As more and more people wait until a later age to try to become pregnant, you may encounter an increase in patients struggling with infertility or subfertility. About 12 percent of women in the United States aged 15 to 44 have impaired fecundity, according to the Centers for Disease Control and Prevention; women over 35 are more likely than younger cohorts to be subfertile with no known cause.
There is, however, also a strong connection between lifestyle and fertility. Weight, environmental exposure, nutrition and smoking can all affect a person's ability to become pregnant. It is important to learn how to talk to your patients about modifiable factors that can help their chances of conceiving.
Weight
There is a growing body of evidence that being overweight or underweight can lead to difficulty conceiving and carrying a pregnancy to term. Research has revealed a link between high body mass index (BMI) and more adverse outcomes after in vitro fertilization. A study of 1,602 Italian women published in Nutrients, for example, found that patients with a BMI higher than 30 had a "significantly reduced percentage of mature oocytes," and patients with a BMI higher than 25 were more likely to miscarry.
Likewise, patients who are underweight can have challenges becoming pregnant. Being outside of a normal weight, usually measured using BMI, seems to affect metabolism and reproductive hormone production, according to separate research published in Nutrients. Both overweight and underweight patients may experience irregular menstrual cycles and anovulation.
Physicians should be especially mindful of fertility and other health concerns if they suspect a patient's irregular weight is due to an eating disorder. The American Pregnancy Association notes that eating disorders can increase the risk of pregnancy complications such as premature labor and stillbirth.
Finally, the health of any male partner or sperm donor also matters. As the European Society for Human Reproduction and Embryology (ESHRE) reports, "more than a quarter of pregnancies might be ectopic or end in miscarriage or stillbirth if the father-to-be is unhealthy and has three or more medical conditions such as obesity, diabetes, high blood pressure or high cholesterol levels."
What your patients need to know: Encourage moderate exercise to regulate menstrual cycles and improve ovulation. Weight-loss interventions for overweight or obese patients have led to improvements in natural pregnancies, according to a meta-analysis published in Human Reproduction Update. If an eating disorder is suspected, be sure to refer the patient for help before exploring fertility treatment.
Nutrition
Ongoing research into diet and fertility show there is a clear connection between what prospective parents eat and their fertility outcomes. However, this connection is not yet clearly understood. Some research has suggested that a low-carbohydrate diet can improve hormonal imbalances and help resume ovulation in anovulatory patients. Other research has found that a Mediterranean diet may have health benefits for patients trying to conceive.
What your patients need to know. Stick to the basics when it comes to healthy eating. Encourage your patients and any partners to eat lots of fruits and vegetables, lean meats, fish and whole grains. Avoid refined carbohydrates, fried foods, trans fats and saturated fats. Limit red meat and sweets. Limit caffeine to about two cups of coffee per day. Following healthy eating habits consistently offers the best chance of helping a patient conceive, and allows patients to learn how to boost the female metabolism in a healthy way rather than relying on crash diets or other unsafe habits.
Smoking, Alcohol and Drugs
Smoking weakens sperm and damages the eggs and ovaries, according to the American Society for Reproductive Medicine (ASRM). If a patient smokes during pregnancy, their chances of miscarriage increase. Secondhand smoke also carries risks.
The relationship between alcohol and fertility is still uncertain, but physicians may advise their patients to reduce their alcohol consumption if they are trying to conceive.
What your patients need to know: Smoking by either or both partners lowers chances of conception and increases the risk of miscarriage. Encourage patients to quit or at least cut down. Even reducing the number of cigarettes smoked daily can improve outcomes.
Environmental Exposure
Chemical and environmental exposures may be a more challenging factor for your patients to change. However, air pollution, heavy metals and pesticides can all negatively affect fertility. Research in Reproductive Biology and Endocrinology notes correlations between miscarriage, preterm delivery and fetal loss in women exposed to high levels of air pollution, lead or pesticides.
What your patients need to know: Reduce exposure to pollutants as much as possible. If a patient or their partner is exposed to chemicals, pesticides or heavy metals in the workplace, they may want to consider a leave of absence if they can afford one. If patients live in urban areas with heavy air pollution, suggest wearing a face mask when outside to reduce exposure.
Your patients may not fully realize the connections between aspects of their lifestyle and infertility. Ask detailed questions about their diet, exercise habits, smoking and environmental exposure. Then, provide actionable advice with steps they can take as they try to become pregnant.
