and little fruit and vegetables more frequently, take on average a longer period to become mothers (41).

Several studies have highlighted the key role of fish in achieving pregnancy, particularly if it contains ω-3 polyunsaturated fats (42,43). One study showed that couples in which both partners have 61% higher fertility and a 13% lower incidence of infertility than couples who consume less fish (44).

Another important aspect seems to be glucose homeostasis and insulin sensitivity (45). It has been widely demonstrated, in fact, that in women, specifically, with the ovarian production of androgens, confirming their role of sugars in the pathogenesis of sub-fertility in particular in women with polycystic ovary syndrome (46-50).

Nutrition during assisted reproduction also seems to play an important role in achieving pregnancy (51-53). It has been reported, in fact, that also in this case a “Mediterranean” diet (vegetables and vegetable oils, fish and legumes, low intake of snacks) before and during an assisted fertilization course is associated with a greater probability of pregnancy, a correlation that instead does not seem to exist with a “healthy” diet, with poorly processed foods (eg fruit, vegetables, legumes, whole grains and fish, low intake of mayonnaise, snacks and meat) but still not of the “Mediterranean” type, highlighting the key , one of the key foods of the Mediterranean diet, for fertility.

Tip: Follow a balanced diet, rich in monounsaturated fats (eg olive oil) and ω-3 polyunsaturated fats (contained in avocado, salmon, dried fruit) limiting trans fats present especially in hydrogenated fatsmainly contained in products of industrial origin (Margarines, snacks, snacks, pretzels, frozen products (breaded fish, chips, etc.), stock cubes, soup preparations, fast-food foods, popcorn bags, etc. Consume a lot of fresh fish, favoring the blue and small cut, which will be less likely to be contaminated with methylmercury. Do not be afraid to use olive oil that does not make you fat, rather it is a powerful antioxidant that can be of great help for your fertility. Rather, limit the consumption of simple sugars, paying more attention to the overall glycemic load of meals, avoiding spikes in blood sugar (blood sugar levels) and therefore insulin, (hormone produced by the pancreas to lower circulating sugar levels).

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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