When does a patient become a parent? For me, as a reproductive endocrinologist and infertility specialist, this precious moment has nothing to do with the religious or moral discussion surrounding when life begins. Instead, it is the moment when a patient starts to make her future baby the priority. Many of our patients adhere to rigorous medical treatment; perhaps more impressive are the patients who make important lifestyle changes to their daily routines for the good of the family they want to have.
Epigenetics is the study of how external and environmental factors affect genes. While many recent studies link our origins and genetics, scientists are still learning just how far reaching the gestational experience is to determining who we are. Our understanding of genetics has resulted in highly technical and advanced procedures such as Comprehensive Chromosome Screening (SelectCCS), as well as how something as seemingly simple as diet can impact our genetic lineage. Daily choices can affect our overall health, as well as the health of an embryo and the life of a child.
At Reproductive Medicine Associates of Connecticut (RMACT), we encourage all of our patients to improve their overall preconception health through their nutrition, stress management and sleeping habits. We even offer a preconception checklist to help patients prepare for conception.
Our genetic potential can be optimized through lifestyle choices. Obesity, diabetes, allergies, asthma, heart disease, post traumatic stress disorder (PTSD), anxiety, schizophrenia, aptitude for early childhood development and even the likelihood of cancer have all been linked to the habits of Mom during pregnancy. Habits such as smoking, drinking too much alcohol or caffeine, and eating too much sugar can also impact a patient’s ability to get pregnant and to stay pregnant full term. Improving patients’ overall health is not just about eliminating detrimental foods and drugs; it is also about incorporating important nutrients (e.g., folic acid, lean protein, calcium, vitamins B and D), getting moderate exercise and managing stress.
Nutrition and Diet
When considering nutrition and diet, there are two areas to consider: weight and nutrients.
Weight management is not only about appearance; it affects our bodies’ health and vulnerability to diseases such as diabetes, heart disease and high cholesterol. Extra body weight can be a result of a poor diet, as well as metabolic conditions such as insulin resistance or diabetes that affect the body’s hormone production.
Elevated insulin contributes to weight gain, especially increased abdominal weight. Weight loss and maintenance is much more challenging with increasing insulin resistance. Insulin resistance is found in 60 percent of obese women and 40 percent of non-obese women. Another interesting fact is that 80 – 90 percent of type 2 diabetics are obese. Obesity can affect male fertility through changes in hormonal profiles, semen parameters and scrotal temperatures.
For female patients who are overweight, a 5 – 10 percent loss in body weight has been shown to not only improve insulin and reduce diabetes risk, but also improve fertility by resuming ovulation. It also has lasting affects in the genetic predisposition of babies. Children of diabetics are more likely to become diabetic themselves.
Eating habits and diseases such as diabetes and insulin resistance are complicated, which is why RMACT has two nutritionists on staff. It’s not enough to simply advise a patient to loose weight or eat better; they need support. Our nutritionists offer classes and one-on-one counseling to coach and teach patients how to eat healthy. These sessions offer life-long lessons for themselves and their future families. Also, our nutritionists, fertility nurses and physicians communicate about the patients’ progress, including blood sugar levels, cholesterol and body mass index (BMI), as part of their comprehensive infertility treatment.
In addition to weight management, a healthy diet includes a wide range of nutrients that come from lean protein, vegetables, fruit and complex carbohydrates. Here are some of the foods that we recommend patients incorporate into their diet:
– Folic acid (citric fruit, fortified breads, lentils) and use a supplement or a multivitamin (800 mcg of folic acid)
– Calcium (yogurt, milk)
– Iron (meat, spinach, beans)
– Omega-3 (low-mercury fish such as salmon)
– Drink water (not soda and minimize caffeine)
External toxins also affect our genes and gene expression. Some, like alcohol, are well known; others, such as cleaning products, are more obscure. The single most important step toward becoming healthier for men and women is to quit smoking. This is good for the intended parents’ health and it is imperative for egg and sperm health.
Prior to conception, women should limit their drinking to less than three servings of alcohol per week, and men should have less than six servings per week to avoid damage to sperm. Household chemicals, such as garden supplies and cleaning products, should be handled with caution. For example, wear gloves. Patients should also avoid heavy metals such as lead and mercury, which can be found in some foods (e.g., tuna) and in our environment.
Women should also lower their caffeine intake to less than 150 mg per day or one 8-oz. cup of coffee. Lastly, men should avoid placing electronics such as laptop computers on their laps.
Stress can manifest in several physical conditions, including high blood pressure, suppression of the immune system, irritability, anxiety, depression, anger management issues, and even infertility. Stress management is important for each patient’s health, and it has a surprising affect on pregnancies and baby’s health.
There is a wide range of approaches to managing stress. Some patients can release their stress by being physically active; even just 30 minutes per day with activities such as walking and yoga can be affective. Other patients benefit from counseling and peer support groups.
At RMACT, we also offer Mind-Body coaching, which can help couples with communication and empower individuals to focus on the positive. By dedicating just 15 – 20 minutes per day to Mind-Body exercises, patients can reverse the effects of daily stresses. Stress management is helpful for couples when they are trying to start a family, and these are tools that can help throughout life, including when the baby arrives.
RMACT’s licensed clinical social worker, Melissa Kelleher, says that breathing techniques, body scans and self-guided meditation are all examples of ways to elicit the relaxation response. They take only minutes, yet they have an immediate physiological affect on the body; its stress hormone production and long-term effects of stress by-products such as high blood pressure. There are several smart phone applications that can assist in Mind-Body practices, such as “Headspace.”
All of these lifestyle changes to our diet, stress management and exposure to toxins can have a positive affect on our health and to our future generation in just 90 days. It only takes three months for patients to improve their chance of a successful fertility treatment cycle and also give their baby the best chance of being healthy.
Spencer Richlin, MD. is the Surgical Director and a partner at Reproductive Medicine Associates of Connecticut (RMACT), as well as Division Director of Reproductive Endocrinology and Infertility (REI) in the Department of Obstetrics and Gynecology at Norwalk Hospital. He was also on the writing committee for the 2015 Reproductive Endocrinology & Infertility PROLOG sponsored by the American College of Obstetrics and Gynecology (ACOG).