Lifestyle

Diet
Lifestyle
Supplements

Diet

Adapting your diet is a simple and powerful way to support your body in its reproductive efforts to boost fertility and prepare for pregnancy. Nutrition plays a major roll when it comes to having a healthy body and reproductive system. The building blocks for hormones and their regulation as well as essential fatty acids and antioxidants that influence the maturation and protection of the egg and sperm are found in the foods we eat.

Ensuring you obtain the correct type and amount of nutrients during pregnancy can also help to avoid miscarriage and support a healthy pregnancy. Good quality fresh food is always the best source of nutrition, however maximising the nutrients available to developing eggs and sperm can also be achieved by incorporating supplements into the diet. Just as nutrients in food can be helpful for fertility, there are some chemicals added to foods that can be harmful for your healthy and fertility that should be eliminated or avoided.

Trying to have a baby can be very challenging and there may be times when we don’t understand why it isn’t working. The food you eat and the way you live life are two aspects of the equation you CAN control and sometimes (as is often the case) it may be as simple as making changes to your diet and lifestyle that will provide you with all the success, so it is definitely worth doing.

The most comprehensive, long-term research study investigating the links between diet and fertility is the Harvard Nurses’ Health Study. Details of the diet and lifestyle among 18,000 women hoping to conceive, was closely monitored over 8 years. It found a six-fold increase in fertility in women who ate in a certain way and maintained a certain lifestyle. Specifically, the study found that women who had the highest fertility ate a low GI, whole food diet incorporating vegetable protein, full fat dairy and monounsaturated fats. Women with the highest fertility exercised more and took a multivitamin mineral supplement.

Fresh Fruit and Vegetables
Whole Foods
Protein
Carbohydrate
Dairy
Hydration
Alcohol
Caffeine

Fresh Fruit and Vegetables

It is best to eat seasonal, local fresh fruit and vegetables organically grown where possible. If organic is not an option then fruit and vegetables can be washed in a sink filled with water and a cup of vinegar, to remove residual pesticides/harmful chemicals. From a TCM point of view it is important to support digestion with cooked vegetables rather than raw. Dark leafy vegetables such as spinach, kale and silver beet are packed with iron, vitamin B6 and E, folic acid and antioxidants. Colourful vegetables (red or green) have loads of vitamin B6 and C while orange vegetables are full of vitamin A.

Fruit contains the highest amount of antioxidants per serving and is best eaten fresh, ripe, raw and at room temperature. However from a TCM perspective, fruit is also cold in nature and may have a descending action on the qi, so it is therefore recommended to limit fruit to 2 pieces per day. Raspberries, blueberries, strawberries, goji berries, pomegranates, prunes and raisins are best.

Whole Foods

Provide maximum nutrients, fibre, enzymes, antioxidants and taste without potentially toxic artificial flavours, colours, preservatives, sweeteners, salt or trans fats.

Avoid processed foods as much as possible ie. those with additives, pre-packaged and take away. The list below is a general guide for food additive numbers in Australia that are particularly harmful or have reported serious side effects and should be eliminated from your diet:

Flavour enhancers: 600s (MSG = 621, 635)
Sweeteners: 420-422, 900s (950-957, 959, 962, 965-968)
Colourings: 100s (160b classified as a ‘Natural Colour’, 102, 104, 107-2G, 110, 122, 123, 124, 127, 128-2G, 129, 132, 133, 142, 151, 155)
Preservatives: 200s (especially 249-252 added to processed meats.

The World Cancer Research Fund recommended ‘Consumers should stop buying and eating all processed meat products for the rest of their lives’)

Protein

Should account for 25% of your calorie intake with vegetables (beans, peas, lentils, nuts and seeds – daily limit of 30g [approx. 20 nuts]) being the best source for improving fertility outcomes according to the Harvard Nurses’ Study. As well as protein, pulses are also rich in iron and folic acid, while nuts and seeds have the added benefit of containing vitamin E, zinc and omega-3 essential fatty acids.

Small amounts of organic animal protein may also be part of a healthful fertility diet, choose grass or pasture fed meat and keep serving size to no more than the size of the palm of your hand. Red meat also provides iron, vitamin B12 and omega-3s. Organic turkey and chicken are great sources of lean protein, especially when eaten without the skin. Organic eggs are an easy to digest inexpensive source of high quality protein (plus vitamin D and B12) you can enjoy 3 – 5 eggs a week, even if your cholesterol is high.

Fish is another good alternative source of protein as well as omega 3 fatty acids, vitamin D and B12 and antioxidants such as selenium and CoQ10. It is safe to eat 2-3 serves a week of most types of fish in particular deep-sea ocean/cold water fish (salmon, snapper, trout, cod, herring). However there are a few types of fish that should be limited in your diet especially if pregnant, due to higher levels of mercury that accumulates from being long-lived and eating other fish. Mercury affects the nervous system, especially a developing nervous system of an unborn baby. One serve adult = 150g, child up to 6yrs old = 75g. Pregnant women, women planning pregnancy and young children should eat shark (flake), broadbill, marlin and swordfish no more than one serve a fortnight and should not eat any other fish during that fortnight. Orange roughy and catfish should be eaten no more than one serve a week, and no other fish should be eaten during that week. The general population should also only eat shark (flake), broadbill, marlin and swordfish one serve per week and no other fish that week (taken from Food Standards Australia New Zealand).

Soy products contain soy isoflavones (SI), a phytoestrogen with potential hormonal activity due to the similarities in chemical structure to 17-β-estradiol (estrogen) often referred to as ‘estrogen mimicking’. Research on exposure to SI from consumption is controversial and inconclusive. There are concerns for the effect of SI on reproductive health from infant exposure in milk formulas, forcing many countries to limit soy availability in this form. Much of the information regarding disruption to endocrine function and sex maturation stems from research done using animal models, however research into long-term biological effects in humans is still required. From a conservative view to
minimize any potential negative effects on fertility health, avoiding soy products is recommended.

Carbohydrate

Women with the highest fertility from the Nurses’ Health Study had a diet based on at least 60% of calories from slow release carbohydrates such as whole grains, legumes, vegetables and fruits. Consumption of processed and high GI foods (especially foods made with white flour and refined sugar, alcohol, lollies, biscuits, pastries, doughnuts, chips, and sodas) reduced fertility. The research concluded that the type of the carbs women ate had significant influence on fertility, more so than the amount. Eating a lot of high GI carbs constantly boosts blood sugar and insulin levels. This affects hormone levels and the natural pattern of ovulation, and can reduce the chances of becoming pregnant. Be sure to replace refined carbohydrate with the whole grain ones such as brown rice, wheat bread, whole-wheat pasta and legumes.

Dairy

Consuming 2 or more serves of low fat dairy products per day can increase anovulatory infertility by twice as much as women who only eat up to one serve. Eating full fat dairy was shown in the Nurses’ Study to have the opposite affect and appears to reduce the rate of infertility. Limit dairy to one serve per day of the full fat variety and consider almond or rice milk substitutes.

Hydration

Stay hydrated to efficiently flush toxins from the body and drink filtered water where possible. Eight glasses of water per day is a good guide however caffeine free herbal teas are also a good alternative to boost flavour (dandelion, rooibos, ginger, peppermint, Jasmine, rosehip, spearmint, fennel, fruit – orange, lemon, berry).

Alcohol

Alcohol intake for both men and women has been linked to a reduced ability to conceive and increased risk of miscarriage. A study from the University of California of 221 couples undergoing fertility treatment found:

For women alcohol consumption in the month before IVF attempt reduced success nearly 3 times with alcohol consumption in the week before egg pick up (one glass per day) increasing the chance of miscarriage by 2 times.
For men alcohol consumption the month before IVF reduced success 2 and a half times and alcohol (one glass per day) in the week before sperm collection reduced success more than 8 times.

The recommendation was made that couples abstain from alcohol consumption at least one month before the attempt to maximize the effectiveness and success of the IVF and GIFT procedure.

Alcohol consumption in the week prior to conception was associated with an increased the rate of miscarriage. For women ten or more drinks a week was associated with 2 to 3 times greater risk of miscarriage while for men it was 2 to 5 times greater risk.

Eur J Clin Nutr. 2009 Jan;63(1):78-86
Hum Reprod. 2007 May;22(5):1340-7
Fertil Steril. 2003 Feb;79(2):330-9
Am J Epidemiol. 2004 Oct 1;160(7):661-7

Caffeine

Caffeine intake from coffee, tea and energy drinks should be limited or at best, omitted from the diet. There is a correlation between the amount of caffeine consumed and the ability to conceive, the higher the caffeine the less likely it is to fall pregnant. Caffeine has also been linked to miscarriage and DNA damage in sperm.

We understand that it can be difficult to stop having these drinks ‘cold turkey’ and another reason to support 3-6 months fertility preparation. Gradually reduce these from everyday life & keep coffee as a treat for the weekends instead of a daily habit. As a general rule black tea has approximately half the caffeine of instant coffee and green tea has half the caffeine of black tea (but with the added benefit of antioxidants).

A study of 1,909 women in America found the risk of not conceiving for 12 months was 55% higher for women drinking 1 cup of coffee per day. It was 100% higher for women drinking 1 ½ to 3 cups and 176 % higher for women drinking more than three cups per day.

Epidemiol Rev. 1992;14:83-100

When healthy men consumed more than 3 cups of coffee per day, the damage to sperm DNA was increased by up to 20% compared to non-coffee drinkers. DNA damage can lead to chromosomal abnormalities and gene mutations after fertilization, increasing the risks of developmental defects and genetic diseases among offspring.

Hum Reprod. 2007 Jan;22(1):180-7. Epub 2006 Oct 19

Coffee drinking before and during pregnancy was associated with over twice the risk of miscarriage when the mother consumed 2 to 3 cups of coffee per day.

JAMA. 1993 Dec 22-29;270(24):2940-3

Caffeine intake of 3 or more cups a day by women or their partners doubled the rate of miscarriage in a Danish study.

Am J Epidemiol. 2004 Oct 1;160(7):661-7

Stress, sleep
Smoking
Body Weight
Exercise
Toxins
Lap tops and Male fertility

Stress, sleep

Insufficient sleep not only induces sleepiness, fatigue and changes in mood, cognition and neurophysiologic function, but also affects metabolism and weight control. Ensuring you get enough quality sleep is essential to maintain optimal hormonal regulation and energy levels. Aim for 8-9hrs of uninterrupted sleep ideally between the hours of 9pm-7am.

Trying to have a baby can be a stressful time, especially if it is taking a little longer than expected, both with natural cycles and even more so when resorting to ART due to its invasive nature. Stress measured by detecting α-amylase in the saliva of women trying to conceive, correlated with a reduced pregnancy rate. Similarly, high anxiety and stress levels in women have been associated with poorer ART outcomes, emphasising the importance of relaxation and stress relief for optimal fertility. Many research studies have demonstrated the effectiveness of acupuncture for stress reduction and inducing relaxation, believe it or not, most people fall asleep during a treatment!

A regular ‘relaxation program’ for infertile women consisting of advise for good nutrition, healthy exercise, yoga, meditation and muscle relaxation improved pregnancy outcomes by nearly three times that of women who did not participate in any relaxation methods.

Fertil Steril. 2011 Jun;95(7):2184-9
Hum Reprod. 2005 Apr;20(4):991-6
Hum Reprod. 2009 Sep;24(9):2173-82
Acupunct Med. 2012 Jun;30(2):85-8
CNS Neurosci Ther. 2012 Apr;18(4):277-84
Chin J Integr Med. 2013 Mar;19(3):187-91
J Altern Complement Med. 2013 May;19(5):420-4
Fertil Steril. 2011 Jun;95(7):2269-73
Fertil Steril. 2003 Oct;80(4):976-81

Smoking

Smoking (including cannabis) has detrimental effects on many aspects of health, including reproductive health. Toxins from smoking can be detected in many parts of the body and can be passed on to the foetus so it is important to stop as soon as possible. Chinese Medicine treatments can help you to overcome cravings and detoxify the body as part of your fertility preparation.

Affects ovarian reserve, antral follicle count, decreases AMH, poorer outcomes with IVF: reduced ovarian response & lower pregnancy rates.
Smoke compounds target reproductive function, reducing the ability to conceive & impairs ovarian reserve, production of sex hormones, function of fallopian tubes & development of embryo. Smoke compounds were detected in ovarian tissue, uterine fluid & embryo.
EVERY stage of reproductive function is a target for cigarette smoke toxicants, including folliculogenesis, steroidogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and uterine myometrium.
Men who smoke have a lower sperm count and a higher proportion of malformed sperm
Women who smoke take longer to conceive
Women who smoke are twice as likely to be infertile as non-smokers
Men and women who smoke have a poorer response to fertility treatment
Women who have stopped smoking take no longer to become pregnant than those who have  never smoked
Stopping smoking improves sperm count and quality

Arch Gynecol Obstet. 2012 Apr;285(4):1177-82
Gynecol Obstet Fertil. 2011 Oct;39(10):559-66
Hum Reprod Update. 2011 Jan-Feb;17(1):76-95
British Medical Association 2004 (link opens in new window)

Body Weight

Being underweight or overweight can negatively impact fertility by interrupting normal menstrual cycles and altering ovulation or stopping it altogether. There is a wide range of body shapes and sizes that can be healthy and your weight alone is not an accurate measure of health. Body mass index (BMI) takes into account your height and weight to indicate a healthy weight range using the formula mass kg/(height m)². A BMI of 18.5 to 24.9 is considered to be a healthy range for fertility. A small change in weight (10%) has been shown to have a positive effect on fertility, highlighting why proper/regular exercise is so important. If you are unsure of your BMI but know your height and weight (kgs) use the chart below to see if you are in the healthy zone.

Body Mass Index (BMI) chart – click image to expand

A body mass index (BMI) of 25 to 29.9 in women is considered overweight and >30 is classified as obese. This excess weight has been  linked to irregular or infrequent menstrual cycles, an increased risk of infertility, miscarriage and development of type II diabetes, Polycystic Ovarian Syndrome (PCOS), as well as decreased success with fertility treatments. Other risks increased by being overweight when pregnant include high blood pressure (pre-eclampsia), gestational diabetes and the possibility of needing a Cesarean section. The positive news is that small amounts of weight loss (5-10%) may dramatically improve ovulation and pregnancy rates.
A low BMI is associated with increased risk of miscarriage and low birth weight babies.
When maternal BMI and IVF were looked at closely, a higher BMI was linked to increased initiated IVF cycles, number of cancelled cycles and total dose of IVF drugs (poor responders). The number of eggs collected at pick up reduced as BMI increased and the number of developed embryos was reduced at either end of the spectrum for both underweight and obese women. As BMI increased the rate of hCG positive pregnancy decreased. Compared to women with a normal BMI, the ongoing pregnancy rate was lower for obese women and live birth rates were significantly reduced (15% vs 22%).
Obesity was linked with smaller (underdeveloped) and poorer quality eggs.
A 3 year multicentre study followed 333 men from sub-fertile couples to conclude that there was an increased rate (on average 2.5 times) of sperm DNA damage in obese men.
Obese men were 3.5 times more likely to have a reduced sperm count compared to men with a BMI in normal range.
Overweight and obesity were associated with reduced or no sperm count.

Hum Reprod Update. 2004 May-Jun;10(3):267-80
Hum Reprod Update. 2007 Sep-Oct;13(5):433-44
Reprod Biomed Online. 2011 Oct;23(4):490-9
Fertil Steril. 2011 May;95(6):2146-9, 2149
Obstet Gynecol. 2006 Jul;108(1):61-9
J Assist Reprod Genet. 2000 Nov;17(10):547-52
Asian J Androl. 2013 Jun 24
Int J Gen Med. 2013 Jun 7;6:447-51
Hum Reprod Update. 2013 May-Jun;19(3):221-31

Exercise

Extreme exercise has been shown to have a negative impact on fertility and may actually inhibit conception. High-intensity workouts produce an oxidative stress state that can alter hormonal balance, disrupt ovulation and alter the entire menstrual cycle. Leading a sedentary lifestyle and being overweight however can also be detrimental to fertility. Regular exercise is important for fertility and has many benefits to general health and wellbeing; moderation and balance is key so stick with something that is low-impact and done on a consistent basis.

Men who ride bicycles for 5hrs or more per week are at a higher risk of low sperm concentration and motility.

Women who are trying to conceive should exercise regularly at a moderate level for 30mins a day, 3 times a week, with 2 x 30min light strength-training sessions to improve bone density and prevent osteoporosis. Some days could include 1-2 sessions of yoga for an hour, fertility yoga has been shown to help support healthy fertility and mind. We do not suggest doing any yoga poses, pilates or sit ups after ovulation that compress the abdomen if you are trying to conceive.

Recommended exercise for women trying to conceive:

Brisk walking, 5 times a week, for 30 minutes to 1 hour
Swimming
Tai chi
Qi gong
2-3 1 hour sessions of yoga
Dancing
Nia, 2-3 times a week
Zumba, 2-3 times a week
Aerobics, 2-3 times a week
Leisurely bike riding
Light jogging

Exercise to avoid while trying to conceive:

Bikram yoga (hot yoga raises core body temperature)
Any type of regular, strenuous training for sports (running, gymnastics, ballet, etc.)
Core strength training after ovulation, including core Pilates training
Exercise 7 days a week for more than 45 minutes to 1 hour
Running for many kilometers each day
Extreme “boot-camp” training
Exercise over an hour long

Hum Reprod. 2009 Dec;24(12):3196-204
Fertil Steril. 2011 Mar 1;95(3):1025-30
Obstet Gynecol. 2006 Oct;108(4):938-45

Toxins

Avoid pesticides and chemicals where possible for example; hair dyes, chemical household cleaners, nail polish remover, garden sprays, and paint fumes.
Sperm DNA fragmentation correlated in a dose dependent manner with air pollution. Young men spraying pesticides without proper protective equipment are at risk of elevated sperm DNA fragmentation.
Toxicol Appl Pharmacol. 2005 Sep 1;207(2 Suppl):532-7
Men experiencing infertility were found to be employed in agriculture/pesticide related jobs 10  times more often than a study group of men not experiencing fertility problems.
Am J Ind Med. 1993 Nov;24(5):587-92
Miscarriage increases in women (2.1 to 4.7 times) were found after exposure to chemical  solvents. The major risk chemicals were those used in dry-cleaning, paint, paint thinners and paint strippers.
Am J Ind Med. 1991;20(2):241-59

Lap tops and Male fertility

Men sitting with their legs together and working on a laptop computer can rise the temperature by up to 2.8 degrees C. An amount sufficient to affect testicular function and impair spermatogenesis. Hum Reprod. 2005 Feb;20(2):452-5. Epub 2004 Dec 9

Supplements

It is advisable to take good quality supplements that are well balanced, highly absorbable and free of contaminants or artificial ingredients. Please note that not all supplements are suitable for everyone depending on individual cases and dosage will be discussed with your practitioner.

Pre natal multi vitamin
Folate (Vitamin B9)
Iodine
Vitamin B6
B12
Omega-3
Iron
Antioxidants
Vitamin E
CoQ10
Selenium
Vitamin D
Zinc
Royal Jelly

Pre natal multi vitamin

Make sure your pre-natal multivitamin includes B group vitamins B9 (folate), B6, B12 and also choline, a nutrient essential for the proper uptake and metabolism of folate. B group vitamins are heat sensitive and destroyed by cooking, alcohol and food processing. Water-soluble vitamin B is not stored by the body, so it is important to maintain adequate amounts as part of a well balanced diet and supplemented where required.

Folate (Vitamin B9)

The terms folic acid and folate are often used interchangeably, however folate is the nutrient utilized by the body and folic acid is the synthetic supplemental form of folate.

Healthy folate levels can help improve fertility and have been associated with a higher chance of conceiving naturally or through IVF. Supplementing 3 months prior to conception is recommended as the requirement for folate increases (doubles) in the first trimester. This is particularly important for women who have been taking the contraceptive pill, as it depletes folate (and vitamin B6) in the body. Folate is particularly important during the first 4 weeks of pregnancy when the neural tube connecting the brain and spinal cord, develops and closes. This process relies heavily on adequate folate for proper development. Deficiency of folate during this stage of pregnancy greatly increases the risk of neural tube defects as well as congenital heart defects, cleft lips, limb defects, and urinary tract anomalies in the developing foetus.

Reduced folate is associated with increased homocysteine in the body which can lead to spontaneous abortion and pregnancy complications, such as placental abruption and pre-eclampsia. Low levels may also increase the risk of going into preterm delivery and low infant birth weight.

Am J Clin Nutr. 2007 Jan;85(1):285S-288S

Food sources: Green leafy vegetables, asparagus, broccoli, corn, lima beans, parsnip, mung beans, soy beans, wheat germ, oranges, pineapple, banana legumes, seeds, liver, poultry, eggs, cereals, citrus fruits.

Iodine

The thyroid gland stores iodine to produce thyroid hormones involved in metabolism in adults and proper foetal brain and nervous system development. Thyroid activity increases during pregnancy to produce 50% more thyroid hormones, so it is essential to ensure adequate intake of iodine to support both mother and baby. Iodine deficiency during pregnancy has been linked to increased risk of miscarriage, preeclampsia, placental abruption, post partum haemorrhage, preterm delivery, stillbirth and irreversible mental retardation and brain damage to the baby.

National Health and Medical Research Council (link opens in new window)

Food sources: Dairy products (yoghurt, milk), potato with skin on, eggs, seafood (salt water), nori (dried seaweed), turkey breast, cranberries, Himalayan salt.

Vitamin B6

Vitamin B6 may be used as a hormone regulator. It also helps to regulate blood sugars, alleviates PMS, and may be useful in relieving symptoms of morning sickness. B6 has also been shown to help with Luteal Phase Defect. Vitamin B6 is required for proper absorption of vitamin B12 and low levels of B6 may contribute to a B12 deficiency. Vitamin B6 is also important for the absorption of zinc and is integral to the transfer of selenium in the body. We are unable to store vitamin B6 and excess is excreted in about 8hrs. Drinking alcohol, smoking, certain drugs including diuretics (as well as drinking caffeinated beverages) and the contraceptive pill, increases elimination from the body and deficiencies in these cases are therefore common.

Am J Epidemiol. 2007 Aug 1;166(3):304-12

Food sources: Sunflower seeds, wheat germ, walnuts, hazelnuts, brown rice, chickpeas, lentils, banana, turkey, chicken, white fish, avocado, beef, brussel sprouts, spinach, garlic, cauliflower, mustard greens, celery, cabbage, asparagus, broccoli, kale.

B12

Vitamin B12 is involved in sperm production and therefore improves sperm quality. It is required for red blood cell production and may also help to boost the endometrium lining important for embryo implantation, decreasing the chances of miscarriage. Some studies have found that a deficiency of B12 may increase the chances of irregular ovulation, and in severe cases stop ovulation altogether. Vitamin B12 is absorbed best in the presence of several other vitamins, namely Vitamins A, C, E and the other B-complex vitamins.

Hum Reprod Update. 2010 Jan-Feb;16(1):80-95

Food sources: Liver, oysters, muscles, sardines, caviar, fish, crab, lobster, beef, lamb, cheese, eggs.

Omega-3

An essential fatty acid with anti-inflammatory properties, the body is unable to produce Omega-3s on its own, so we therefore need to obtain them from foods or supplement the diet. Omega-3 is required for hormone production and balance (including prostaglandins), ovulation, increased cervical mucus, blood flow to the reproductive organs and fertilisation. In one study fertilisation rates were increased from 50.4% for untreated couples to 76.5% for couples taking omega 3 supplements and it has also been shown to improve embryo quality for IVF/ICSI procedures.

Another study looking at men with abnormal sperm, who supplemented Omega-3 into their diet, showed it almost doubled the count and concentration of total sperm cell number and improved sperm motility and morphology, and the antioxidant status of seminal plasma.

In pregnancy it aids in the development of the foetal brain and nervous systems. Omega 3 fatty acids contain EPA and DHA; low levels of DHA have been linked to depression and other mental health issues and during pregnancy may be associated with premature birth, low birth weight, chromosomal defects, spontaneous abortion, hyperactivity and asthma in children.

Obstet Gynecol Surv. 2004 Oct;59(10):722-30
Fertil Steril. 2011 Apr;95(5):1820-3
Andrologia. 2011 Feb;43(1):38-47

Food sources: Fish, prawns, scallops, sardines, mono-unsaturated cold-pressed oils (especially flaxseed), walnuts, hemp and chia seeds.

Iron

Studies have shown that women who do not have sufficient iron levels may suffer anovulation (lack of ovulation) and possibly poor egg health, which can inhibit pregnancy at a rate 60% higher than those with sufficient iron stores in their blood. The demand for iron is increased during pregnancy due to the production of new red blood cells and increased plasma volume. During the second and third trimesters the foetus will draw on the mother’s iron sores in preparation for the 4-6 months after birth, as breast milk is low in iron. Iron deficiency during pregnancy increases the risk of anaemia, pre-term delivery an low birth weight. Iron is also important for the developing brain and early developmental iron deficiency strongly indicates irreversible changes in brain structure and function.

Semin Fetal Neonatal Med. 2007 Feb;12(1):54-63
J Nutr. 2008 Dec;138(12):2534-6
Obstet Gynecol. 2006 Nov;108(5):1145-52

Food sources: Lentils, spinach, tofu, sesame seeds, kidney beans, pumpkin seeds (raw), venison, garbanzo beans, navy beans, molasses, beef.

Antioxidants

Free radicals are unstable molecules generated in the body through normal physiological processes and are usually kept in balance by antioxidants. When there are insufficient antioxidants the balance is tipped towards an overabundance of free radicals that cause cellular damage by reacting with membranes, DNA, lipids and proteins.

Reactive oxygen species are a type of free radical that cause oxidative stress (OS) and can affect many aspects of female fertility from oocyte maturation to fertilization, embryo development and pregnancy. It is thought that OS is responsible for the age-related decline in fertility as well as being involved in polycysitic ovarian disease and endometriosis. OS is also known to play a role during pregnancy and normal parturition, initiation of preterm labor, spontaneous abortions and preeclampsia.

Factors that increase the presence of free radicals in the body include environmental variables such as pollution, pesticides and radiation, as well as lifestyle factors such as smoking, stress, alcohol and poor diet.

Some common antioxidants that can supplement the diet include Vitamin E, CoQ10 and selenium.

Reprod Biol Endocrinol. 2005 Jul 14;3:28
Antioxid Redox Signal. 2008 Aug;10(8):1375-403

Vitamin E

Vitamin E is an important antioxidant to help protect sperm and egg DNA integrity from toxicity and oxidative stress. It can counteract ageing by preventing the decline of egg quality and quantity (shown in mice) and has a protective effect on sperm health to improve motility, count, viability and reduce DNA fragmentation. Two months of daily vitamin E (and vitamin C) supplementation improved the success of ICSI/IVF cycles for previously unsuccessful men with high sperm DNA fragmentation, increasing pregnancy rates 7 times from 6.9% to 48.2% and also implantation rates by up to 10 times (19.6% vs 2.2%).

Hum Reprod. 2005 Sep;20(9):2590-4
Mol Reprod Dev. 2002 Mar;61(3):385-97
Antioxid Redox Signal. 2008 Aug;10(8):1375-403

Food sources: Sunflower seeds, almonds, olives, spinach, papaya, dark leafy greens.

CoQ10

Necessary for energy function in every cell in the body, CoQ10 has also been shown to increase sperm density, motility and morphology in semen. It is also an important antioxidant that helps to protect cells from free radical damage and in this way improves egg health.

J Urol. 2012 Aug;188(2):526-31
Biofactors. 2011 Sep-Oct;37(5):374-80

Food sources: Oily fish (salmon, tuna, sardines), organ meats (liver) and whole grains. (CoQ10 levels in the body decline with age).

Selenium

A trace mineral and potent antioxidant that protects the eggs and sperm from free radical damage that can cause chromosome breaks that give rise to miscarriage and birth abnormalities. Selenium is an essential element for normal testicular development and sperm production, motility and function. Studies have shown that men with low sperm counts also have low levels of selenium. A 2011 study looking at selenium and vitamin E (another antioxidant) supplementation in a group of 690 infertile men, saw 52.6% total improvement in sperm motility, morphology, or both and 10.8% spontaneous pregnancy in comparison to men who had no treatment.

Int J Gen Med. 2011 Jan 23;4:99-104
Biol Trace Elem Res. 2011 Dec;143(3):1247-54
BMC Urol. 2012 Mar 19;12:6

Food sources: Oily fish (salmon, tuna, sardines, makerel), organ meats (liver), snapper, cod, halibut, prawns, crimini mushrooms, turkey.

Vitamin D

Vitamin D is required for the development of healthy teeth and bones, as well as the generation of sex hormones and maintaining their delicate balance. In men it is involved in the production of testosterone, an essential hormone for sperm development. In women vitamin D influences ovulation by affecting the ability of the ovaries to regulate estrogen for follicle maturation and growth. It also appears to impact the role of estrogen in the uterus, via the endometrial lining. In cases of low vitamin D the lining may not be sufficient to hold an embryo, which can lead to early stage miscarriage. A Yale study found that 97% of infertile women had a vitamin D deficiency.

In pregnancy, low vitamin D levels have been linked to low birth weight and growth retardation as well as affecting immune function and fetal bone development through to adulthood. Low maternal vitamin D levels are also linked to an increased prevalence and severity of pre-eclampsia, gestational diabetes and premature labour. Research published in 2012 following over 11,000 adults aged 25 or older, found one third of Australians to be vitamin D deficient.

Most efficiently obtained from sunlight exposure and accounting for 80-100% of the body’s supply, vitamin D is synthesized by the skin. If the UV index is above 3 then sun protection is still recommended (especially in the northern states of Australia) but a general guide is for 5-15mins of sun exposure to the face and upper limbs 4-6 times per week, before 10am and after 2pm is the safest. The time is impacted by the darkness of your skin; darker skin is more sun resistant therefore requiring longer exposures to adsorb adequate vitamin D.

Reprod Biol Endocrinol. 2011 Nov 2;9:146
Hum Reprod. 2011 Jun;26(6):1307-17

Food sources: Oily fish (salmon, tuna, sardines, mackerel, herring catfish), oysters, organ meats (liver), eggs, dairy, soymilk, cod liver oil, shiitake & button mushrooms.

Zinc

Interacts with more than 300 different enzymes in the body for optimal cell division and hormone balance to keep your reproductive system functioning properly.

In women zinc is important for the maturation of eggs so they are ready for fertilisation and maintaining sufficient fluid levels in the follicles, so that an egg can travel through the fallopian tubes and into the uterus for implantation. Crucial to hormone regulation during the menstrual cycle (especially at ovulation and post ovulation) zinc stabilizes the reproductive hormones estrogen, progesterone and testosterone. Low levels of zinc have been directly linked to miscarriage in the early stages of a pregnancy, according to The Centers for Disease Control’s Assisted Reproductive Technology Report in the USA and also low birth weights.

Increasing the level of zinc in infertile men has been shown to boost sperm numbers, improve the form, function and quality of male sperm and decrease male infertility. Zinc is required during the sperm maturation process to create the outer membrane and tail, essential for mobility and strength to survive the long journey through the vagina, cervix, uterus and fallopian tubes, to reach and fertilise an egg. Low zinc is also associated with chromosomal defects in sperm, linked to poor embryo development and also miscarriage, even after fertilization or implantation has taken place and even if embryos initially look healthy.

BMC Urol. 2012 Mar 19;12:6
Nutr Res. 2009 Feb;29(2):82-8
Mymensingh Med J. 2012 Oct;21(4):588-93

Food sources: Calf liver, oysters, beef, lamb, venison, sesame seeds, pumpkin seeds (pepitas), yogurt, turkey, green peas, prawns. Cooking food can damage zinc so it is important to eat some foods high in zinc in their raw forms.

Royal Jelly

A natural bee product rich in all of the essential amino acids, containing high levels of vitamin A, B, C, D and E, plus minerals calcium and iron. A super food for fertility, Royal Jelly has traditionally been used in Chinese culture to support health and longevity, hormone balance, egg health/quality and general fertility.

Many properties of Royal Jelly have been reported by medical research including anti-inflammatory, antioxidant, anti-tumor, antibiotic, antidepressant, immunomodulatory (affecting the immune system), estrogenic (estrogen like), neurogenic (impacting the nervous system) and improve glucose tolerance.

Only royal jelly is fed to the queen bee throughout her lifetime who will last for approximately 6 years (most bees live for 2 months) in which time she will lay millions of eggs, up to 2,000 per day.

Royal Jelly can be taken in capsule form but it is not suitable for asthma sufferers or those allergic to bee stings, due to potential to induce allergic reactions.

J Food Sci. 2008 Nov;73(9):R117-24