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!

Part of my job is to regularly review the top medical journals for recent findings related to nutrition, metabolism, supplementation, fertility, physical activity and other topics related to health and wellness. I’ve put together some of the most reputable and applicable research conclusions that you can put into practice now to aid the success of your fertility journey.

1. 1. Moderate Exercise Increases Pregnancy Rate.
      Regular, moderate physical activity is associated with the highest pregnancy rates, regardless of your Body Mass Index (BMI). For example, taking 100 steps per minute or 3,000 in 30 minutes. But beware that too much exercise that is high intensity, of long duration, or that includes poor recovery, may jeopardize your fertility.  – Fertility and Sterility Journal.
   2. Enhance Weight Loss with Exercise.
      Following a diet can inhibit your calorie-burning metabolism by 15 percent, which makes weight loss even harder. Make sure to add exercise to your strategy as it controls the appetite-inducing hormone ghrelin and keeps your metabolism running at high speed.  – Diabetes Metabolic Syndrome Obesity: Targets Therapy
   3. Better Sleep for IVF Success.
      Keep tabs on the amount of sleep you get when undergoing IVF treatment. Sixty patients with sleep disturbances, who received lifestyle-counseling treatment, including melatonin supplements, increased their mean number of the retrieved eggs.  – Journal of Assisted Reproduction and Genetics, 2012.
   4. Invest in a Fitness Monitor.
      A University of South Carolina study shows that people who used an energy-monitoring armband to help them lose weight dropped triple the amount of weight than those without such a device.
   5. Vitamins Help You Get Pregnant Faster.
      Research shows women with BMIs greater than 25 got pregnant faster when they had more beta-carotene in their diet. Women under age 35 benefited from more vitamin C plus beta-carotene. And women aged 35 and older benefited from extra vitamin E.  — Gynecologic and Obstetric Investigation, 2014.
   6. “How To Eat An Elephant?” One Piece At A Time!
      Take the same approach with your healthy lifestyle goals. The British Psychological Society found that breaking goals down into smaller, manageable tasks increases the chances of achieving the goals faster. So think, “I’ll have a healthy breakfast every day,” instead of “I want to lose 15 pounds.”
   7. Do Vitamin D Levels Affect Fertility In Men?
      The Unit of Reproductive Endocrinology at Aristotle University of Thessaloniki in Greece, recently reviewed 30 years of research involving vitamin D and human reproduction. They found evidence for a “favorable effect of vitamin D supplementation on semen quality, testosterone concentrations, and fertility outcomes.”
   8. A+ for Avocados.
      A study in Nutrition Journal shows that subjects who have avocado at lunch decreased their appetite by 40%. Likewise, avocado may ignite your metabolism due to its content of the amino acid L-Carnitine, which has shown to speed up the burning of body fat.
   9. Lower Stress to Keep Your Libido And Fertility In Full Swing.
      A recent study found that stress in young healthy adults (age 25-50) lowers DHEA-S levels, a precursor of sex hormones, by 23 percent. Make sure to set aside “me” time to decompress during the day. Studies show just 15 minutes has a tremendous impact on stress level reduction.  – IDEA Fitness Journal, 2014.
   10. Crave Sugary-Fat Foods? Check Your Sleep Habits.
       People who get less than 7 hours of sleep select greater portion sizes of energy-dense food snacks – those high in sugar and fat –and meals than they do after one night of normal sleep, says a study in Psychoneuroendocrinology. Lack of sleep disrupts two hormones that control appetite and satiety: ghrelin and leptin.
   11. Strategies to Lower Calorie Intake.
       -Surround yourself with healthy pictures like colorful salads and real-life people working out—you’ll make weight-friendly choices.
       -Read labels for ingredient information—people eat about 35% more calories from brands labeled “organic” or “gluten free” because they see them as “healthy.”
       -Be the first one to order in a restaurant—otherwise you can be tempted to follow another diner’s less-than-healthy menu choices.
   12. Belly Laughs Can Make Baby Bellies!
       A good laugh can lower blood pressure, stress, and even glucose response after eating high-carbs foods. But it can also help make babies. Women who underwent in vitro fertilization treatment (IVF) and were then exposed to humorous clowning routines became pregnant at a higher rate than those who did not get the laugh exposure. – Fertility and Sterility Journal
   13. Know Your Good and Bad Fats.
       LPoly-unsaturated fats (salmon, seeds, nuts) improve embryonic quality
       Trans-fats (chips, cookies, junk foods) have been tied to ovulatory infertility and miscarriage
       Saturated fats (red meat, fried foods, cheese) have been linked to lower sperm concentrations and fewer mature eggs, which may mean fewer embryos to choose from for fresh transfer— European Society of Human Reproduction and Embryology
   14. For greater IVF treatment success, eat more protein before, during, and after undergoing the procedure.
       Women who underwent IVF and had at least 25% of their daily caloric intake allocated to protein-rich foods, became pregnant 67% of the time. Those who ate less had only a 32% pregnancy rate. But keep your protein healthy—avoid saturated fat from animal sources like red meat. – American College of Obstetricians and Gynecologists, 2013.
   15. Seeds of Success
       To improve your implantation and pregnancy rate—increase your intake of poly-unsaturated fatty acids. Snack on walnuts and unsalted peanuts, and sprinkle sesame, sunflower and chia seeds over salads and soups. – The Journal of Clinical Endocrinologist and Metabolism, 2010.
   16. Folate is for women and men.
       Folate is not just a vitamin important for women during pregnancy, but men can bump up their fertility with folate. In a study published in  The Journal of Human Reproduction men who ate more folate-rich food were 20%-30% less likely to have abnormal sperm. To up your folate intake, make beans like pinto, navy and lentils good food pals.

It is no secret that being overweight brings with it a laundry list of health problems, and impaired fertility surely makes the list. However, to improve fertility outcomes, don’t just keep an eye on your own waist, but also that of your male partner. And, though we know that making dietary changes is essential to losing or maintaining weight, too often we consider physical activity as an “extra” that it is not as important as diet. Wrong! Exercise and a healthy diet are a marriage in weight management, an unbreakable one.

At Massachusetts General Hospital Fertility Center, 137 men seeking fertility treatments between 2006-2012 were evaluated on the relationship between their sperm concentrations and their exercise habits. The study found men who engaged in moderate to high intensity exercise for seven hours a week, showed 48% higher sperm concentrations 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 higher sperm performance. The study’s authors attribute these results to the testosterone increase and improved insulin management effect of weight lifting; whereas, outdoor activities may increase levels of vitamin D, which has shown to impact fertility.

Keep Moving!

Plenty of studies show lifting weights in the following manner produces the greatest testosterone boost: three to four sets, 8-12 reps, and selecting exercises that work different muscles at the same time—squats, pull-ups, and push-ups. Likewise, one study observed subjects with increased risk of Type 2 diabetes – a condition often associated to years of excess sugar intake and weight gain. The subjects participated in resistance-training workouts, twice a week, for 16 weeks. The study revealed a favorable impact on insulin sensitivity and/or an increase in the activity of the transporters of glucose to the muscles.

Also, don’t ever think exercise works likes a savings account that bears benefits with little effort. You have to make daily deposits to keep your health balance in the black. Barbara Bushman, Ph.D., FACSM, of Missouri State University, explains in her article in the ACSM’s Health & Fitness Journal, that exercising on a regular basis is particularly important as the effects on blood glucose levels are lost within days of the activity.

In fact, when healthy subjects reduced their physical activity from more than 10,000 steps per day to less than 5,000 within three days, postprandial glucose (glucose levels measured after a carbohydrate-rich meal) increased significantly. (“Lowering Physical Activity Impairs Glycemic Control in Healthy Volunteers,” published in Medicine & Science In Sports & Exercise.)

It’s worthwhile to mention that as great as lifting weights and outdoor cardio may be for male fertility, if biking is your chosen activity, hold off for a while. In the same study, men who biked for more than an hour a week had 34% lower sperm count than those who didn’t cycle. The pressure placed against the scrotum by a bike’s seat, and/or the increased temperature in this area, has shown to impair fertility.

We’ve been told that to lose weight, we’d better have a healthy, balanced diet, eat fewer calories than we burn, and exercise regularly. And somewhere we read something about also managing stress to keep the pounds from piling up. However, other than the standard recommendations, not many people connect losing stubborn pounds with sleep habits. Indeed, you can be doing everything you are supposed to do, but still don’t see the scale balance in your favor. If this is the case for you, read and learn from my patient Mary.

BMI, IVF and Sleep: What do they have in common?

Mary, a patient evaluating fertility treatment options, ate clean and worked out four times a week, but began to notice, little by little, that her pants got tighter. Since she was doing the right things in terms of her health, she thought her weight gain was caused by a hormonal problem. “It must be my thyroid,” she said. After her physician ran all the proper tests, she came to me for overall dietary, exercise and other health-related lifestyle counseling.

By reviewing Mary’s lifestyle, I found she had begun to get up at midnight to make sure her husband was home safe from his night job. So, with this nightly interruption, Mary was getting only about six total hours of sleep a night. Not terrible, but the problem was that her sleep time and quality was being disrupted. And this disturbance she was messing up her metabolism. Translation: she didn’t know why she was hungry all the time or why she was craving sugary food throughout the day. These symptoms were something that she didn’t have before.

Mary’s body mass index (BMI) – a measure of weight-height relationship classification – was now over 25, when it used to be 23. This put Mary in the overweight category. The fact that Mary now was overweight increased not only her pant size, but also her risked her fertility and overall health. In fact, a recent study, in which more than 47,000 treatment cycles were included, found that raised BMI (>25) is associated with adverse pregnancy outcome in women undergoing IVF with ICSI treatment, including lower live birth rates. (Reproductive Biomedicine Online, 2011.)

Unfortunately, Mary could now be part of this statistic. How are sleep deprivation or erratic sleep patters linked to weight increase? In a study published in the international journal Psychoneruendocrinology, sleep-deprived people selected greater portion sizes of energy-dense food snacks – high in sugar and fat –and meals than they do after one night of normal sleep. Another study published in Journal of Clinical Endocrinology & Metabolismshows that even with subjects of healthy weight, when they experienced just a single night of sleep loss, the part of the brain related to the desire to eat experienced a greater activation than when they slept their regular number of hours.

Experts explain that lack of sleep or sleep disruption, throws off important hormones that control appetite and satiety: ghrelin and leptin. When these two hormones are out of whack, hunger increases while satiety is slow to kick in. This affects other hormones that also impact the metabolism, such as insulin and cortisol. So, basically, your energy goes down and neither your body nor mind processes that you’ve already eaten, therefore you feel hungry all day, and your energy stays low. All this makes it harder for you to do the two things that can best control your weight: making nutritious food choices and exercising.

Even when you do manage to control your diet, in a study in which subjects on a diet slept 8.5 hours or 5.5 hours, they lost the same amount of weight, but the ones who slept the 8.5 hours lost more body fat and less lean muscle than those who slept less.

The takeaway message: we know how important is to maintain a healthy weight during fertility treatments; one more thing to evaluate if you’re fighting the pounds is your sleep pattern.