The Fertility Diet - Fellowship in Reproductive Medicine in India

 

What should you eat if you want to get pregnant? This is one of the top questions you get asked and as a fertility doctor it is very important that you give them the right guidance. Is there such thing as a fertility diet? What should you eat if you want to get pregnant and what should you avoid? Are there things that you should know as you start this stage of your journey?

Nutrition is really hard to study on population base because how do you look at one variable in context of a whole diet? Reproduction is hard to study also, that's because what is your end goal? However, with Medline Academics’ Fellowship in Reproductive Medicine in Bangalore, nothing is difficult! What is your outcome of interest? Is it positive pregnancy tests, live birth, clinical pregnancy? What does it mean and what's really impacted by your diet at the preconception or early pregnancy stage? Taking both of that into consideration, there's a lot of research out there because people want to control what they can. And this evidence does suggest that diet is a modifiable factor of fertility, meaning there may be foods that you eat or you avoid that improve your odds of getting pregnant.

Most of these studies are looking at fecundability. Fecundability is the probability of getting pregnant per cycle. This is one of the most finite metrics that we use because we're able to look at a per month basis and compare it to what we know to be averages.

Some of this data also looks at IVF data, so patients undergoing fertility treatment. And I'm bringing it all together today to give you the summary of what you need to know. The take-home message is there's nothing shocking in here. The basic fertility diet is how we know to be healthy. What's healthy for your body is healthy for your eggs, is healthy for your uterus. Diet high in fruits and vegetables, whole grain carbohydrates, limited in processed foods and sugars, limiting red meat, and increase in your plant-based protein sources.

In this article we are going to break this down into a food group or type so we can hit the high points of what's been studied.

·       Carbohydrates

Carbohydrates are a combination of fatty acids. They're the basic building block of our diet. They give us energy and they help us function. There's different type of carbohydrates and whole grain or complex carbohydrates are harder for your body to break down. These carbohydrates are good for you. They are anti-inflammatory. They have antioxidant properties and they have been associated with a decrease in insulin resistance and an improved glucose sensitivity. And they've also been associated with higher live birth rates in studies. I get asked all the time about the keto diet. So, the keto diet is when you're avoiding carbohydrates altogether. Therefore, your body has to get into your fat and break down your fat. Yes, keto diet can help with quick weight loss. If you're wanting to drop pounds quickly, that can be beneficial. It is not a way to sustain long-term. Most people cannot, and it's not really improving your parameters overall. Although if you have a significant amount of weight to lose, it may be a strategy to weight loss that can help you get to a healthy weight to conceive.

·       Omega-3 fatty acids

Fat in the American diet has been such a faux pas. There was such an emphasis on low-fat foods for so long that many of us grew up in an era of being ingrained in our brain that fats are bad for us. But that's not really the case. It depends on the type of fat. And there are good fats that are good for you. And there's bad fats that are not. Omega-3 fatty acids are some of those good fats that are good for you. They are very antioxidant and anti-inflammatory. It can be found in foods such as fish, but also in walnuts, chia seeds, flax. Generally, studies that look at omega-3 fatty acids look at intake of higher omega-3s versus other types of fats. And these studies look like there's improved across the board in reproductive parameters, meaning the more omega-3s that you intake, the lower the chance of anovulation or not ovulating, the shorter the time to pregnancy, improved embryo development in the lab, and improvement in endometriosis on pain scores or stage of disease.

·       What about fish? Fish are a source of omega-3 fatty acids. So, under the premise of omega-3s are good for you, fish should be good for you too. fish data is hard because sometimes fish is grouped into meat and sometimes fish is separated out as its own category. It appears as compared to other meats that fish alone is probably fine. The concern with fish is that it is a risk for an environmental exposure of methylmercury. Big fish, eat the little fish, eat the littler fish. And the more fish that you eat, the more mercury levels that fish has in it, especially the bigger fish like tuna that it is.

And that can actually lead to deposits of mercury into the brain and brain development of a foetus. Therefore, the current recommendation is less than three servings of fish per week.

·       What about plants?

To truly be plant-based, you eat all plants and no animal products at all. No meat, no dairy, no eggs, no honey, none of it. However, I think of plant-based as you can eat a lot of plants and that's still if it's the basis of the majority of your diet, you can still be plant-based. Plant-based eating is good for reproduction across the board in different studies, in different circumstances. So, by no level is eating plants bad for you. No data supports that. One of the largest studies of women in general, looking at kind of population-based characteristics of reproductive age women was called the Nurses’ Health Study. In this study, specifically looking at women who do not ovulate. So, your PCOS women, the higher level of protein that came from plant sources over animal sources, higher rates of ovulation and higher rates of getting pregnant. So, everyone with PCOS, you really need to be plant-focused in your diet. Similarly in IVF studies - you're going to spend all the money in the world. You're going to go do IVF. Patients who ate more plants and had a lower intake of red meat had better embryo development. So, if you're going to invest all the time, money, emotional and physical energy into IVF, we want you to know that study support eating less red meat and more plants is going to be better for your embryos.

·       Now, why red meat?

Red meat has the highest levels of advanced glycation and products, has endocrine disrupting chemicals. It has hormones in it. It's very inflammatory to the body. So, the foods that I said are good so far are all anti-inflammatory. Red meat is inflammatory. And so we see across the board, whether it's worsening stage of endometriosis, poor embryo development in the lab, red meat consistently, the more you eat of it, the worse your reproductive parameters are going to be.

·       What about soya?

Soya gets like so many questions about it. Like soy is bad for you. There's this thought that since soya is a phytoestrogen, that it's going to give them in boobs and be really terrible. Nope, not true. Soya is not bad for you. It has not been associated with negative reproductive outcomes. And in fact, people who ate more soy had both increased fecundity. So natural fertility, they got pregnant faster and reproductive outcomes under fertility treatments.

·       What about dairy?

Dairy has been very inconsistent across the board. I think this is because dairy has a lot of vitamin D in it. So, in some people who are vitamin D deficient, we know that can hurt reproductive outcomes. On the other hand, dairy can be modified. So, if you take your full fat dairy versus your skim, those are different compositions. Two large studies have shown us that dairy may be associated with poor reproductive outcomes if you eat more low-fat dairy. So actually, the processing and taking the fat out to make it skim milk may actually cause more harm than good. So, if you're going to consume dairy, consume your full fat, your whole milk, your real yoghurt, none of that low fat stuff. But two large prospective cohort studies did show a negative association with natural fertility, the more dairy that was consumed.

·       Speaking of vitamin D reproductive outcomes, live birth rate, clinical pregnancy rate, even improvement in donor egg cycles. When you take maternal age out of the picture, more vitamin D. So having replenished vitamin D levels, those people have better reproductive outcomes. So, we do know that vitamin D is important in the diet. Most people do not intake enough vitamin D just in their natural foods that they're eating. But it is recommended that most people take a vitamin D supplement with at least a thousand IU's or international units of vitamin D a day, just so that you're making sure that's a very easy thing that you can control.

·       Folate

You need folate or folic acid in your diet before you get pregnant. Folate is essential in cell division and development and reproduction. If you are folate deficient, you have a higher risk of neural tube defects. These are really terrible outcomes that could have been prevented by a folate fortified diet. Some people have a hard time processing folic acid, which is in a lot of prenatal supplements and vitamins, and they do better with the methylated folate. For the vast majority of people, it doesn't matter, but often for my fertility patients, just because I don't want you to be one of those people, I recommend a prenatal that just has a methylated folate in it.

So, we don't have to worry about that. Iron actually has not been shown to change in infertility at all, but it's important as you're starting to get pregnant because anaemia can be a huge risk factor as your blood volume expands with pregnancy. However, iron can make you really constipated. A lot of your gummy vitamins don't have iron. It's just not compatible with the gummy texture of your vitamin.

In those types of circumstances, you just don't take iron until you're in your second trimester and you'll be fine unless you have previously been diagnosed with anaemia. A few thoughts on PCOS, as already mentioned - complex carbohydrates, plant-based eating, those things are going to be better for PCOS. The key here really is insulin resistance.

We improve that glucose sensitivity and drop that resistance to insulin. There is some evidence that maybe intermittent fasting can help some people with this, that losing weight. If you have the obese or the overweight phenotype of PCOS, I have a whole video on PCOS talking about the differences in thin versus overweight PCOS, but there is a metabolic disturbance and PCOS and trying to consistently eat less sugar, less refined carbohydrates, more plant-based sources, fibre, that's going to be better for you.

·       Some questions about miracle foods like pineapple for implantation. Pineapple core has been kind of around because it has bromelain in it. Bromelain does have some antioxidant properties and the thought process is having that plus a little bit of blood thinning properties could be helpful for implantation. There's been no proof that this actually helps, but certainly it's not going to hurt you to eat pineapple core around implantation.

Is there anything food-related backed by studies? How do I know that my diet is affecting my fertility?

As already mentioned in the article previously, diet's are hard to study. There are some people who get pregnant and they eat not at all a healthy diet and they do just fine. There are other people who have infertility despite being as healthy as possible. My general take is that you want to set yourself up for success. If there's something you can do that could improve your chance of pregnancy, decrease your time to conception, or improve your outcomes when you're doing fertility treatments.

·       Can you be vegan throughout your pregnancy?

You certainly can. It's not going to harm you in any way, and there was a study done in the British Journal of OB-GYN looking at vegetarian and vegan eating on maternal health outcomes. There were 22 papers that were reviewed in this study. Vegan vegetarian diets were considered safe. There was no birth defects or higher risk of maternal complications or foetal complications. If this is how you want to eat and you feel better, and you want to carry it through your fertility and your pregnancy, do it. Anybody who's vegan eating B12 that's fortified in a lot of foods, you can also take a supplement with it. But if you're truly eating zero animal products, you may have a harder time getting B12 into your diet, depending on what you eat.

If you want more information on fertility, you can always follow Medline Academics, where there are multiple in-depth into fertility related topics. Medline Academics, an eLearning portal offering hybrid mode of education for Fellowship in Reproductive Medicine, Fellowship in Embryology, Basic and Advanced ART programs. Headed by Padma Shri Prof. Dr. Kamini A. Rao, this institution has many in house expert faculties who have mastered their subjects. Besides the online and hybrid mode of education, Medline Academics also offers Fulltime Fellowship in Reproductive Medicine in India.

The Clinical Postings for Fellowship in Reproductive Medicine training is done in Dr. Kamini Rao Hospitals which a leading IVF center in Bangalore for treatment of gynae health related issues and conceiving through IVF. These hospitals get the modern technological amenities concerning reproductive health and the best process such as IVF, IUI and the superior gynaecology approach. Characterized by patient-oriented treatments and physician-led team of specialists, Doctors, at Kamini Rao Hospitals have higher success rates in infertility treatments and a humane approach to women health issues.