Marta Montenegro | PhD-c | MS | MSF | CSFN | CSCS

Doctorate in Clinical Nutrition, candidate | Fertility Counselor

Men on a mission: Make a sweat and boost your sperm count

It is not a secret that being overweight brings a laundry list of health issues, and fertility surely makes the list. However, to improve the fertility outcome do not just look at your waist but also at your partner pant’s size.  And, as we know of the importance of making dietary changes to lose or to maintain our weight, most of the time we think that physical activity is an “extra” thing that it is not as important as the diet. Wrong! Exercise and a healthy diet are a marriage, but an unbreakable one!

Indeed, when 137 men who were seeking fertility treatment at Massachusetts General Hospital Fertility Center, between 2006-2012, were evaluated on the relationship sperm concentration and exercise, the study found that men who engaged on levels of moderate to high intensity exercise for seven hours a week, showed 48% higher sperm concentration than those who exercised less than one hour per week.

But, does the type of physical activity matter? It does. Outdoor activities and weight lifting were associated with the higher sperm performance result. The authors of the study attribute these results to the testosterone increase and better insulin management effect of weight lifting;  whereas, outdoor activities may increase vitamin D which has shown to impact fertility.

Keep moving!

Plenty of studies show that lifting weights in this manner: three to four sets, 8-12 reps, and selecting exercises that work different muscles at the same time – squats, pull-ups, push-ups, etc- produces the greater testosterone boost. Likewise, In a study, in which subjects with increase risk of type 2 diabetes – a condition mostly associated to years of sugar over intake and crippling the pounds- were put into a resistance training workout, twice a week, for 16 weeks, showed a favorable impact on insulin sensitivity and/or increased in the activity of the transporters of glucose to the muscles.

Nevertheless, never think that exercise works as a Deposit account. For good or bad, you better be making daily deposits to see your balance on black. Barbara Bushman, Ph.D., FACSM, professor at Missouri State University, explains in her article “Would you like to know?” published in the ACSM’s Health & Fitness Journal, that exercising on a regular basis is particularly important as the effect on blood glucose control will be lost within days.

Glucose levels are affected for up to 12 hours or more after exercising while a transit exercise reduction or physical inactivity can substantially reduce insulin sensitivity.

When healthy subjects reduced their physical activity in three days from over 10,000 steps per day to 5,000 steps per day, postpandrial glucose (glucose levels measured after a carbohydrate meal intake) increased significantly, concludes the study “Lowering Physical Activity Impairs Glycemic Control in Healthy Volunteers,” published in the Medicine & Science in Sports & Exercise.

It’s worth to mention that as great as lifting weights and doing outdoors cardio may be on male fertility,  if you like biking, hold the bike for a while. In the same study, those who bike for more than an hour a week had 34% lower sperm count than those who don’t bike. The pressure placed against the scrotum by a bike seat and/or the increased temperature in this area has shown to impair fertility. –  Study from Harvard School of Public Health-.

The relationship between weight and fertility is a sensitive and complicated one. With so much weight bias in the medical industry, it can be tricky to figure out what to believe. While there is research that supports that weight affects fertility, all bodies are different — and an individualized approach to discovering what’s true for your body is critical. Women of all sizes have successful pregnancies and give birth to healthy children.

That said, knowledge is power. So, in an effort to navigate all of the information out there about how weight can impact fertility, we’re taking a look at what the science actually says.

• Research indicates that weight can affect your fertility, but all bodies are different — there are many factors that impact your ability to conceive.
• Hormones play a major role when it comes to fertility. Being “underweight” or “overweight” can throw off your hormones, which in turn can impact your periods and ovulation.
• You don’t necessarily need to be within the “normal” range for BMI (which is between 19-24) to increase your chances of getting pregnant.
• If you don’t have a BMI within “normal” range and are trying to conceive, talk to a health professional who specializes in metabolic fertility issues.
• Remember: BMI is not a perfect measurement — and many women with low and high BMI successfully get pregnant.

First things first: What is BMI?

Body mass index, or BMI, is a way to measure weight relative to height and is often used as a way to predict body fat.

Your BMI is calculated by taking your weight in kg divided by height in meters squared (kg/m^2). You can use an online tool like this one to calculate your BMI, or your healthcare provider can help you.

Here are the general guidelines for women:

• Under 19: “Underweight”
• 19-24: “Normal”
• 25-29: “Overweight”
• Over 30: “Obese”

But, BMI is an imperfect measurement, and doesn’t necessarily speak to overall health. It can’t distinguish between fat and muscle, which means that you could be toned and still register as having a high BMI, because muscle weighs more than fat.

BMI also can’t tell the difference between various kinds of fat, or how fat is distributed in the body, which is an important distinction. Visceral fat, for example, is in the abdominal cavity and wraps around organs like the liver, pancreas, and intestines. High amounts of visceral fat can lead to health problems, such as Type 2 diabetes. People of all sizes can have higher-than-expected amounts of visceral fat, but a BMI test can’t ascertain that.

“Although BMI has been the gold standard test for classifying patients as underweight, normal weight, overweight, or obese, it’s a poor test for measuring the health of the patient,” explains Marta Montenegro, a fertility lifestyles specialist at IVFMD. “I can’t say that patient ‘X’ is healthier than ‘Y’ solely based on BMI.”

How BMI and weight can impact your fertility

It’s important to remember that many women with low and high BMI successfully get pregnant.

Conception depends on many factors, including the health and function of your reproductive system, as well as your hormone levels. An egg and sperm need to meet at just the right time — otherwise known as your fertile window — for fertilization to occur. Your hormones need to be at normal levels for all of this to take place. “Normal” depends on many factors, including your age and where you are in your menstrual cycle (i.e. follicular phase, luteal phase, etc).

Estrogens, specifically how much of the hormones you have, play a major role when it comes to weight and fertility. Estrogens are produced by the ovaries, as well as in fat cells and the adrenal gland.

If you have a high BMI, you may have more fat cells. The more fat cells you have, the more estrogens are being produced in your body. Estrogens are also responsible for the growth of the uterine lining, so more fat cells lead to a thicker uterine lining, and heavier periods. Enough estrogens can interrupt your cycle, lead to infrequent periods, and prevent you from ovulating. High levels of estrogens can also affect how your body processes insulin, therefore causing problems like diabetes and insulin resistance, as is the case with polycystic ovarian syndrome, or PCOS (more on this below). According to the American Society for Reproductive Medicine (ASRM), a higher body-fat percentage can also affect the success of fertility treatments, such as IVF.

On the flip side, when you have a low BMI, or a low body-fat percentage, your body doesn’t have enough energy to run properly. When this happens, non-essential systems, like reproductive function, slow and shut down. Your hypothalamus, where hormones such as estrogens are regulated, gets sluggish, and this leads to irregular, or entirely absent, menstrual cycles. “Irregular” could mean a shorter time between periods, a period lasting longer than eight days, or skipping cycles altogether (lack of a menstrual cycle is known as anovulation).

Certain health conditions can also affect BMI

Despite what our mainstream culture would have us believe, being “overweight” or “underweight” isn’t just about how many calories you’re taking in. For example, research has been looking into how genetics plays a role in your body weight. There are also treatable medical conditions, like hormonal conditions or eating disorders, that play a role in BMI.

Polycystic ovary syndrome (PCOS) is a hormonal condition that can cause irregular menstrual cycles, extra hair growth, fatigue, and weight gain. If you have PCOS, you’ll often have much higher levels of anti-mullerian hormone (AMH). You may also have higher levels of androgens (called hyperandrogenism) — but not all women with PCOS experience this. Androgens are a class of steroid hormones often thought of as “male” (including testosterone, androstenedione, and DHEAS), but are actually present in all healthy adult bodies. In women, they’re produced in the ovaries and adrenal glands.

Insulin, the hormone that allows your body to absorb blood sugar, is also part of the PCOS equation — if you have PCOS, your body may not be as responsive to insulin as it’s supposed to be (aka “insulin resistance”), so your blood sugar doesn’t get processed as easily. This may result in chronically elevated blood sugar and insulin levels. 80% of women with PCOS have a higher than normal BMI due to the fact that it’s a metabolic disorder, in which the body’s metabolism fails to regulate a specific substance the body needs (in this case insulin), and how it interacts with glucose in the body. Women who are “overweight” can have more issues with insulin resistance than those who aren’t.

Eating disorders, such as anorexia, can also lead to nutrient deficiencies that decrease levels of estrogens, negatively affecting ovulation and leading to the absence of periods altogether. When a woman is in recovery, and gaining weight, she might also experience changes in her cycle as her hormones recalibrate.

What to do if your BMI isn’t within the “normal” range

You don’t have to be at a BMI over 18 and under 25 to increase your chances of getting pregnant. But if you’re classified as “overweight” with a high BMI, losing just 5-10% of your body weight may positively impact your fertility. A 2014 study showed that people who were “overweight” and being treated for infertility lost 10% of their body weight and had higher rates of conceiving than those who didn’t. (Note: There are also meta-analyses — studies that combine estimates from a whole bunch of studies — that also suggest that weight loss has a positive effect on fertility.)

Losing weight, however, isn’t necessarily the answer. Dr. Montenegro recommends talking to a health professional who specializes in metabolic fertility issues. Without being properly evaluated, you may be doing more harm than good for your fertility by losing subcutaneous body fat — the fat you can “pinch” — and not losing visceral body fat, the latter which is the root of metabolic fertility issues, according to Montenegro.

Being “underweight” or “overweight” can have varying complications for your fertility. The good news is that there are steps you can take to improve your overall health, especially when it comes to conceiving. One of the things you can be proactive about is getting your hormone levels tested with Modern Fertility. Knowing your levels can help start a conversation with your doctor about your ability to conceive, and they can work with you to decide whether your BMI could potentially be a factor in getting pregnant.

This article was medically reviewed by Dr. Nataki Douglas, the Chair of the Modern Fertility Medical Advisory Board.

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Should you pass on your dark roasted cup of coffee? Switch your “joe” for The Queen of England’s favorite beverage?

When filling out any lifestyle questionnaire, chances are that somewhere in the dietary intake section this question arises: how many cups of coffee do you drink a day? Inevitably, you wonder if answering three cups will be seen as too much, so you decide it’s better to just answer with 2-3 cups per day. Right?

There is no “right or wrong” answer to the question because one of the main components of coffee, caffeine, has been shown not to be the “health hazard” that we once thought it was. Indeed, plenty of rigorous studies have shown that coffee intake can benefit diabetes type 2, improve circulation, increase fat expenditure and may even prevent endometrial cancer.

Certainly, if coffee has passed the test for improving some health conditions, it may also positively affect your family dreams. We know that carrying excess body fat impairs some fertility-related hormones, for instance, or that type 2 diabetes increases circulatory inflammatory compounds, and coffee helps with both of these. A cup of Joe may be a daily “must-have,” and just one more reason to order a Venti cup at Starbucks.

While daily coffee intake may be helpful – added flavors, cream, syrups, etc. are not a good idea. Just keep it simple. Coffee can amp up your antioxidant intake as well, thus battling oxidation that speeds up the aging process. Coffee is certainly popular in the American diet. The National Coffee Association and The Specialty Coffee Association of America report that over 50% of the population, age 18 plus, drink coffee regularly and that the average daily consumption is 3.1 cup of coffee a day. So, if you’re looking to change diapers anytime soon, hold onto your cuppa Joe for now. This holds true for both women and men.

Slow down the biological clock

You may be wondering about all the talk about free radicals and antioxidants. All human cells have mitochondria – the energy-releasing powerhouses. While this energy keeps our body up and running, certain not-so-healthy lifestyle habits increase the toxic byproducts of this energy supply, increasing the number of free radicals in the body. Eating too much sugar and saturated fat, eating too few fruits, veggies and omega-3 fatty acid-rich foods (such as salmon and walnuts), exercising too much or too little, all add to the body’s oxidative stress. Even poor sleep habits increase the number of free radicals, all of which lead to cell malfunction which speeds aging and increases the risks of chronic illness.

Antioxidants come to the rescue by preventing free-radical damage. Some foods are richer in antioxidants than others, so you need to pay attention. There are some good sources – peaches – and some great ones – plums. “The strength of an anti-oxidant molecule can be measured by its ability to neutralize free radicals”, says Barry Sears, PhD. author of The Mediterranean Zone book and the number one New York Times Bestselling author of The Zone.

The potency of the antioxidant capacity of foods depends on its polyphenol content – a chemical found in plants. And this is where coffee gets its health benefits. Studies show that the compound chlorogenic acid found coffee is the source of the powerful antioxidants that decreases oxidative stress by: a) keeping glucose metabolism under control; b) improving insulin sensitivity; and c) increasing fat expenditure.

But at the same time that coffee aids in metabolic processes that arise with infertility issues, if the short-term goal is parenthood, you can up your antioxidant quota in other areas. For example, the spice shelf is a good place to look. According to Sears, spices are the richest source of polyphenols, particularly, oregano, turmeric, thyme, rosemary, sage, cinnamon and basil.

Should you switch coffee for tea? 

Women’s call: A study published in British Journal of Pharmacology shows that caffeine reduces muscle activity in the fallopian tubes that carry eggs from a woman’s ovaries to her womb. “This provides an intriguing explanation as to why women with high caffeine consumption often take longer to conceive than women who do not consume caffeine,” says Sean Ward, professor of physiology and cell biology at the University of Nevada School Of Medicine, who conducted the study.

Men’s call: According to a study published in Toxicology journal, caffeine alters the sertoli cell’s metabolism. The main function of this cell is to nourish the sperm cells’ antioxidant capacity, which is critical for healthy sperm.

Tea may be the winner: But not all sources of caffeine and/or daily intake are equal. Indeed, some studies show that fewer than 3 cups of coffee a day does not affect fertility. However, when caffeine comes from sodas, the outcome may vary.

In a study published in Epidemiology journal from Boston University School of Public Health, shows that 3 cups of coffee – around 300 mg of caffeine a day – seems safe. Nevertheless, caffeine from soda was associated with reduced fertility – from 1 to 3 plus servings a day compared to none, while tea was the winner with slightly increased fertility when having 2 servings plus a day versus none.

Tea’s antioxidant properties do not just come from its caffeine, but also a much stronger polyphenol: ECGC, which has some of the highest antioxidant capacities. So, instead of hitting Starbucks next time, you may want to brew a cup of tea instead and help yourself to two of the best antioxidants available to aid your fertility outcome: a little bit of caffeine and some ECGC.

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Your doctor usually orders the standard tests to rule out possible causes of infertility, but one is often left out: lipid panel, or in less fancy terminology, cholesterol.

If you don’t remember the last time your doctor mentioned your cholesterol numbers, and you are now facing fertility issues, it is high time to check your levels. A fertility study published in the Journal of Clinical Endocrinology & Metabolism included 501 couples with mean ages of 30 for the women and 31.8 for the men. The overall Body Mass Index (BMI) of the participants was 27.6 for women and 29.8 for men–overweight, but not obese. Of the 501 couples, only 347 of them achieved pregnancy.

Researchers found that free cholesterol levels in both women and men were significantly higher among the couples that did not achieve pregnancy within a year. Elevated cholesterol is associated with an inflammatory body state which affects the inner walls of the blood vessels (the endothelium) – thus, impairing the normal blood flow, called vasodilatation. This cellular inflammation impairs metabolism, sex hormones, and overall circulation. This can negatively affect, among other things, the health of egg and sperm cells, as some studies suggest.

Are you getting the “right” fats?
You may not have a diet high in cholesterol – (when was the last time that you had eggs?) – but that doesn’t mean your cholesterol levels are not high. Dietary cholesterol does not impact total cholesterol levels as much as overall intake of saturated fats, refined carbohydrates and trans fat. High intake of these substances sets up the environment for cholesterol to be oxidized, which is when plaque starts building up in the arteries. Equally, it may not be what you are eating, rather what you are NOT eating that could be the problem.

When substituting saturated fats for anti-inflammatory fats such as omega-3 fatty acids and mono-unsaturated fats along with fiber, you will not just regulate better cholesterol levels, but it will also help you lose visceral fat. This is the most dangerous type of body fat due to the pro-inflammatory components it releases. Visceral fat harms not just your heart, pancreas, and other organs, but also your family goals as it is a problem for both women and men.

Better eggs! 
One of the biggest challenges to fertility – both natural and assisted – is advanced maternal age. As women age the egg quality can be highly affected. How to improve women’s egg reserves remains a medical challenge. However there is something that you can do now to improve egg quality. A study published in Aging Cell demonstrated that women who consumed a diet rich in omega-3 fatty acids prolonged egg quality. Conversely, the study found that a diet rich in omega-6 fatty acids is associated with poor egg quality.

Essential fatty acids are polyunsaturated fats that our bodies can’t produce, so we must obtain them from food. The two groups of EFAs are omega 3s and omega 6, both of which are important for regulating and improving energy production in the body, cell growth, blood circulation, nerve function, hormone function and strengthening the immune system. The problem is that the Western diet is already high in the “pro-inflammatory” omega 6 fatty acids. Evidence shows a disproportional ratio between omega 3 and omega 6, some as high as 1:10. Ideally, omega 3 to 6 ratio should be 1:1.

Eating a diet high in omega 6 can create an imbalance of the two EFAs because they both omega 3 and 6 compete for the same enzymes that metabolize them. The omega 6 will use up all the metabolizing enzymes making them unavailable for omega 3 metabolism and absorption.

So, if you have elevated cholesterol, do not look for a quick fix with cholesterol lowering drug medication just yet. These may bring on other unhealthy side effects, particularly unwelcome when trying to get pregnant. Instead, focus on some dietary and overall lifestyle changes that will truly make you healthier from the inside out. For example:

1. Increase food sources of omega-3 fatty acids such as salmon, pacific halibut, black cod, and nuts and seeds such as walnuts and flaxseeds.
2. Favor mono-unsaturated fats such as olive oil, nuts, avocado and sunflower seeds.
3. Reduce the intake of omega-6 fatty acids like soybean, corn and safflower oil.
4. Avoid saturated fats and trans fat found in fatty meats, full-fat dairy, and processed foods such as cookies, snack bars, chips, pastry, etc.
   Increase the intake of high-fiber foods such as apples, raspberries, oatmeal, lentils, barley, and split peas, among others.
5. Get plenty of food high in vitamin C like broccoli, kiwi, pineapple, strawberries, asparagus, etc.
6. Mooo: include food high in calcium such as Greek non-fat yogurt, low-fat cheese, kale, almonds, and broccoli.
7. Amp up the intake of antioxidants, particularly resveratrol (which does not have to come from red wine as it is also found in peanuts and grapes.)
8. It doesn’t hurt to add some probiotics. Make sure the yogurt you buy has “live and active cultures” on the label. Studies show that that these gut microorganism may inhibit intestinal cholesterol absorption.

Equally important is to check your vitamin D blood levels, (which some studies have linked to elevated cholesterol when the sunshine vitamin is low) as it may increase the High Density Lipoprotein (HDL) or good cholesterol. Also mind other lifestyle components when trying to lower your cholesterol numbers: stress management, sleep hygiene, and physical activity.
I hope you take note and start working on this cholesterol issue now. In the end, these changes will make a healthier YOU and, hopefully, a healthier family!