Fertility Nutrition

• Important to highlight that conception is a miracle! And for many couples this is not an easy journey. 
• 1 in 6 Australian couples are unable to become pregnant after a year of unprotected sex.
• Nutrition and lifestyle can play a role and have a positive effect on fertility, in fact, it may improve fertility by up to 69%! https://pubmed.ncbi.nlm.nih.gov/17978119/

Female Fertility

• A balanced diet is important, including a wide variety of fresh produce daily
• Mediterranean-style diets have been associated with improved fertility 
• Which foods and nutrients are important to include? 
  • Folic acid has been shown to be important in female fertility, even with assisted reproduction. It is recommended to include a daily prenatal multivitamin supplement with folic acid (400-500 µg/day) from 12 weeks pre-conception and for the first 12 weeks of pregnancy to decrease the risk of neural tube defects. This supplementation is particularly important in early stages of pregnancy when many women may not yet know they are pregnant, so if you have the opportunity to forward plan it’s always a good idea. 
  • Vitamin B12 - animal products, vegans should consider supplementation under guidance from their doctor or dietitian 
  • Omega-3 fatty acids - EPA and DHA are important for fertility, conception and foetal development 
  • Antioxidants are important for fertility and conception. They help to keep both our sperm and eggs healthy! Include a wide variety of plant based products including vegetables, fruits, nuts, seeds and wholegrains to boost beneficial antioxidants like vitamins C, E, folate, beta-carotene and lutein. It’s beneficial to try to get these nutrients from food sources and always speak to your doctor or dietitian before considering a supplement (especially Vitamin E).
  • Opt for complex, low GI, high fibre carbohydrates from whole grains, vegetables, nuts and seeds. 
  • Include plant-based proteins, reducing your reliance on animal proteins. Get creative with legumes and pulses, whole grains, nuts and seeds.
  • Seafood may have a positive association with fertility. Couples eating more seafood were pregnant sooner than those rarely eating seafood.
  • Choose full fat instead of low fat dairy
  • Iodine may be important - get this from seafood, seaweed (nori), potatoes, cranberries, strawberries iodised salt and our bread supply which is fortified. This is a good one to start with folate in the lead up to conception, and is included in most prenatal vitamin blends. 
  • Your eating window may be important. Some studies suggest that shifting towards an earlier eating pattern, with a larger breakfast and lunch and a smaller evening meal with reduced late-night eating, may improve fertility. 
• Which foods and nutrients are worth eating less of?
  • Swap out trans fats for mono- and omega 3 poly-unsaturated fats. This means less processed and fried foods, commercially-prepared baked   products and margarines.
  • Reduce processed meat intake. Replace these with lean meats, eggs, full cream dairy and plant alternatives such as legumes, tofu, nuts, seeds and grains. 
  • Reduce intake of refined carbohydrates found in sweet drinks, lollies, cakes, biscuits, desserts, and refined products like white bread, rice and cereals. Instead opt for the low GI options listed above. 
  • Energy drinks - it’s no surprise that they don’t do us any fertility favours. 
  • Reduce alcohol intake 
  • Don’t overdo the caffeine. Some studies have suggested that large intake (over 500 mg of caffeine daily) may take up to 9.5 months longer to get pregnant  https://pubmed.ncbi.nlm.nih.gov/9054236/
• Movement is important! Exercise has many benefits for your health, including increased fertility. A sedentary lifestyle has been associated with a higher risk of infertility and increasing movement has been found to reduce the risk of infertility. 
• Mindset and stress is another important factor. Managing stress and anxiety may be easier said than done, particularly when trying to conceive, so consider seeking professional support to optimising your mental wellbeing and therefore fertility. 
• Recommend tailored advice from a dietitian in the case of any medical conditions  including PCOS, diabetes or GDM, if you’re in a small or larger body and have any concerns, and if taking any complementary or alternative therapies. 

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30311-8/fulltext

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)90458-6/fulltext

https://www.thelancet.com/series/preconception-health

https://www.health.harvard.edu/blog/fertility-and-diet-is-there-a-connection-2018053113949

https://www.eatright.org/health/pregnancy/fertility-and-reproduction/fertility-foods

https://www.healthline.com/nutrition/17-fertility-tips-to-get-pregnant#1.-Eat-Foods-That-Are-Rich-in-Antioxidants

https://pubmed.ncbi.nlm.nih.gov/22425198/

https://pubmed.ncbi.nlm.nih.gov/11880759/

https://pubmed.ncbi.nlm.nih.gov/11594714/

https://www.pennutrition.com/KnowledgePathway.aspx?kpid=1323&pqcatid=146&pqid=1313 - sweeteners 

Male fertility 

• A balanced diet is important, including a wide variety of fresh produce daily
• Mediterranean-style diets have been associated with improved fertility and semen quality in men
• Which foods and nutrients are important to include? 
  • Omega-3 fatty acids - EPA and DHA are important for fertility
  • Antioxidants are important for fertility and conception. They help to keep both our sperm and eggs healthy! Include a wide variety of plant based products including vegetables, fruits, nuts, seeds and wholegrains to boost beneficial antioxidants like vitamins C, E, folate, beta-carotene and lutein. It’s beneficial to try to get these nutrients from food sources and always speak to your doctor or dietitian before considering a supplement (especially Vitamin E).
• Which foods and nutrients are worth eating less of?
  • Swap out trans fats for mono- and omega 3 poly-unsaturated fats. This means less processed and fried foods, commercially-prepared baked   products and margarines.
  • Reduce processed meat intake. Replace these with lean meats, eggs, full cream dairy and plant alternatives such as legumes, tofu, nuts, seeds and grains. 
  • Reduce intake of refined carbohydrates found in sweet drinks, lollies, cakes, biscuits, desserts, and refined products like white bread, rice and cereals. Instead opt for the low GI options listed above. 
  • Energy drinks - it’s no surprise that they don’t do us any fertility favours. 
• Movement is important! Exercise has many benefits for your health, including increased fertility. A sedentary lifestyle has been associated with a higher risk of infertility and increasing movement has been found to reduce the risk of infertility. 
• Mindset and stress is another important factor. Managing stress and anxiety may be easier said than done, particularly when trying to conceive, so consider seeking professional support to optimising your mental wellbeing and therefore fertility. 

Caffeine for fertility

You certainly don’t need to forego your daily coffee! If you’re trying to conceive it is a good idea to not overdo the caffeine. Some studies have suggested that large intake (over 500 mg of caffeine daily) may take up to 9.5 months longer to get pregnant  https://pubmed.ncbi.nlm.nih.gov/9054236/

Decaf -3mg caffeine per tsp

1 Tsp of instant coffee - 60mg per tsp

Espresso shot (30-35ml) - 90-200mg 

Percolated - 100mg per cup

Energy drinks - up to 110mg per serve

Cola - 40mg per serve

Black Tea - 50mg 

Green tea - 30mg

Chocolate - 60g of milk or dark Choc has about 30-40mg

Pregnant women can safely have two instant coffees a day and two to three cups of tea OR one cap/latte 

Pesticides fertility

Some studies suggest that higher consumption of produce prone to harbour higher pesticide residues may be associated with lower probabilities of pregnancy. Those looking to conceive may wish to consider where they source fruits and vegetables that may be more likely to hold residual pesticides, such as strawberries, spinach, capsicum, apples, pears, nectarines, peaches, cherries and grapes. 

While this is important to be aware of, washing fresh produce well will help to reduce exposure. And it’s important to keep eating PLENTY of fresh produce as the nutritional benefits of this is very important to consider (as well as any possible pesticide risks). For many, this may be easy to achieve with non-organic produce that’s easier on the purse strings. 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2659557

During Pregnancy

Things to be aware of / avoid

• Vit A - Beta carotene safe, avoid retinol/retinyl esters - upper limit for preformed vitamin A (retinyl esters and retinol from food and supplements) during pregnancy of 3000 µg /day (~10,000 IU). Be cautious of liver (≤1 serving/week), particularly in 1st trimester. Avoid any topical creams, ointments, serums which contain vitamin A or vitamin A derivatives. 
• Mercury in high doses may harm a developing baby's brain. Limit large loads of mercury by:
  • Limit orange roughy (sea perch) or catfish to 150 g/week and to have no other fish that week or 
  • Limit shark (flake) or billfish (swordfish/broadbill and marlin) to 150 g/two weeks and to have no other fish during those two weeks

Examples of low mercury fish that are high in omega-3 fats include sardines, mackerel, silver warehou, Atlantic salmon, canned salmon and tuna in oil and herrings. Pregnant women are advised to consume 300-450 g/week of lower mercury fish and seafood. 

• Food safety is important to minimise the risk of food-borne illness. Elevated progesterone levels in pregnancy suppressed the immune system, making women more prone to infection and illness. In particular, we want to reduce the risk of foodborne illnesses listeriosis, toxoplasmosis, campylobacteriosis and salmonellosis. The consequences of foodborne illness can be particularly devastating during pregnancy because both the woman and her foetus are at risk. Risk is very rare, especially in Australia (> 300,000 pregnancies per year and around seven cases of listeria during pregnancy). 

Listeria risk:

• raw or unpasteurized dairy products, fruit juices or cider
• soft and semi-soft cheeses (e.g. Brie, Camembert, feta), blue-veined cheeses, gorgonzola, Hispanic-style fresh cheeses (e.g. queso blanco) unless they are cooked until steaming hot 74°C
• refrigerated pâtés, meat spreads and smoked seafood 
• pre-packaged or prepared fruit/vegetable salads and raw sprouts 
• ready-to-eat deli meats and ready-prepared meals unless they are reheated until steaming hot (74°C)
• raw or undercooked meat, poultry, seafood and eggs.

Toxoplasma, Campylobacter and Salmonella infection:

• Unpasteurized milk products and juices. 
• Raw or undercooked meat, poultry, shellfish and eggs.
• Rinse fresh fruits and vegetables thoroughly. 
• Avoid raw sprouts.
• Follow safe food handling practices including washing hands and food preparation surfaces well.

Sushi - generally safe if the raw fish has been previously frozen, and is from a source that you trust. If raw fish hasn’t been previously frozen, it may contain small parasitic worms, called anisakis worms. And you don’t want day old rice - salmonella and listeria risk. 

• Alcohol - no safe level and the recommendation is to avoid alcohol during pregnancy 
• Avoid excessive flaxseed (linseed) intake - adverse events in rats 
• Artificial sweeteners - most common sweeteners in Aus - aspartame, stevia, sucralose, sorbitol, mannitol, isomalt, xylitol have been approved for use during pregnancy and lactation

https://www.pennutrition.com/KnowledgePathway.aspx?kpid=3043&tkid=22118&secid=3104#1

https://www.health.gov.au/resources/collections/pregnancy-care-guidelines-and-related-documents

https://www.health.gov.au/sites/default/files/lifestyle-considerations_0.pdf