Untitled

Preconception Nutrition and Fertility

• Specific preconceptional and periconceptional nutrition-related conditions may influence fertility, pregnancy course, and outcomes.
• Fertility and pregnancy can be affected by obesity, being underweight, negative energy balance, eating disorders, diabetes, polycystic ovary syndrome, phenylketonuria, and celiac disease.

Obesity and Infertility

• Overweight and obese women should receive counseling on the roles of diet and physical activity in reproductive health.
• A loss of 5-10% of body weight can restore ovulation.
• Weight loss should be the first choice of treatment for obese women and men with fertility problems.
• Overweight/obesity relates to fertility issues like PCOS, insulin resistance, and menstruation/ovulation problems.
• Obesity reduces sperm quality.
• Simple diet and exercise interventions can reverse the damaging effects of obesity on sperm function.
• Male obesity impairs offspring metabolic and reproductive health.
• Increased fat tissue enhances endogenous and exogenous steroidal hormones and increases storage of lipid-soluble steroids.
• Changes in metabolism and excretion of hormones or altered production of steroid hormone binding proteins (SHBG) can occur.
• Estrogen receptor changes.
• Enhanced peripheral conversion of adrenal androgens to additional estrogens in adipose tissue.
• Excessive estrogen feedback to the HPO axis inhibits ovary function.
• Weight reduction methods should focus on behavioral goals and skills, including meal planning and physical activity.
• Medications or weight loss surgery may also be indicated.

Diabetes and Infertility

• Type 1, type 2, and gestational diabetes can contribute to infertility in men and women if poorly controlled.
• Chronic high blood glucose levels affect hormone levels.
• Men with diabetes are twice as likely to suffer from low testosterone than men without diabetes.
• Carbohydrate counting tends to be an effective management strategy for diabetes.

Polycystic Ovary Syndrome (PCOS) and Fertility

• PCOS is a leading cause of female infertility, affecting 5-10% of reproductive-age women.
• Many with PCOS are obese or have high levels of intra-abdominal fat.
• The cause is uncertain, but insulin resistance is a leading candidate.
• Insulin acts synergistically with LH to enhance androgen production in the ovary.
• Insulin decreases hepatic synthesis and secretion of sex hormone-binding globulin, increasing free testosterone levels.
• Nutritional management of PCOS: aim to increase insulin sensitivity with insulin-sensitizing drugs.
• Recommended diet: lean proteins, whole grains, fruits and vegetables, regular meals, non-fat dairy, and low-glycemic index carbohydrates.
• Weight loss and exercise are also recommended.

Underweight and Fertility

• Women with low BMIs may develop anovulation and amenorrhea.
• BMI <18.5 can be a contributing factor.
• It is related to reduced hypothalamic production of gonadotropin-releasing hormone and insufficient fat for proper hormonal balance.
• Increasing food intake is the best way to increase BMI.

Negative Energy Balance and Fertility

• Hypothalamic amenorrhea involves the loss of menstrual cycles due to the absence of ovulation and is caused by deficits in energy and nutrients.
• Anorexia nervosa and bulimia nervosa are linked to hypothalamic amenorrhea in some women.
• It can lead to higher likelihoods women will miscarry, have preterm delivery, and deliver low-birthweight infants.
• Ovulation and menstruation resume with normal eating and weight gain.

Theory of Nutritional Infertility

• Low fuel detected by cells in the hindbrain triggers the release of neuropeptide Y and catecholamines.
• This, in turn, can block GnRH, which can inhibit ovum or sperm production.
• Lack of oxidizable fuels can be due to low energy intake, excess energy expenditure, or interference with energy availability due to diseases like diabetes or malabsorption.

Dutch Hunger Winter ('44-'45)

• During this period, the Nazi occupation of the Netherlands caused transportation problems and food shortages.
• In other areas of the same war that did not experience the event, were no strike & no effect on reproduction.
• Menstrual cycles were abnormal in about 50% of women.
• Sperm counts were lower, with shorter lifespans and reduced motility.
• Lowered interest in sex.

Energy Deficiency and Male Fertility

• Decreased energy intake (50%) & weight loss occured during World War 2
• Lower interest in sex
• Altered sperm numbers and activity.
• Sperm counts normalized after weight regain.

Negative Energy Balance and Fertility (cont'd)

• Female athletic triad and fertility: triggered when energy intake is 30% less than required.
• Results in a decrease in LH and FSH an a lack of estrogen.

Treatment of the female athletic triad

• Correction of negative energy balance
• Restoration of ovulation
• Bone mass accretion

Celiac Disease

• Celiac disease is an autoimmune disorder that damages the intestinal lining due to gluten consumption.
• This can impair the absorption of critical nutrients, impacting fertility and health in both men and women.
• There is a significantly higher risk of miscarriage, low birth weight, and preterm delivery for people with celiac disease
• Treatment involves eliminating foods containing gluten.
• Vitamin and mineral deficiencies and other health consequences in people with untreated celiac disease include:
  • Vitamin Deficiencies: Folate, Vitamin B12, Vitamin A, Vitamin D, Vitamin E, Vitamin K
  • Mineral Deficiencies: Calcium, Iron
  • Other potential Health Problems: Lactose maldigestion / intolerance, weight Loss, Anemia, Osteoporosis, Subfertility, Growth failure, Irritable bowel disease.
• Nutrition Care Process for individuals with celiac disease includes:
  • Nutrition Assessment of food/nutrition-related history and assessment of biochemical data and medical results.
  • Nutrition Intervention by providing education and guidance on nutritionally adequate, gluten-free diet.
  • Nutrition Monitoring and Evaluation of dietary intake, gluten intake from all sources, and persistent gastrointestinal symptoms.

Nutrition Recommendations During Preconception

• Women need extra folate, iron, and DHA (an omega-3 fatty acid).
• Men need adequate zinc and antioxidants.
• Plays a critical role in creating hemoglobin, which attaches to red blood cells and delivers oxygen throughout the body.
• Women who are anemic during their first trimester of pregnancy have babies who show more delays in development and have behavioral and learning issues.
• Recommended intake during preconception/pregnancy: 27 mg / day of iron.
• Women should begin taking iron supplements prior to becoming pregnant and continue taking iron throughout pregnancy.
• Iodine is necessary for propery thyroid function, and a thyroid disfunction may result in subfertility.

Lifestyle Habits During Preconception

• Data remain mixed on whether caffeine contributes to miscarriage and low birth weight.
• Caffeine recommendations: no more than 200 mg per day for women who are pregnant.
• Alcohol is a known teratogen during pregnancy, and intake can cause stillbirth, preterm birth, and miscarriage.
• No amount of alcohol is recommended during pregnancy.
• There is some evidence to suggest binge or excessive drinking affects fertility.
• Marijuana has been found to be teratogenic during pregnancy.
• 23.3% of women reported smoking in the 3 months prior to pregnancy.
• Smoking limits the amount of oxygen available to the baby and can cause tissue damage.
• Can lead to fewer nutrients delivered and less waste removed, leading to birth complications and low birth weight.
• Can make it harder for a woman to get pregnant.

Nutrition Recommendations During Preconception for men

• Antioxidants in the diet, such as vitamin E, vitamin C, glutathione, and coenzyme Q10, can boost fertility.
• Zinc may support increasing fertility.
• An important component of sperm development
• Folate status may affect male fertility.
• Higher levels of dietary folate intake are related to fewer chromosomally abnormal sperm
• Moderate soy intake is recommended.
• Alcohol consumption may cause infertility by affecting male reproductive hormones and impairing sperm.