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1. Preconception planning for expectant parents

To give birth to a strong and healthy child, prenatal physical, mental, and environmental preparations are crucial. Maternal preconception physical planning can lower the risk of complications harmful to both the mother and fetus. The purpose of preconception planning is to identify conditions in a married couple that can adversely affect their future child, mitigates those risks to minimize harmful effects to the upcoming pregnancy, and promote health for optimal pregnancy outcome.

Benefits of preconception planning

• Safe pregnancy
• Strong and healthy baby with the lowest risk of complications

It is essential to have preconception planning in promoting the most suitable condition for pregnancy. Improving physical fitness through exercises, weight control measures, diet, lifestyle modification, and premarital and prenatal screening tests can help to identify the risky lifestyle that can impact pregnancy and childbirth. People planning to get married or have a baby should have a screening test to check out their health and infectious diseases, specifically sexually transmitted diseases and genetic disorders that can pass down from parents to children.

Purposes of premarital and prenatal screening tests

• Assess the health of both male and female partners or married couples
• Identify the risk of developing diseases in children.
• Make a plan to prevent diseases that can pass on to your partner or children.
• Advise both male and female partners or married couples how to look after themselves and help each other during pregnancy and childbirth.

The screening tests include a general health screening in which a doctor will ask about your overall health, medical condition, illnesses, and risky lifestyle, which can affect your health, such as smoking and drinking. The doctor will do a physical exam and premarital and prenatal blood tests to identify conditions that can pass on to your partner or children.

2. Body Weight, Pregnancy, and Fertility

Being overweight or underweight can adversely affect pregnancy and fertility. According to studies, in women, being overweight is related to irregular menstruation, anovulation, and decreased quality of eggs. It can affect the lining of the uterus and implantation. In those with infertility undergoing ovarian stimulation and IVF (in vitro fertilization), overweight women have a poorer ovarian response, resulting in higher doses of medication required, lengthier ovarian induction, and fewer eggs harvested than women with a healthy weight. Moreover, during IVF, the cancellation rate of ovarian stimulation is higher, and the pregnancy rate is lower in overweight women.

Obesity not only inhibits the success rate of pregnancy and IVF but also increases pregnancy complications in both mother and child. As stated in studies, there is an escalation of gestational diabetes, hypertension in pregnancy, eclampsia, premature baby, smaller or larger babies than gestational age, and stillbirth.

In men, there is an association between obesity and lower sperm quality. There is an increased incidence of low sperm count and abnormal sperm mobility. The scrotum of obese men may hang closer to the body than healthy men, causing scrotal hyperthermia. The rising scrotal temperature can impact sperm production. Additionally, obesity is associated with erectile dysfunction, affecting the sexual health and women.

Healthy Weight and Fertility

Recently, being overweight and obese has become a growing public health issue in nearly every country, including Thailand. Obesity is when the body weight rises above the normal range due to excessive body fat accumulation. It can lead to conditions, e.g., hypertension, hyperlipidemia, heart disease, etc. Besides personal health concerns, being overweight and obese in men and women can impact fertility.

To determine if we are overweight or obese, we can calculate our body mass index (BMI) by dividing our weight in kilograms by our height in meters squared (See image). The healthy BMI based on WHO’s recommendation is 18.5 – 22.9 kg/m2 in Asians (See BMI table).

Proper weight – not being overweight or obese – in both male and female partners can significantly contribute to a strong and healthy baby. Those who plan pregnancy should keep their weight within the normal BMI range of 18.5 – 22.9 kg/m2 in Asians.

3. Nutrition and Fertility

When preparing for pregnancy, one of the most frequent questions asked by married couples is how and what they should eat. Food nutrients are essential to a woman’s health and prepare her for pregnancy and childbirth. Certain nutrients can improve the health of oocytes and sperm, enhancing the success rate of pregnancy. Nutrient deficiency or insufficiency can increase the risk of miscarriage and congenital anomalies.

Nutrients that may affect maternal fertility

• Carbohydrates
  The amount and quality of carbohydrates in the diet can affect the ovarian function and production of androgens in women. Eating foods high in carbohydrates and glycemic index can lead to anovulation. The glycemic index is a rating system for carbohydrate-containing foods to check how each food affects blood sugar 1-2 hours after consumption. Foods with a high glycemic index are absorbed faster, causing a higher spike in blood sugar than those with a low glycemic index.
  
  Studies show that in women with polycystic ovarian syndrome (PCOS), reducing carbohydrate intake improves ovarian functions, lowering the level of androgens and increasing ovulation. However, this does not apply to women with regular menstruation. 

• Whole Grains
  Whole grains are entire grains that are minimally refined, thus retaining their intrinsic nutritional values. Whole grain contains antioxidants with anti-inflammatory effects, which are beneficial for fertility. Studies show that eating wholegrains while preparing for pregnancy can increase the success rate of conception and childbirth.
• Fatty Acids
  There are many types of fatty acids. Two major classifications are saturated and unsaturated fatty acids. Fatty acids play a role in the fertility potential, i.e., they are the energy source for the growth of oocytes and embryos at the early stage. Moreover, fatty acids are precursors of many metabolites crucial for implantation and pregnancy.
  • Trans fats
    Trans fats are unsaturated fatty acids that are rarely present naturally; they are more commonly formed during cooking foods with unsaturated fats at high temperatures, such as baking or frying. Trans fats increase the risk of heart attack as they raise LDL and lower HDL. They cause high triglycerides and inflammation throughout the body. Concerning fertility, studies show trans fats are associated with insulin resistance and anovulation. Women with high trans fats consumption have more problems with anovulation and endometriosis.
  • Omega-3 Fatty Acids
    Omega-3 fatty acids are a type of unsaturated fatty acids found in marine animals and plants. Regarding fertility, omega-3s can increase the level of estrogen and progesterone and decrease the risk of anovulation. In addition, some studies indicate that omega-3 fatty acids can reduce the risk of endometriosis. Eating omega-3-rich foods can slow down ovarian aging.
    
    In people undergoing IVF treatment, omega-3s can be beneficial. Pregnancy and childbirth improve by 80% with every 1% increase in the omega-3 level in the blood
    
    Consuming foods high in omega-3 fatty acids and low in trans fats is good for fertility in those who plan for pregnancy and those with infertility problems.

• Proteins
  The protein food sources are meat, such as pork, chicken, fish, beef, dairy products, and nuts. There is insufficient information regarding the relative benefits and harms of protein from meat, fish, and dairy products, especially concerning the contamination of marine fish. Studies on soybean proteins do not uncover any harmful effects; on the other hand, they may benefit fertility.
  
  In summary, macronutrients that positively affect fertility are carbohydrates with low glycemic index, fatty acids rich in omega-3s and have no trans fats, and soy proteins. Food sources that can improve fertility are whole grains, fruits and vegetables, and fish containing high omega-3s.

Nutrients that affect male fertility

During spermatogenesis, there is overexpression of free radicals. The morphology of sperm hampers the sperm’s defense mechanism against free radicals. During sperm final maturation, components of the sperm cell membrane transform into substances more sensitive to free radicals.

• Fats
  To develop into full-grown sperms or spermatozoa, the fatty acids composition of the sperm plasma membrane will transform into more unsaturated fats, particularly the omega-3s. According to studies, matured spermatozoa contain omega-3 fatty acids – DHA type – as high as 20%, compared to immature sperms with only 4% of DHA. Omega-3 fatty acids level correlates with the concentration, morphology, and mobility of sperm. Omega-3s are present in fish, seafood, and walnuts. According to studies of men who have issues with sperm count, morphology, and mobility, taking omega-3 supplements can significantly improve the quantity and quality of sperm. Additionally, studies of people who want to conceive a child show that eating fish rich in omega-3 in male partners is associated with faster pregnancy and fewer infertility problems.
  
  On the contrary, trans fats and saturated fats found in baked goods or fried foods have negative impacts correlated with low sperm counts and quality.
  
  Therefore, men who plan to have a child should take high omega-3 diets such as fish, seafood, and walnuts. They should avoid bakery products and fried foods high in trans fats and saturated fats.

• Antioxidants
  As mentioned earlier, spermatogenesis leads to the overexpression of free radicals. The unique sperm morphology makes them highly sensitive to free radicals. Based on the statistics accumulated thus far, giving antioxidants, including vitamins C & E, to infertile men can improve their sperm quality, particularly motility, pregnancy rate, and live birth.
• Folic
  Folic is essential for DNA synthesis, a part of sperm cell development. According to studies, taking 5-15 mg of folic acids supplement daily for 3-6 months can increase sperm concentration by 53-70% and sperm motility by twofold.
• Zinc
  It is ubiquitous in dietary supplements for men who plan to have a child. An adequate amount of zinc in semen is essential for sperm motility and function. Studies show that giving zinc supplements to men can increase semen volume and the proportion of normal sperm with good swimming ability.
  
  In summary, nutrients that help promote male fertility include omega-3s, folic acids, zinc, and antioxidants such as vitamins C and E. On the other hand, trans and saturated fats are harmful.

4. Lifestyle and Fertility

• Smoking
  Smoking is harmful to the health and fertility of men and women. According to research, the prevalence of infertility increases, and it takes longer to become pregnant in female smokers. The time it takes to get pregnant is linked to the number of cigarettes smoked daily. The more cigarettes, the longer it takes to conceive. The infertility mechanisms in female smokers are from toxins in tobacco that can affect the quantity and quality of oocytes. Studies show that cigarettes cause a faster drop in oocyte numbers than expected. Women who smoke enter menopause 1-4-year earlier than nonsmokers from the early diminished ovarian reserve. Female smokers using IVF have a lower success rate than nonsmokers. Smoking is associated with miscarriage, ectopic pregnancy, and increased preterm births.
  
  In men, smoking can also affect fertility. In male smokers, the concentration of sperm is reduced by 22 %, compared to nonsmokers, and the number of abnormal sperm increases, leading to a lower fertility rate.
  
  The smoking habits of both men and women are detrimental to pregnancy and fertility. However, studies show that the adverse effects decline if you quit smoking before pregnancy, and the risks drop to the usual level within one year of smoking cessation. People who plan for pregnancy should quit smoking one year before stopping contraception.

• Alcohols consumption
  The impact of alcohol consumption on fertility is still up for debate. Current information indicates drinking alcoholic beverages can harm fertility. Infertility rates double in women who consume more than two standard drinks daily. There is no effect on women who consume less than this amount, particularly those who drink less than one standard drink.
  
  One standard drink (or one drink for short) contains 10 grams of alcohol, the amount the liver can excrete in 1 hour. One standard drink of different alcoholic beverages differs in volume: for beers with 5% alcohol, one drink is a can or a small 300 ml. bottle; for whiskey or vodka with 40-43% alcohol, one drink is three caps or 30 ml; and for wine with 11-13% alcohol, one drink is one glass or 100 ml.
  
  In men, there is no evidence that alcoholic beverages affect the quantity and quality of sperm.
  
  Those who plan to have a child should refrain from drinking more than two drinks daily, particularly women.

• Caffeine
  Caffeine is in beverages like coffee or tea. In women, excessive caffeine intake poses risks of infertility. Research indicates consuming 500 ml of caffeine, equivalent to more than 5 cups, can decrease pregnancy success rate. During pregnancy, drinking more than 2-3 cups of coffee a day (200-300 ml of caffeine a day) increases the risk of miscarriage.
  
  In men, there is no evidence that caffeine affects the quantity and quality of sperm.
  
  Moderate caffeine consumption, i.e., 1-2 cups of coffee while planning for a pregnancy or during pregnancy, does not interfere with fertility. Those who plan to have a child can drink coffee moderately, not more than 1-2 cups daily.

• Exercise-Yoga
  Exercise can improve the overall health of men and women. A proper exercise routine is what you should do when preparing for pregnancy. However, there is no direct line of research showing if exercise can increase or decrease the chance of pregnancy.
  
  Physical activities recommended by the American College of Sports Medicine are to exercise at least 150 minutes a week. They can be aerobic exercises such as brisk walking, swimming, jogging, or biking 30 minutes a day, five days a week.
  
  Yoga could be beneficial for fertility. Studies show that yoga can help those with infertility relax and reduce their anxiety. It helps improve the pregnancy rate in those treated with assisted reproductive technology.

Article by
Dr Pimpagar Chavanaves

An obstetrician & gynecologist specializing in reproductive endocrinology and menopause
Doctor profile
Fertility and Genetics Clinic