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The worldwide incidence of infertility is 8 to 12%. The World Health Organization has recognized infertility as a public health issue and infertility is an Iceberg phenomenon. The term iceberg phenomenon highlights how the visible cases - those who actively seek medical help or are diagnosed- represent only a small portion of the problem. A significant number of cases remain ‘hidden’ or unreported much like the submerged part of an iceberg.

In India, about 27.5 million people are suffering from infertility and the incidence is rising. Fertility can be affected by different factors, the most important being maternal age which cannot be changed. Amongst all ,other modifiable factors such as stress, exposure to environmental pollutants, excessive consumption of alcohol, caffeine, aerated drinks and other poor nutritional habits. Diet has recently emerged as very crucial, since nutrition, healthy body weight, and BMI can have a significant impact on fertility and the ability to conceive.

History says Hippocrates advocated a special diet for both men and women to optimize fertility. Current statistics also point towards each partner playing an equal and important role in conception and fertility and therefore both need to optimize their nutritional status prior to conception.

Couple who are anxious to conceive should have a pre-conceptional counselling session with the dietician.

Women and fertility

Reproductive function is a complex process, driven by mainly hormonal and metabolic pathways, and the optimum functioning of this axis is impacted greatly by the nutritional status of the individual. Body mass index, when in excess of 25 or below 18 has a negative impact on various functions such as

• Ovulation
• Menstruation
• Thyroid abnormalities
• Insulin levels and regulation of blood sugar
  In fact, in PCO patients, metabolic disorders including obesity, diabetes, hyperlipidaemia due to hypercaloric diets and hyperinsulinaemia, reduced insulin sensitivity etc., all are majorly correctable factors (if good nutrition is followed)
  All these affects physical health and also have a bearing on mental and cognitive health.

Men and fertility

Nutrients are the precursors for various body functions, and mainly the regulation of the endocrine system is hugely dependent on the balance of these nutrients. Alteration of the hormonal milieu under the influence of disbalanced nutrition can lead to the following

• Deranged sex hormones
• Abnormal spermatogenesis
• Reduced sperm count and motility
• Abnormal morphology and increased DNA fragmentation
• Abnormal development of secondary sexual characteristics
• Metabolic diseases like Diabetes, Hypertension, Dyslipidaemia, Thyroid abnormalities etc., affecting sexual function, arousal and performance.

The Fertility Diet

Nutritionists have advocated tailor made diet plans, such as mediterranean diet, keto diet, western diet, intermittent fasting, vegan/ vegetarian diet, etc., for people to adhere to, based on BMI, diet preferences, ethnicity, underlying metabolic and endocrine derangements, as there isn’t a universal ‘fertility diet’ that works for everyone.

5-10% of bodyweight loss, moderate physical activity and optimum nutrition with corrective measures can lead to improvement in insulin sensitivity and better outcomes in fertility treatment.

Some of the major role players on the nutrition stage are:

• Folic Acid- 800 mcg of Folic acid and Prenatal vitamins are essential to reduce the risk of neural tube defects (spinal or brain malformation) and optimize reproductive outcomes
• Antioxidants-There is overwhelming evidence to suggest that oxidative stress has a vital role in the etiology of infertility which could lead to abnormal sperm parameters and high levels of sperm DNA fragmentation in males. The concept of MOSI or male oxidative stress in fertility points out a high level of ROS in the sperms of the majority of men suffering from infertility and therefore the use of antioxidants has a potential in treating these conditions by supplementing with L- carnitine, Omega 3 fatty acids, Co-enzyme Q10, Selenium, zinc, vitamin A and Vitamin C. All these have been found to improve sperm motility, morphology and concentration.

ROS also have a very crucial role in females in the functional processes of oocyte maturation and ovulation, endometrial decidualization, menstruation, fertilization, embryo development and implantation, all of which have a bearing on the reproductive outcome.

Natural Antioxidants as well as supplementation can help repair the damage caused by the ROS by offsetting the imbalance between the excess of ROS and the lack of antioxidants. Along with Vitamins A, C, E and B9, some of the other promising ones are- polyphenols, Quercetin, melatonin and Resveretrol.

• Vitamin D - Vitamin D is vital for the hormonal axis to function optimally and for cell wall integrity both in males and females as well as for proper reproductive function during pregnancy. Vitamin D is crucial to major reproductive functions such as ovarian steroidogenesis, folliculogenesis and acrosome reaction, as well as for sperm quality and ovarian reserve. Vitamin D also as a vital role in conception, implantation and early development of the placenta. as well as its deficiency in the occurrence of certain conditions such as preeclampsia, gestational diabetes and preterm labour.
• Carbohydrates - The type and amount of carbohydrates consumed can have an impact on insulin levels and blood sugar control, both of which need to be optimum for proper functioning of the cellular mechanisms that control the Hypothalamic-Pitutary axis. It is preferable to consume foods with low glycemic index (55 or below) and less glycemic load such as brown rice, sweet potatoes, whole grains and millets, apples etc., as these increase the body’s sensitivity to insulin and helps keep the body weight and thereby the BMI under control.

• Trans fats - It is important to be aware of the type of fats being consumed. A diet with a high quantity of fresh seasonal vegetables and monounsaturated fats such as avocado and olive oil and less of saturated and trans fats as well as a good quantity of calcium through dairy sources helps balance dietary intake. Trans fats, included in prepackaged baked goods, fried foods and fatty meats increase the risk of insulin resistance, ovulatory infertility and endometriosis. Higher intake of Omega 3 and Omega 6 fatty acids as is found in Salmon or plant sources such as avocados, flax and chia seeds are known to be hugely beneficial in improving fecundity.
• Black Cohosh - (Cimicifuga Racemosa)- Mainly thought to exert its effects through a serotonergic pathway and acts as an anti-inflammatory and antioxidant. In combination with Clomiphene citrate, it is known to increase ovulation function mainly in PCOS patients by increasing progesterone levels.
• Chaste Berry - (Vitex Agnus castus)- Studies have shown Chaste Berry to be useful in lowering levels of prolactin and prolonging the luteal phase by significantly increasing the levels of progesterone, thus being useful in patients with luteal phase defects. This has a beneficiary effect on improving fertility.
• Gut Microbiomes - The role of Probiotics in reinforcing general health and improving fertility is being extensively studied and some of the results are very promising, whereby by nutritional awareness to include these naturally or by way of supplements is recommended, to improve chances of conception. The foods rich in natural probiotics that enhance gut health are
  • Yogurt / home made fresh curd
  • Buttermilk
  • Kefir
  • Fermented foods like Idly/ dosas
  • Fermented pickles
  • Beetroot, greenpeas, apples

Conclusion

Reproductive health is very closely linked to having a healthy lifestyle with a balance of physical activity. A nutrition rich diet that provides for most of the nutrients required for optimum functioning of the various mechanisms at a cellular level and a healthy and stable mental state which in turn can work favorably for couples trying to achieve a pregnancy either by natural methods or through Assisted Reproduction.

From offering compassionate care at the best IVF hospital in Bangalore, India to providing top-notch courses in infertility treatment, offering the best IVF fellowship in India, we are here to guide and support your journey toward hope, healing, and excellence in reproductive medicine.