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.

More often than not, we look at the woman’s health side when discussing fertility issues. But men need to be part of the conversation too. One major topic of discussion: low vitamin D levels.

Chances are you have heard about the benefits of adequate vitamin D – from heart health to diabetes to decreased belly fat. But does vitamin D levels affect fertility, especially for 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.” The bad news: some studies have reported that most people, especially men, run low in vitamin D. The leading factors include aging, limited sun exposure, and/or certain cholesterol drugs.

If a man suspects low vitamin D is the source of his fertility problems, he should first talk to his doctor who can run a blood test to measure serum 25(OH) D concentration, which can determine if he is D deficient. A serum level of 20 ng/mL is considered “good” although some studies have shown higher benefits in the 25-35 ng/mL range.

The Recommended Dietary Allowances (RDAs) of vitamin D for most people is 600IU. How much should you take to reach serum 25 (OH) D levels? It is quite easy. For every 1ng/mL that you need to bump up, you require an additional 100IU of vitamin D per day.

Supplements are an easy way to get more D. If your doctor advises to take one, look for Vitamin D-3, which has shown to raise the levels more effectively than D-2. Equally important is to take it with your biggest meal as this increases its absorption by 50%, according to a study from the Cleveland Clinic Foundation Bone Clinic.

Besides supplements, you can increase your vitamin D levels with foods, such as egg yolk, salmon, fortified milk, yogurt, and cheese. Vitamin D is called the “sunshine vitamin” because your body can get it from the sun. And while some sun exposure (about 10 minutes) can complement your vitamin D diet and supplements, relying too much on sunlight may increase your risk of skin cancer. It’s often safer to stick with supplements and food.

Be aware that too much vitamin D can increase one’s risk of heart and liver issues. However, if the “boys” need some help, a little extra D may do the trick.

Actresses, athletes, and not so famous people swear their weight loss, improved mood, joint pain relief, and any other ailment cure is the result of a gluten free diet—avoiding foods made with wheat, rye, and barley. Certainly, if you are among the 1% of the American who suffer from celiac disease (a condition in which you cannot digest gluten) you must be put on a gluten free diet. But what about the rest of us? Will going gluten-free really work as an almost one-size-fits-all type of remedy for so many health issues? Unfortunately, there is no one-size-fits-all answer either.

Gluten is a protein found in those grains. People without celiac disease can still experience an inflammatory response from consuming gluten (called non-celiac gluten sensitivity, NCGS). This may decrease the absorption of important nutrients while increasing oxidative stress (cell damage). So they may benefit from avoiding gluten rich foods. But what you choose as food substitute matters as much as staying gluten clear. If your first choice is to eat any of the hundreds of gluten-free products on grocery shelves, you also could consume extra sugar, fats, and other poor nutritious content that may lead to other health issues. However, gluten-free can also mean increasing more foods like veggies, fruits, beans and lentils, and gluten-free grains, all of which are high in fiber, amino-acids, magnesium, iron and other important nutrients. This option can help you lose weight as well as improve your overall health.

Nowadays, we know that behind many health problems, such as diabetes, obesity, arthritis and even some conditions that affect fertility like endometriosis, lays chronic inflammation. Thus, by avoiding gluten you may better manage these conditions. In fact, a recent study found that women who suffer from painful endometriosis symptoms and followed a gluten-free diet reported significantly less painful symptoms compared to those who did not follow the diet. (Department of Gynecology and Obstetrics, Tor Vergata University, Rome, Italy.) Keep in mind that going gluten free may mean you need to supplement your diet with vitamins A, D, E, and K, iron, calcium, folic acid, and B-complex vitamins. Gluten-free takes dedication and discipline to follow. But if you have digestive issues, it could help you find welcomed relief.