Trying to get pregnant? 5 things you should know about lifestyle and fertility
Fertility and lifestyle is a tricky and complex topic. It is always possible to find people who have not taken good care of themselves, but still easily have children and live a long time. Still we do know that our lifestyle does affect our general health which can in turn affect our fertility. Things like what we eat, if we smoke, and how we sleep undoubtedly affect our body in many ways.
When it comes to fertility, there are unfortunately lots of generalizations out there, like "coffee is not good for fertility" or "stick to eating a Mediterranean diet." It can be stressful to try to adhere to those rules exactly and they're unlikely to all be helpful given your specific challenges.
Fertility problems can be due to a wide range of factors and you alwys have to consider your own case before taking any advise. As an example, if you have ovulation issues, cutting down on coffee may help. But if your problem is blocked fallopian tubes, then drinking less coffee will not address the issue.
It's basically a good idea to learn why and how different things can affect health and fertility in order to make informed decisions.
Let's go through a variety of lifestyle factors, and what the research says about how they can affect fertility.
1. Smoking + Fertility = ?
Smoking is proven to be harmful for everyone, and quitting smoking is always a good decision - for your health in general, and if you want to get pregnant. This applies to all genders. Quitting smoking can be difficult, but it might help to better understand what effects it has on your body and on fertility in particular.
Smoking affects fertility in several different ways:
- The chemicals found in cigarette smoke contribute to you losing your ovarian reserve at a faster rate. Studies show that on average, women who smoke reach menopause 2 years earlier than those who do not. Those who are exposed to passive smoking have also been shown to reach menopause somewhat earlier, which says a lot about how harmful smoking is.
- Because your eggs are cells, they are negatively affected by something called oxidative stress, and which smoking contributes to. Oxidative stress damages the egg cells' DNA or chromosomes, which means the egg quality deteriorates affecting the eggs' ability to lead to a healthy pregnancy. Egg quality decreases with age for everyone, regardless of their lifestyle (because increasing age also drives oxidative stress). Egg quality is difficult to research, so it's hard to say exactly how much effect smoking has. But it's clear that it does have a negative effect.
- The sperm are also cells, and their quality is thus also negatively affected by smoking.
- Smoking affects your hormone production (like estrogen and progesterone). The right hormone balance is crucial for being able to ovulate, build up the uterine lining so it can receive an embryo, and other aspects of your cycle as well.
- Smoking can also reduce the formation of new vessels in the uterus, which can make it more difficult for embryos to implant.
It is primarily the nicotine in cigarettes that affects fertility, but other toxins have an affect too, like benzo(a)pyrene (BaP). The good news is that most affects of smoking are not permanent - many can be improved by quitting smoking.
2. Can I drink wine when trying to conceive (TTC)?
Most people know that you shouldn't drink alcohol when you're pregnant because alcohol can harm the fetus, but what about when you are trying to get pregnant?
Researchers have found a correlation between high alcohol intake and fertility problems, but it's difficult to determine whether it's due to the alcohol alone, or if other unhealthy lifestyle factors play a role.
And exactly how much is TOO much is still debated. Large intakes of alcohol are never good for your overall health, and if you have begun fertility treatment, decreasing your intake is often recommended.
But regardless of where you are in your TTC process, it's good to understand HOW alcohol can actually affect fertility...
Alcohol must be broken down in the liver, which means the liver cannot focus as much on breaking down things related to fertility, like estrogen. Alcohol can also increase the conversion of androgens to estrogen in the liver. Have you ever felt that your PMS or menstrual cramps got worse when you drank more than usual? That makes sense, because that leads to too much estrogen compared to other hormones. That's called "estrogen dominance," and it can cause these symptoms:
- Irregular cycle
- Sore breasts
- Insomnia & fatigue
- Slow metabolism & weight gain
An irregular cycle can make it harder to identify your fertile days. So if you drink alcohol and have trouble tracking your cycle, it may be worth seeing if a reduction in alcohol changes anything.
Our bodies can react differently, and your overall lifestyle comes into play too, so it's good to test things out for yourself.
Endometriosis is triggered by estrogen dominance (and inflammation, which alcohol also contributes to). So if you have endometriosis, alcohol is not your best friend.
Egg and sperm quality
Just like smoking, alcohol creates oxidative stress, which affects the germ cells - eggs and sperm.
When it comes to eggs, a lot more research needs to be done to understand the impact of alcohol on egg quality. Sperm are easier to study because they are easier to collect, and they're created continuously, so it's easier to compare different lifestyles.
A high alcohol intake has been linked to reduced sperm quality - in terms of volume, concentration and mobility - so if you have seen a reduced sperm quality from a sperm sample, it can be good to review your alcohol intake.
At the end of the day, you don't have to say no to every happy hour because you want to get pregnant. But, long-term excessive intake isn't good for either your general health or your fertility. If you have an irregular cycle, endometriosis or low egg and/or sperm quality, then it may be worthwhile to review how much you drink before and while trying to conceive.
3. Is it true that caffeine impairs fertility?
There are a lot of generalizing statements out there about caffeine reducing fertility. At the same time, lots of people get pregnant even though they drink coffee. So what's the deal?
Well, caffeine can affect your hormone balance because it's broken down by the liver using an enzyme called CYP1A2, one of the enzymes that also breaks down estrogen.
Too much caffeine (more than 200-300 mg/day, which roughly corresponds to more than 2-3 cups of coffee) can therefore affect how different hormones are metabolized in the body, and how well your menstrual cycle works.
Should I stop drinking caffeine
Knowing now the effect that caffeine can have on your body, you can determine if it's something you'd like to explore and adjust, given your personal circumstances and how you experience your cycle.
We are all different, but an irregular cycle, or a lot of menstrual pain or PMS, are not things to simply live with. They typically point to some form of hormonal imbalance, and if your cycle improves when you reduce alcohol or caffeine, you can assume that they affect you and your hormonal balance.
4. Fertility lifestyle: what about diet, exercise and weight?
Overweight and underweight people are overrepresented among those who need help getting pregnant. But, that doesn't mean that someone's BMI is directly connected to their fertility. Instead, you can explore whether there are underlying causes of weight issues that affect fertility, or whether your weight contributes to a hormonal imbalance that can make it harder to get pregnant.
In other words, it's the state of your health, like what you eat and how you exercise, that affects fertility - not just the number on the scales.
Studies do show that it tends to take overweight people longer to get pregnant, due to everything from hormonal imbalances that lead to missed ovulation to reduced egg quality. But WHY?
That's the interesting part. Let's go through a number of conditions that can be triggered by weight gain or loss, and how different types of diet and exercise affect fertility.
Polycystic Ovary Syndrome, or PCOS, is a relatively common syndrome that is estimated to be present in 10-15% of all fertile women, often manifested by irregular cycles and other symptoms.
This can make it harder to get pregnant, primarily because ovulation can be absent or very difficult to identify. With PCOS, the body produces too much of the male sex hormones, and also has difficulty assimilating insulin (which is called insulin resistance).
So, it's extra important to maintain a healthy weight and even blood sugar levels if you have PCOS.
In obese women with PCOS, a weight loss of as little as 5-10% can improve hormone balance and contribute to a more regular menstrual cycle.
Regardless of your weight, if you have PCOS, it's good for you to do regular physical activity - especially strength training that increases your muscle mass and improves your insulin sensitivity and your hormone balance.
To stabilize your blood sugar through your diet, sugar and fast carbohydrates create fast fluctuations that you want to avoid. Try adjusting your intakes and use your menstrual cycle as a diagnostic tool to figure out what works for you. Do your blood sugar levels stabilize when you change your diet or lose weight? If it does, maybe it's worth it to adjust your food intake more permanently.
We mentioned before that it can be good to avoid alcohol if you experience signs of estrogen dominance. But your estrogen levels can also be too low. Symptoms of estrogen deficiency are:
- Missed or sparse menstruation (meaning you rarely get your period)
- Light bleeding
- Dry mucous membranes
- Decreased sex drive
- Increased feeling of coldness
Estrogen deficiency is most common among women who have lost a lot of weight or lost it quickly, and/or overtrain. This appears not only in elite sports women or those with severe eating disorders. People who think they're very healthy, but whose bodies don't really get what they need, can also have estrogen deficiency. Remember - an irregular cycle is always a sign that something is not right, and it can be valuable to find out the cause.
If estrogen deficiency is the problem and you know that you avoid foods high in calories or fat, or you exercise a lot (especially endurance training such as running), then it may be worth trying to eat more (especially fat), reduce your training, and focus more on strength training.
So it's not just about weight - you can be very slim and still have a fully functioning cycle, but that's not the case for everyone. It's how we treat our bodies on a daily basis that matters most.
Impaired thyroid function
If you have an over- or underactive thyroid gland, it can affect not only your weight an ability to gain or lose wight, it can also affect your hormone levels and thus your ovulation and your ability to become pregnant.
It's easy to get your thyroid checked via blood test and there are medications to get, but many also manage to stabilise thyroid values through lifestyle changes.
Testosterone deficiency in men
In men, researchers have been able to see a link between obesity and a reduced chance of pregnancy. This is mainly due to abdominal obesity, high blood sugar and high blood fats, lowering the levels of the hormone testosterone, which is necessary for male fertility.
Egg & sperm quality
Earlier, we looked at how eggs and sperm are cells that are affected by oxidative stress.
Sperm are constantly being produced, so you have the opportunity to influence your sperm quality through lifestyle changes. Women, on the other hand, are born with all the eggs you have. Avoiding the reduction in egg quality that comes with age is difficult, but it doesn't hurt to maintain a healthy lifestyle.
Studies have shown that overweight women have poorer egg quality, which is probably due to an overrepresentation of people with an unhealthy lifestyle that creates oxidative stress (which impairs egg quality). Below you can see what drives oxidative stress and what can counteract it - namely antioxidants.
5. Stress and fertility: Does it help to de-stress?
Stress is something we have all felt at some point, but it can be difficult to determine how stressed you really are.
There is conscious stress (e.g. "I know I have too much to do"), but also unconscious stress. If you go through something very tiring or if you workout very hard, it can stresses the body. But it can be hard to know just how much.
Extra intense workouts are tricky, because they can make you feel good, even if your body does not. Your menstrual cycle can be a good diagnostic tool in this case.
Many people who try to get pregnant are told that they need to "just relax." Even if it's said with good intentions, it usually has the opposite effect.
Those who give that "advice" don't understand the complexity surrounding either stress or fertility. Walking around and actively trying not to be stressed, and trying to do everything right, is extremely stressful in itself.
So, we know that relaxing is not a cure for infertility. But it's still good to understand a little more about how stress can affect your hormones, and what warning signs are important to look out for.
A disturbed cycle is always a sign that something is not right
If you start menstruating less often or bleeding less, or if menstruation is completely absent, AND you know that you expose your body to stress in the form of too little energy intake and high energy outputs, then that stress can be a reason for your irregular cycle.
This is because your body goes into "survival mode," and the brain shuts down all processes that are not vital, including your reproduction. When that happens, the amount stress a body can handle is individual, so you simply have to listen to your own cycle and find what works for you.
If your period has completely disappeared, the condition is called "hypothalamic amenorrhea." Getting your cycle back can take time, so the earlier you identify warning signs the better.
This type of problem often manifests itself in low estrogen levels, so keeping track of your hormone levels is valuable. With Tilly Fertility Check, you can get a good idea of how things are looking for you.
Prolonged stress can affect your thyroid gland
Quite simply, you can say that stress affects your hypothalamus and pituitary gland, which are located in your brain. Because these organs interact with the thyroid gland, it is also impacted.
Thyroid problems can also disrupt your cycle, but also have other symptoms that are good to be vigilant about. You can read more here.
Always listen to your cycle, but don't just accept the first explanation you find for why things might be out of balance. Consider how you feel, and how you live your life, and find what works for you.
1 - https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
2 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079277/
Evangelia Elenis, MD, PhD.
This text is fact checked by Evangelia Elenis, MD, PhD. Dr. Elenis is a chief physician in Obstetrics and Gynecology, and a subspecialist in Reproductive Medicine. She is a PhD and affiliated researcher at Uppsala University with postdoctoral studies at Harvard Medical School.
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