Health Begins Before Birth- An Audioblog!

This week, we're featuring an audio blog!  Dr. Heather Tallman-Ruhm is one of my favorite MDs- a family practice physician who caught the "bug" of integrative medicine.  She launched Health Matters to spread the word in New England about the top concerns in medicine and the best way to approach it.  Last week, I was honored to be her guest, to talk about getting pregnant, how to have a healthy pregnancy and birth, and the ULTIMATE way to prevent chronic illness (a hint- you've got to start NOW!)

I hope you enjoy!  Share your comments and questions here!

The 3 Things You Must Do to Prevent a Miscarriage

Miscarriage is one of the most difficult aspects of infertility.  When I work with couples having trouble getting pregnant, and then they get pregnant, it’s a celebration for all of us!  And losing a pregnancy (or more than one) can be a roller coaster of emotions- where you almost don’t even want to get your hopes up AFTER you find out you’re pregnant, in case something happens…

You know that for me and with Perfect Fertility, the goal is not just to get pregnant, but to have a healthy baby.  And if you’ve worked with me, you know just how much I focus on how you prepare for pregnancy in the 4 months before you conceive.  Well, here’s another reason why- it helps you not only GET pregnant, but also STAY pregnant!

Last July, there was an interesting article about this published in Fertility & Sterility, one of the top medical journals for infertility.  In this study, about 350 pregnant couples from Michigan and Texas were followed though their pregnancies and researchers looked to determine what lifestyle behaviors were correlated with miscarriage. 

Not surprisingly, a few trends really showed through.  First, guess what had the strongest correlation with miscarriage?  I’m so sorry to tell you this…. caffeine.   Greater than 2 caffeinated beverages daily prior to pregnancy was correlated with higher risk of miscarriage, especially with MEN!  That’s right, when men drank caffeine before conception, it had an even bigger impact on miscarriage rates.  So, if your man is still downing Red Bulls, it might be time to sit and share this article.

Other factors that contributed to increased risk of miscarriage included age (>35 years old) and alcohol intake (>10 drinks/weekprior to pregnancy, and >4 drinks/week in pregnant moms). 

On the plus side, taking a multivitamin consistently had a huge positive impact on miscarriage rates, meaning they went down.  Women who took their prenatal multivitamin 100% of the time had a 55% reduction in miscarriage rates.  That’s worth swallowing those pills even when nauseous! 

These are simple factors that every couple should adhere to when trying to get pregnant.  Most miscarriages (especially in early pregnancy) are caused by genetic defects.  So, if these interventions help strengthen the DNA for your future baby, it seems a no brainer!  A few tips for you when you’re trying to conceive:

1.     Don’t consume more than 3 drinks/week when trying to conceive (both mom & dad!)

2.     Take your prenatal daily.  (There are lots more things you can add here, but that’s for another day!)

3.     Cut out the caffeine.  If >2 cups per day is enough to influence miscarriage rates, I’d recommend just cutting it out altogether!  This study didn’t look at whether substitutions are safe, butif you can go decaf or just stick with water and diluted juices, you’ll be better off.

We need more research in this area- anything we can do to lower the 22-25% miscarriage rate in the US can help to make this process easier in every way!


Starting at the Beginning: Addressing Obesity

Starting at the Beginning

Several lifestyle factors have been identified which can promote optimal fertility, including dietary behaviors, stress management, and maintenance of a healthy weight.  In addition, adequate nutrient status can influence not only the ability to get pregnant, but the health of the egg and sperm, and thus the health of the child born to those parents.  The following interventions can greatly influence fertility, and it is recommended that all couples trying to conceive consider these interventions, whether they have trouble with fertility or not.

Addressing Obesity

Obesity poses a significant threat to fertility as well as for the offspring born to obese parents.  In obese men, there is increased aromatase activity, which irreversibly converts testosterone to estradiol resulting in decreased testosterone and increased estrogen levels.[i]  It is likely that this plays a role in the lower sperm counts, lower sperm concentration, and poor sperm morphology seen in men with increased BMI and central adiposity.  Obese men also have fewer motile sperm and lower testosterone levels, as mentioned above.[ii][iii]

It’s not only men who experience decreased fertility as their weight creeps up; women are also affected.  Obese women have lower pregnancy rates (20.8% versus 28.3% successful cycles, p=0.04) when they undergo IVF and obese women are more likely to experience preterm births after IVF. [iv] [v] [vi]  Although this study represents women undergoing IVF, similar fertility trends exist in women trying to conceive naturally. [vii]  Together, obese couples experience higher rates of miscarriage in both spontaneous conception as well as assisted reproduction.[viii]  In addition to the hormonal changes noted for men, this decrease fertility may be due to increased levels of inflammation which affect ovarian response and the uterine/endometrial environment.

Obesity poses such a hinderance to fecundity that many fertility clinics place a BMI limit for candidacy for the procedure.  Addressing obesity for patients is essential to support a healthy conception and pregnancy, and maintenance of a healthy weight should be a first goal for couples wishing to get pregnant.  If a weight loss plan is implemented, it is strongly recommended that clinicians consider promoting a modified Mediterranean diet, as this diet also has fertility-promoting effects.

[i] Cohen, PG. Obesity in men: the hypogonadal-estrogen receptor relationship and its effects on glucose homeostasis. Med Hypotheses. 2008;70(2):358-60.

[ii] Sermondade N, Faure C, Fezeu L et al.  Obesity and increased risk for oligozoospermia and azoospermia. Arch Intern Med. 2012;172(5):440-2.

[iii] Hakonsen LB, Thulstrup AM, Aggerholm AS et al.  Does weight loss improve semen quality and reproductive hormones?  Results from a cohort study of severely obese men. Reprod Health. 2011 Aug 17;8-24.

[iv] Pinborg A, Gaarsley C, Hougaard CO et al. Influence of female bodyweight on IVF outcome: a longitudinal multicentre cohort study of 487 infertile couples. Reprod Biomed Online. 2011 Oct;23(4):490-9.

[v] Kumbak B, Oral E, Bukulmez O. Female obesity and assisted reproductive technologies. Semin Reprod Med. 2012 Dec;30(6):507-16.

[vi] Dickey RP, Xiong X, Gee RE et al. Effect of maternal height and weight on risk of preterm birth in singleton and twin births resulting from in vitro fertilization: a respective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System.  Fertil Steril. 2012;97(2):349-54.

[vii] Cardozo ER, Neff LM, Brocks ME, et al. Infertility patients’ knowlede of the effects of obesity on reproductive health outcomes. Am J Obstet Gynecol. 2012 Dec;207(6):509.

[viii] Boots C, Stephenson MD.  Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review.  Semin Reprod Med. 2011;29(6):507-13.