We all too often hear about the decline in fertility with female age but little attention is given the other 50% of the equation.
A father’s health prior to conception can influence pregnancy progress and their future child’s health. It sounds a bit far fetched that your current health can have an impact on future generations but that is the science of epigenetics! And like most things, this can be for good if you are looking after yourself with a healthy lifestyle, or for bad if your health is not getting the attention it needs.
What the Heck is Epigenetics?
Epigenetics is essentially the modulator and interpreter of your DNA. DNA is our inherited genetic material, but epigenetics can change the way that our genes are turned up or turned down. Lifestyle is a key regulator of these chemical messages that can turn a gene on or off so you can appreciate how important exercise, sleep, diet and stress are influencing our health.
If you would like to read more about epigenetics check out this article at the Australian Academy of Science.
Why Does Age Matter?
As men age there is a decrease in fertility and an increase in pregnancy complications such as gestational diabetes, low birth weight and preterm birth. The children of fathers over 45 years have increased risks of chromosomal and non-chromosomal birth defects and has been linked to an increased incidence of childhood autism and cancers.
One reason for the decline in fertility is that with age comes a decrease in the key male sex hormone testosterone. As testosterone levels decline sperm quality is reduced and in a double whammy, it is likely that libido is reduced too.
Can You Turn Back the Clock?
While you can’t change your chronological age, there are some great strategies to reduce the impacts of ageing on fertility.
Endurance exercise like jogging, cycling and swimming is key for driving anti-ageing changes at the cellular level. Regular aerobic exercise at the optimal intensity will dampen oxidative stress and inflammation, ultimately influencing the expression of your genetic material within the cell so you can pass on positive health traits to your future offspring.
Resistance training twice a week is also a great way to increase testosterone concentrations that may decline with age. Aerobic exercise helps raise testosterone by reducing body fat levels (which reduce fertility) but a strength training session will raise testosterone concentrations immediately, improving sperm health. Aim to strength train all major muscle groups at least twice a week.
How is YOUR sperm health?
Never underestimate the power of positive thinking, and while you are imagining your little embryo implanting to become a big fat positive (BFP) there are some positive steps you can take to get that egg to stick!
Time to put your feet up?
I have read some advice suggesting that women have complete bed rest for two days after their transfer. PLEASE NO!!! While it is not the time to run a marathon, everything we know about the negative effects of bed rest for physiology and your mental state suggests that this would be detrimental. The concept of bed rest stems from old school thinking that the contents of your uterus will fall out as soon as you stand up and walk. Hmmm... no.
Studies that have used ultrasound to track air bubbles delivered into the uterus have shown that 15 minutes of walking straight after transfer had no effect on the uterus contents so it is safe to say that your embryo will not fall out.
Ban the bed rest
Excitingly a systematic review (scientific analysis of all literature on the topic) exploring the effects of bed rest after embryo transfer and the outcome of IVF/ICSI has recently been published – and guess what? Bed rest is NOT GOOD.
The review included studies involving autologous transfers (women’s own eggs) and varied fertility issues such as oligomenorrhea (infrequent menstrual periods), endometriosis and male factor infertility. In one study included in the review the patients were even catheterized so they didn’t have to get up and go to the toilet! Who has two days to hang around in bed??
Anyway, prolonged bed rest (24 hours) was found to be associated with lower rates of clinical pregnancy. Women who rested in bed were 40% less likely to have a Big Fat Positive (pregnancy test) (1).
So if bed rest, or a marathon, is not on the menu then what should you be doing? The IVF Project can guide you during this two week wait with your individualised exercise prescription!
1.Craciunas L, Tsampras N. Bed rest following embryo transfer might negatively affect the outcome of IVF/ICSI: a systematic review and meta-analysis. Human fertility (Cambridge, England). 2016; 19: 16-22.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects 5-20% of women of reproductive age worldwide. PCOS is characterised by increased levels of androgen hormones such as testosterone and menstrual / ovulatory dysfunction. It is frequently accompanied by insulin resistance and obesity, resulting in a high risk for type 2 diabetes and cardiovascular disease. Losing body weight when you have PCOS is difficult – and it should not be your primary focus. Focus instead on moving regularly (sit less) and eating a wide variety of fresh, unprocessed food which will have a real impact on improving your fertility.
Lifestyle Modification Works!
Ovulation rates improve dramatically in women with PCOS after adopting an active lifestyle and eating a nutritionally balanced, energy restricted diet [3, 4]. Live birth rates also more than double! . Delaying fertility treatment to give yourself time to be the healthiest you can be is associated with improved assisted reproductive treatment outcomes.
Research shows that differences in the expression of progesterone receptors in the endometrium of women with PCOS could impact upon embryo implantation. The right exercise prescription can restore balance to the menstrual cycle, and in particular women with PCOS can realize benefits of improved blood glucose control and insulin resistance, even without weight loss. Exercise can also restore progesterone receptors in the endometrium, which can benefit embryo implantation. At a minimum, a three-month investment in making positive lifestyle changes that include exercising right could save you treatment cycles (which translates to saving your emotional sanity and money). It’s no wonder that Medical Research Guidelines state that exercise should be first line therapy for all women with PCOS.
If you conceive, this is just the start of a very long journey where your health has a direct influence on not only the health of your pregnancy but your child’s health. Exercise during pregnancy reduces gestational diabetes, low back pain assists with gestational weight control and reduces the need for a caesarean section (C-section). Exercise during pregnancy also boosts newborn brain development so start planning not just for the timing of your trigger shots but for a healthy pregnancy and beyond.
Our brain plays a key role in regulating food intake along with our gut and fat tissue. These communication channels involve a number of hormones to relay messages and there is evidence that two of these hormones, insulin and neuropeptide Y, are differently regulated in PCOS .
Insulin is a hormone secreted from the pancreas that plays an important role in regulating our blood sugar levels, and energy (fat) storage. When we eat foods containing carbohydrate, the carbohydrate is broken down to glucose and absorbed into the bloodstream. The glucose provides fuel for our body and almost every cells needs glucose to function. Insulin is required for cells to take up glucose or to store glucose for later. Cells have special receptors to recognise insulin which will then ‘open the door’ for glucose to enter the cell. If the cells have fewer insulin receptors than normal or they are not working properly, they are described as insulin resistant.
Without glucose getting into the cells, the pancreas works overtime to produce more insulin, leading to high levels in the blood. When the cells do not respond as they should to insulin and the pancreas produces more and more insulin, this is described as ‘insulin resistance’ that over time leads to diabetes. One way to lower insulin levels in the blood is to ensure your diet is designed to reduce insulin levels by incorporating the right amount and type of carbohydrate. Another way to lower insulin is to ensure you are engaging in regular physical activity. We can provide you with your personalised exercise program and comprehensive dietary feedback from your nutrition analysis to give you the best chance of conception!
There is also evidence that in PCOS the usual concentrations and response to Neuropeptide Y is affected. Neuropeptide Y initiates appetite drive so typically levels are elevated during periods of food restriction. In PCOS, levels of this hormone have been reported as both lower than normal  and higher than normal  and may contribute to the reduced feeling of fullness and increased hunger following a meal in women with PCOS when they are compared to healthy women.
When hormone levels are low for prolonged periods the body sometimes become hypersensitive to the hormone so it takes far less hormone to stimulate a response than normal. Low levels of neuropeptide Y could increase the body’s sensitivity to the hormone, increasing appetite. Similarly, high levels of neuropeptide Y reported in PCOS women would also stimulate appetite. Insulin concentrations can regulate neuropeptide Y so strategies to reduce insulin levels will also modulate appetite. For this reason (and many others), exercise and nutrition are key in the treatment and managements of PCOS .
Where to Start?
Lifestyle change can improve your chance of pregnancy by over 200%. To get the best, evidence based guidance book in your initial consultation with Dr Kitic for access to our fertility specialist practitioners who will take you on a step by step journey to enhance your reproductive health!
It’s the New Year! Despite this been the time that some people sit down and write a list I must admit that I’m not one for making New Year resolutions.
If I realise something I need to be doing to improve my wellbeing, personal or professional growth, I find planning a strategy to incorporate this into every day life is far more effective than an unrealistic New Year resolution.
Working out how you can improve aspects of your health can seem overwhelming but there are often small things we can do each day that will take us in the right direction. Change does not always have to be drastic as over committing may see you set yourself up for failure and back at square one.
Little things such as taking the stairs when you have the opportunity and getting to bed earlier are great starters. Building healthy habits into your daily routine will not only improve your long term health but also benefit fertility!
You may want to start the year with a process of self-reflection to help guide you in what you plan for the New Year. What went well in 2018? What constructive and positive elements do you want to carry over into 2019? What didn’t work so well in 2018 and what are you looking to change in the New Year? What elements can you take control of to reach your goal?
A great exercise to include in this self-reflection is an oldie but a goodie- the pros and cons list! This can be considered like a balance sheet for weighing up how important change is to you and also letting you know what habits you don’t want to let go of! Get out a pen and a clean sheet of paper that you divide into three columns.
For an example of how to fill out the sheet, we can focus on a health behaviour where someone may not be regularly exercising (we could consider regular as a minimum of 3 aerobic sessions a week plus two strength sessions) write down in the first column “staying sedentary” and then you can put the pros (all the positives) of that behaviour in the second column and then write the cons (any negative consequences) associated with that behaviour in the third column.
Beneath this they would write an alternative behaviour such as “exercising regularly”. They would then list all the pros and cons associated with this behaviour.
Think about any behaviours you have thought about changing or that you know may be holding you back. Once you have your own table complete, take some time to contemplate the pros and cons of each behaviour and see if you have some clarity around where you will focus your energies for 2019.
Plan little changes into your current daily routine to give yourself every chance of success and may 2019 be your year!
Does this sound familiar? I found myself saying this last week so it’s a good time to anticipate that at some point you may be feeling this way, or have you already said 'I'm too tired to exercise'?
The desire to give yourself the best chance of conception and set routines for a healthy pregnancy and baby may be all the motivation you may need to get moving but some days this can be a challenge. Some tips here may help you find that extra incentive!
What Physical Activity Makes you Feel Good?
This could be an interval session with some high intensity exercise, a Pilates session that really challenges your core or a quick walk outdoors among fresh air and greenery. It is so rare not to feel better after some exercise so when I feel tired and just want to sit down rather than get moving I go straight to my inner monologue that reminds me how good I feel afterwards.
Exercising is like an instant mood lift – even if it’s a quick lounge room strength workout you will almost always feel better for doing something rather than nothing.
Regular Exercise Actually Increases Energy and Reduces Fatigue.
If you find yourself too tired this is when you really need to be exercising! The vitality boosting quality of exercise is why it is an effective component of treatment for conditions associated with fatigue such as cancer, where exercise improves fatigue, enhances sleep quality and even reduces depression.
As you look forward, these benefits will also carry over to a healthy pregnancy. Women who resistance train experience less fatigue, better sleep quality and more energy during pregnancy.
Fit in Your Workout First Thing.
Resist hitting snooze and put on your workout gear as soon as your feet hit the floor out of bed. Do a quick lounge room workout, fit in your gym session or a walk before you start the rest of your day. YOU are incredibly important and looking after your physical and mental health will be a great asset on your fertility journey.
Are you Getting Enough Sleep?
While you are out hitting the pavement or doing some strength exercises contemplate WHY you may be feeling tired. We know that sleep is one of the most important tools for physical and psychological health. The amount of sleep we get impacts our production of hormones, how we regulate blood sugar and can also affect our weight.
It is not too much of a surprise then that missing out on quality sleep can also affect our fertility. Sleep disruption, or not getting enough sleep, can alter levels of reproductive hormones, affecting ovulation, endometrium receptivity and libido!
Aim for 7-8 hours of undisturbed sleep a night. A great excuse to hit the pillow early!
Just how much does exercise improve your chance of taking home a baby if you are undergoing assisted reproductive treatments?
We have talked about meta-analysis before but if this is a foreign sounding term to you don't worry. Here is our quick explanation: A meta-analyses is a way that we can combine the findings from multiple studies and analyse them to draw conclusions about the effect of a particular treatment or intervention. Essentially it provides a snapshot of how big or small, positive or negative an effect may be once all the results of separate studies are pooled together.
Earlier this year a meta-analysis was published that explored the benefits of a mother’s physical activity before IVF/ICSI cycles and the treatment outcome.
What Did They Find?
We know that fertility decreases with age and that a high BMI negatively affects fertility, reducing embryo development, implantation and clinical pregnancy rate. A number of studies in the meta-analysis controlled for these two factors and found that pregnancy rate was 89-352% greater in women that regularly exercised compared to women that did not exercise.
Even without accounting for age or BMI, live birth rate was significantly greater in women that exercised > 2.5 h/week by 56%!
Importantly there was no greater incidence of miscarriage in women that were physically active. With a safe, effective exercise prescription you have the power to potentially triple your chance of getting pregnant!
For general health, the Australian Guidelines stipulate that you should participate in 2.5 hours of aerobic exercise per week and strength training 2-3 times a week. While this is a great guide for overall health, to optimise your fertility you may need a different prescription that is tailored to your previous physical activity levels and stage of fertility treatment.
If you are unsure of where to start or are afraid you are doing too much or not enough, we would love to help you on your journey and improve your chance of pregnancy!
The best predictor of making a healthy embryo is having healthy sperm and healthy eggs. No surprises there! As sperm is half of the equation, you may be wondering “how can I increase the health of my sperm?” or “what can my husband do to improve our chances of conception?”
Well, there are proven ways to improve sperm health and two of the most effective strategies are with the right exercise and diet. Once again- it sounds pretty straight forward but how do you know if you are getting all of the micronutrients you need to make healthy sperm? How do you know if you are doing too much or not enough exercise?
Six months of moderate exercise in males with low sperm counts with or without low motility increased live birth rates by over 90%! The birth rate in men that did not exercise was 0%. That is correct. Every male wanting a baby should be physically active!
Adapted from data from Hajizadeh et al 2017
The key is getting the balance right though as too much high intensity exercise and many hours of cycling impair sperm health. If in doubt, keep your exercise at a low to moderate intensity and minimise your sedentary time. Remember that watching TV for more than 20 hours a week is associated with a huge 44% reduction in sperm quality and if your waist circumference is greater than 100 cm you are likely to have a 22% decrease in healthy sperm.
If you don’t get enough fruit, veg and wholegrains into your daily food intake you are 2.6 times more likely to have an abnormal sperm concentration and reduced motility. Aim for five serves of veggies a day, preferably non-starchy vegetables (no potato). One serve of veggies is equivalent to 1 cup of salad or ½ cup cooked non-starchy vegetables. For some this would be a huge increase in vegetable intake but with the right strategies you can incorporate some veggies at snack times and definitely in your lunches and dinners. A veggie packed stir fry for dinner anyone?
Leptin is a hormone released from body fat that helps regulate our food intake and energy balance. We know that energy balance is linked to reproductive function, and it appears that leptin may play a key role in linking these.
Higher levels of leptin are found in infertile men and women when compared to fertile couples and there is a clear association between increasing leptin concentration and higher body fat. There are also complications that come with very low levels of body fat and being in a negative energy balance and in this instance, leptin may help restore fertility. Read more about energy balance here.
High levels of leptin in overweight males and females have been shown to impair fertility and attenuate embryo development. Leptin concentration has also been found to predict unexplained infertility in a North Indian population and can be a sensitive marker for anovulatory fertility disorders.
So if levels of leptin are associated with impaired fertility, how can they be modified?
It is true that Exercise is Medicine and incredibly within two weeks of initiating regular exercise in those with normal to high levels of body fat, leptin levels start to reduce, regardless of gender or age. Part of this is attributable to reducing body fat levels and one of the best ways to influence body composition (how much fat mass and muscle mass you have) is to engage in regular resistance training. Indeed, leptin levels are reduced to a greater extent with a combination of strength and aerobic training when compared to just aerobic training.
The reduction in leptin that accompanies regular exercise is believed to be one of the mechanisms by which exercise improves the regulation of blood sugar levels. With a lowering of leptin comes enhanced insulin sensitivity which has many benefits for improving fertility and is one of the key reasons why engaging in regular exercise and adopting a healthy diet can be such effective strategy to improve the chance of conception.
Body composition (the balance between muscle mass and body fat) influences the chance of spontaneous conception and the outcome of assisted reproductive treatments so maintaining optimal body composition is a great way to improve your reproductive health. Did you know that exercise guidelines recommend strength training 2-3 times per week for optimal health?
Strength training is the best way to maintain or build muscle mass, boost your metabolism and reduce body fat. And you can do this all without having to set foot into a gym! All you need is a small space and a towel and you can follow your program on The IVF Project app and realise all the fabulous benefits of strength training which include:
The Australian guidelines for health state that we need to move more and sit less. Specifically, they recommend including 150-300 minutes of moderate intensity aerobic activity a week (and of course strength training twice a week!). But what is ‘moderate intensity’? Do you know if you are working hard enough or too hard?
Monitoring your heart rate will enable you to determine your exercise intensity. If you have a heart rate monitor then this can be easy to track the intensity of your aerobic sessions but you can also take your heart rate manually. The range classed as moderate intensity is between 55% and <70% of your maximum heart rate.
You can estimate your maximum heart rate by the simple formula: 220 – age = maximum heart rate. Once you have your maximum heart rate you can work out the intensity range as a percentage of this. For example, someone aged 35 would have a predicted maximum HR of 185 beats per minute. Working at the top end of moderate intensity (ie. 69%) would mean that they had a HR of 128 beats per minute.
Be cautious with any heart rate monitor that records heart rate at the wrist rather than using a chest strap as these are not very accurate, particularly when moving at pace.
To measure your heart rate manually find your pulse at your wrist (the radial artery) or at your carotid artery in your neck. Using your index and middle finger, count the number of beats you feel in 20 seconds. Multiply the number of beats you count in 20 seconds by three to find the number of beats per minute. This is not so easy when you are on the move but you can always stop mid walk or jog to take a measure and know you are on track.
No Heart Rate Monitor? No Worries!
The intensity of aerobic sessions can also be determined using the Borg Rating of Perceived Exertion scale, or RPE. Perceived exertion refers to how hard you feel you are working. RPE is based on the physical sensations you experience during exercise, including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue.
The scale is from 6 to 20 (Table below). As your exercise intensity increases, your RPE number will increase as you feel you are working harder. On the scale below 6 means "no exertion at all" and 20 means "maximal exertion." If you were sitting at your computer reading this your RPE of the physical activity you are doing is likely to be 6 (particularly if you are sitting!). 19-20 on the scale would be extremely strenuous exercise level. For most people this is the most strenuous exercise they have ever experienced.
Moderate exercise on the RPE scale is in the range of 11 to 12. If you have a noticeable increase in breathing rate during your exercise session but can maintain a conversation, then you are most likely in the moderate range.
What Exercise is Safe During IVF or for Maximising Fertility?
If you are looking to boost your fertility, either naturally or with fertility treatment, then exercise should be an important component of the positive lifestyle changes you make to benefit conception and the health of your baby. Knowing how much to do though can be tricky as each individual has different health considerations and different levels of fitness. There is no one size fits all approach when the end goal is so precious!
Different stages of an IVF treatment cycle require different exercise prescriptions. For men, the exercise you do in preparation for providing a sperm sample may be different to the exercise you do in the post-collection period. For women, your exercise prescription will differ between pre-treatment, stimulation, the period between egg collection and transfer day, and the seemingly forever two week wait. There will also be differences in your exercise prescription for frozen treatment cycles.
Just as you want a specialist extracting your eggs or handling your sperm sample, make sure you see an expert for exercise guidance. An Exercise Physiologist can help to create the right program to improve your chance of success needs to be based on your current health and activity levels, the cause of infertility and in particular your stage of fertility treatment. The scientific evidence is clear that the correct exercise prescription can improve your chance of success.
Male factor infertility accounts for ~20% of IVF/ICSI cycles undertaken. While there are many reasons for male infertility, there is a 50% greater chance of reductions in fertility in overweight males. Male factor infertility is associated with increased levels of inflammation and oxidative stress that can damage sperm, causing DNA fragmentation. Male factors, such as increased oxidative stress, are also implicated in recurrent pregnancy loss. So how can you improve the health of your swimmers?
Does Exercise Work?
Exercise has been shown to improve sperm quality and DNA damage by reducing markers of inflammation and oxidative stress. Research also shows that exercise can combat the negative effects of a bad diet for sperm, improving sperm quality by 68%. Importantly, moderate intensity exercise is superior to high-intensity interval training for improving sperm health so you need to get the exercise prescription right. For highly trained athletes, regular, high-intensity exercise with minimal recovery between sessions may actually reduce sperm quality. An Exercise Physiologist can provide you with the optimal exercise program to enhance your fertility.
If you are male and your preferred mode of exercise is cycling there is also evidence to suggest that you may need to back off time spent on the bike and swap this for another aerobic activity. Cycling for more than five hours a week is associated with a 92% chance of low sperm concentration. If you are trying for a baby then you can still cycle but may need to modify the frequency and intensity of your sessions.
If you are a gym junkie then keep training at moderate levels and avoid the use of supplements which may be contaminated with steroid-like substances. It goes without saying, avoid the use of anabolic steroids too. After two years of anabolic steroid use, 80% of bodybuilders (average age 27 years) had testicular atrophy, 24% reduction in sperm volume, 32% reduction in sperm motility, and a 62% reduction in sperm fertility index – not great for baby making.
Best Chance of Success
Even if male factor fertility issues are not the primary reason you are undergoing IVF, ensuring your sperm are in tip-top shape will help you to maximize your chance of success. If you have not exercised regularly before and are planning to undergo IVF, exercise will benefit your sperm health. The bonus is that improved sperm health will improve the health of your offspring too!