The best approach to staying fertile in today's busy world is to take care of yourself: Eat well, sleep well, reduce your stress, and take all things in moderation.
If you are undergoing treatment or are trying to get pregnant, you may be looking for some additional guidance and recommendations around particular topics – from acupuncture to vitamins.
At CRH, we talk through all questions with our patients. Below are some of the most common topics that come up in those discussions. Learn more about what's permissible, and what to avoid throughout fertility treatment and your journey to pregnancy.
Lifestyle Impact FAQs
Acupuncture is fine throughout treatment! We do recommend stopping herbal preparations as these are not regulated and may contain hormones or other agents that can interfere with treatment medications.
Alcohol use leading up to fertility treatment does not affect treatment outcomes.
For women, one glass of beer/wine is fine until ovulation or day of retrieval, but we recommend minimizing alcohol intake after ovulation or after embryo transfer. It is recommended to stop alcohol use after a positive pregnancy test.
For men, 1-2 glasses of wine or beer a day is fine.
The goal is BMI < 25 for all patients. BMI > 25 can negatively impact sperm and oocyte quality. In women, BMI > 25 can decrease pregnancy rates, and increase risk for miscarriage and pregnancy complications (hypertension, diabetes).
There are no adverse effects of moderate caffeine use leading up to or during fertility treatments. Recommend limiting caffeine consumption to 1-2 cups of coffee per day (~200mg) during fertility treatment and pregnancy.
Everything in moderation, but here are some specifics:
Decrease foods with a high glycemic index (processed foods, sugars, simple carbohydrates).
Increase intake of whole grains.
No evidence that dairy or animal protein negatively impacts fertility, though these typically contain higher levels of environmental contaminants.
No evidence that gluten negatively impacts fertility (except in individuals with celiac disease).
There is some evidence that a Mediterranean diet is associated with higher sperm quality.
Moderate exercise is part of a healthy lifestyle, and permitted during treatment and pregnancy.
For intrauterine insemination (IUI) cycles: no restrictions on exercise before or after the IUI.
For IVF cycles: moderate exercise is fine (walking, light jogging, hiking, biking, light weights).
For frozen embryo transfer cycles: No restrictions on exercise prior to embryo transfer.
Moderate intensity exercise in pregnancy is fine.
Women: preconception use is fine. Avoid after ovulation or embryo transfer and in pregnancy.
Men: limit use as prolonged exposure to heat can negatively impact sperm quantity and motility.
Medications to avoid or limit after cycle day 5 (IUI and IVF cycles):
Botox: no data on safety of Botox in pregnancy. Recommend patients who are pregnant or trying to become pregnant avoid Botox.
Acne treatments: avoid Retin-A and retinoids
Very little (5% or less) of the active medication applied to the skin is absorbed into the body, so it is not thought that these products pose an increased risk of birth defects. However, as studies are lacking, we recommend using these judiciously.
If you are doing IVF with an embryo transfer, we would prefer you remain local from a positive pregnancy test until the first ultrasound that confirms an intrauterine pregnancy. It is okay to travel from the time of an IUI or embryo transfer until the time of the pregnancy test. Airline travel is safe in patients with uncomplicated pregnancies until 36 weeks.
We recognize that there may be some concern around vaccinations during treatment or pregnancy. Here are some guidelines:
Ensuring immunity against measles, mumps and rubella (MMR) and chickenpox (varicella) is important as these immunizations cannot be given during pregnancy, and infection in non-immune pregnant patients can adversely affect the fetus.
Recommend vaccination for non-immune patients prior to attempting pregnancy. Patients need to wait 1 month prior to pregnancy after getting the MMR vaccine and 2 months prior to pregnancy after getting the varicelle vaccine.
Vaccines recommended for all pregnant patients include: influenza and tDAP (tetanus, diphtheria, pertus sis). Flu vaccine is recommended for patients undergoing fertility treatment during flu season.
Information regarding the COVID-19 vaccine can be found here.
Below is a list of vitamins and supplements that may be beneficial or should be avoided.
For women:
Folic acid (400-800mcg per day; included in prenatal vitamins)
Omega-3 fatty acids (DHA, EPA)
May be beneficial but not necessary (studies are limited):
DHEA 50-75mg per day
Coenzyme Q10/ubiquinol 200-600mg per day
Melatonin 2-4mg per day (at bedtime)
Very high dose of vitamin A (>5000 IU per day) should be avoided as this has been associated with birth defects
For men:
Folic acid (5mg per day)
Zinc
Antioxidants may improve sperm quantity and quality.
Antioxidants can be found in dietary sources as well as supplements.
Supplements: Arginine, Carnitines, Coenzyme Q10/Ubiquinol, Folic acid, Glutathione, Lycopene, N-acetylcysteine, Selenium, Vitamin A, Vitamin E, Zinc
Risk Factors
For Women
Maternal age is the most significant factor related to a woman's ability to conceive. While many women today are waiting to become pregnant, the ovary's ability to produce normal, healthy eggs declines with age, increasing the risk of chromosomal abnormalities and unsuccessful implantation and pregnancy.
The likelihood for successful pregnancy begins to decrease in the early 30s. While this decline is initially quite minimal, as years pass, the rate of decline in fertility increases and begins to rapidly accelerate around 37-38 with an acute fall beyond 42 years of age. Because of the importance of maternal age, many physicians recommend that women over 35 should pursue a fertility evaluation after attempting for six months. Couples under age 35 should consider evaluation if conception does not occur after a year of trying to conceive. (A woman using donor insemination should ask her physician about an infertility evaluation after six months.)
Other factors, such as endometriosis or uterine fibroids can also play a role in infertility, though many women with these conditions conceive healthy children without trouble.
Weight is another significant risk factor for women. Women who are overweight have decreased fertility (chance for conception) and an increased risk for miscarriage. Additionally, very low body weight may be associated with infertility and miscarriage. It is important to maintain a healthy body weight (BMI 20-25) and to live a healthy lifestyle. Extremes in diet and exercise are to be avoided.
For Men
Over the last several decades, concern has risen about the impact of industrialization on reproductive health. This concern stems largely from reports that show that semen quality of men in Europe and the U.S. has decreased over the latter half of the twentieth century. Some environmental factors may be implicated in semen quality decline and that may affect reproductive health.
Exposure to environmental agents is thought to have a toxic effect on sperm quality, but the evidence behind most of these scientific claims is rather weak. This is because it is hard to actually demonstrate the cause-effect relationship of toxins to sperm quality. Human toxin studies are generally not well-controlled because of many variables that influence the findings. Most of the information we have is derived from animal studies and may not necessarily reflect a true effect that exists in the human condition.
The environmental toxins that are most often cited as potential contributors to infertility can be organized into physical, chemical, occupational, and lifestyle factors. Hyperthermia (increased temperature), radiation, and electromagnetic fields, for example, are several physical factors that have been linked to infertility in men. Cigarette smoking, excessive alcohol consumption, marijuana and cocaine use, and excessive caffeine intake may contribute to chemical causes of infertility. Occupational hazards such as some pesticides, industrial toxins like dioxin and PCBs, and exposure to heavy metals may also be linked to infertility. Finally, stress, nutrition, and other lifestyle factors can also play a role.
Unfortunately, it is difficult to make recommendations on how to prevent exposure to many of these toxins because their sources are common, the exposure levels unclear, and the populations at risk difficult to define. One very reassuring thing to know is that, recently, the government has taken a keen interest in developing ways to precisely define these variables and therefore get a feel for the magnitude of the problem.
What you can do to reduce your risk
Your overall health is a reflection of your reproductive health. Give yourself a long and healthy life. Consider the following tips to stay healthy:
Maintain a normal body weight. Weighing too much OR too little can put your health at risk and can also diminish your fertility.
Exercise to maintain fitness, adding weight training as you age (especially over 40) to increase muscle mass and maintain a healthy body. But be careful not to over-exercise and strain your body (e.g., consistently running more than 6-10 miles/day).
Don't smoke. Smoking lowers your chances for pregnancy, increases the risk of miscarriage, and smokers tend to go through menopause 2 years earlier than non-smokers.
Never have unprotected sex until you are ready to conceive. The sexually transmitted disease that you acquire today can affect your fertility tomorrow.
When you're ready to have children, don't delay. Age of female partner is the number one determinant of successful fertility treatment for all couples. Duration of infertility is the second most important factor. Once you're actively trying to conceive, don't delay evaluation, especially if you're over 35. If your cycles are regular, seek help after 12 months or after 6 months if you're over 35. If your cycles are not regular, seek help immediately. Once you've started treatment, expect the evaluation to be completed in no more than 2 months and treatment cycles to range from 3-6 months before progressing to the next step.
Stay informed. Be the captain of your ship and always understand what is asked of you by your physician. Ask questions, understand the process and become actively involved in your health.
Visit us in San Francisco
Academic standards. Pioneering research. Personalized care. Start your journey at the UCSF Center for Reproductive Health, located in Northern California's San Francisco Bay Area.
Academic standards. Pioneering research. Personalized care. Start your journey at the UCSF Center for Reproductive Health, located in Northern California's San Francisco Bay Area.