While dark green leafy vegetables may not always be a favourite at the dinner table, there is no denying the ‘eat your greens’ mealtime mantra is spoken as a gesture of love and good intention, founded in the wisdom that dark green and leafy vegetables are a rich source of body-loving nutrients. Let’s look at the humble vegetable group we call ‘dark green & leafy’ to see what all the fuss is about.
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This group of vegetables includes arugula (rocket), Bok choy (Chinese chard), collard greens (a variety of cabbage that produces long leaves instead of a head), dandelion greens, kale, mustard greens, rapini (broccoli raab), Swiss chard, turnip greens and spinach.

It also includes the brassica vegetables since there are many nutritional overlaps. Brassicas (also called cruciferous vegetables) are broccoli, cauliflower, broccolini, turnip, Brussels sprouts, and cabbage. This short list is limited to those most cultivated in the West, but Mother Nature’s generosity in producing edible green plants the globe over means that many cultures have leafy greens native to their geographical location, and thus include them in their dietary pattern.
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Nutritionally, dark green and leafy vegetables are rich in:

• dietary fibre for lowering serum cholesterol, improving blood sugar control, lowering blood pressure, improving stool regularity, feeding healthy gut bugs

 

• folate for cell growth and repair, preventing neural tube defects in developing fetuses

 

• vitamin C contributes to antioxidant defense system and immune function, used to make collagen and neurotransmitters such as serotonin

 

•  vitamin E contributes to antioxidant defence system and immune function, provides cell protection

 

• vitamin K for blood clotting, bone health, and blood vessel health

 

• vitamin A for eye health, reproductive health in men and women, immune function, cell growth and development

 

• iron for healthy red blood cells to transport oxygen around the body, immune function, and supporting the antioxidant defense system

 

• magnesium for bone and teeth health, nerve health, muscle health, and takes part in hundreds of essential cellular reactions

 

• calcium for bone and teeth health, nerve health, muscle health, healthy blood pressure, balancing blood pH

 

• potassium for fluid balance, nerve health, muscle health, blood pressure health

 

• flavonoids which contribute to antioxidant defenses       (1)(2)

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While dark green and leafy vegetable consumption and fertility has not been heavily studied, research is consistent when it comes to the protective effects of dark green and leafy vegetables for positive birth outcomes and all-round health.

Zerfu and colleagues (3) found that poor or inconsistent consumption of dark green leafy vegetables was associated with a 92% higher risk of experiencing an adverse pregnancy outcome compared to those with a higher or more consistent intake. Low or no green leafy vegetables consumption has also been identified as a risk factor for small for gestational age (4; 5), spontaneous preterm birth (4; 6), and gestational diabetes mellitus (4; 7).
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Low dark green and leafy vegetable intake has also been positively associated with anaemia during pregnancy, particularly in those with a low red meat consumption (8; 9). Finally, as rich sources of magnesium, dark green and leafy vegetables are important for preventing hypomagnesemia during pregnancy, which is associated with pre-eclampsia and pre-term birth (6).
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Some nutrients in dark green leafy vegetables cannot be absorbed by the body in the absence of fat, so pairing these vegetables with a source of fat is a great way to ensure you’re getting all the nutritional benefits.
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Stuetz and colleagues (10) write about this beautifully in discussion of their findings that women in Tanzania who cooked their leafy vegetables with peanuts (a source of fat) were found to have higher levels of fat-soluble vitamin A in their blood.

Here are some ideas for including dark green and leafy vegetables in your week:

• Crush up black peppercorns and mustard seeds in a mortar and pestle, and sprinkle over broccoli or broccolini with a generous splash of extra virgin olive oil (mustard seeds also enhance the potency of an anti-inflammatory compound called sulforaphane found in broccoli)

• Chop fresh or frozen green leaves or dark green veg finely and add to soups, stews, chilli, or pasta sauce (e.g. Bolognese)

• Use spinach or arugula to make a pesto with nuts (pine or other) and olive oil, and use on pasta, white fish, chicken, or salad.

• Add chopped greens to a stir-fry near the end of the cooking time.

• Cook green leaves (e.g. chard, spinach, Bok choy) until they are wilted but still bright green. Serve drizzled in extra virgin olive, citrus juice and pepper, or a splash of sesame oil, soy sauce and sesame seeds.

• Fold cooked greens into an omelette or frittata (include the egg yolks for a fat source).

• Try arugula, baby spinach, mesclun mix, watercress, or baby mustard greens in your salad and dress with an oil-based salad dressing, such as this easy recipe: 3Tbsp extra virgin olive oil; 4Tbsp apple cider vinegar; juice one lemon; 1Tbsp dijon mustard; 1 Tbsp honey/maple syrup.

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• Chuck some dark green leaves into your morning smoothie and add some coconut milk or full fat yoghurt/kefir.

Preparing for conception is a wonderful time to care for your body with the health-protective powers of dark green and leafy vegetables. If you’re looking for some further guidance on your fertility journey, we’d love to support you in clinic or via telehealth.

You can book a complimentary phone call with us here or check out our science backed approach to get pregnant sooner in Create a Fertile Gut!

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1. Randhawa, MA Khan, AA Javed, MS & Sajid, MW (2015) Chapter 18 - Green Leafy Vegetables: A Health Promoting Source, in Ronald Ross Watson (ed) Handbook of Fertility, Academic Press, pp 205-220, doi: 10.1016/B978-0-12-800872-0.00018-4.
2. Babu, PVA & Liu, D (2009) Chapter 18 - Flavonoids and Cardiovascular Health, in Ronald Ross Watson (eds), Complementary and Alternative Therapies and the Aging Population, Academic Press, pp. 371-392, doi:10.1016/B978-0-12-374228-5.00018.
3. Zerfu, TA Pinto, E & Baye, K (2018) Consumption of dairy, fruits and dark green leafy vegetables is associated with lower risk of adverse pregnancy outcomes (APO): a prospective cohort study in rural Ethiopia, Nutrition and Diabetes, 8:52, doi: 10.1038/s41387-018-0060-y.
4. Jankovic-Karasoulos T, Furness DL, Leemaqz SY, Dekker GA, Grzeskowiak LE, Grieger JA, Andraweera PH, McCullough D, McAninch D, McCowan LM, Bianco-Miotto T, Roberts CT. Maternal folate, one-carbon metabolism and pregnancy outcomes. Matern Child Nutr. 2021 Jan;17(1):e13064. doi: 10.1111/mcn.13064. Epub 2020 Jul 28. PMID: 32720760; PMCID: PMC7729528.
5. McCowan L, Horgan RP. Risk factors for small for gestational age infants. Best Pract Res Clin Obstet Gynaecol. 2009 Dec;23(6):779-93. doi: 10.1016/j.bpobgyn.2009.06.003. Epub 2009 Jul 14. PMID: 19604726.
6. Enaruna NO, Ande A, Okpere EE. Clinical significance of low serum magnesium in pregnant women attending the University of Benin Teaching Hospital. Niger J Clin Pract. 2013 Oct-Dec;16(4):448-53. doi: 10.4103/1119-3077.116887. PMID: 23974737.
7. Chen Q, Wu W, Yang H, Zhang P, Feng Y, Wang K, Wang Y, Wang S, Zhang Y. A Vegetable Dietary Pattern Is Associated with Lowered Risk of Gestational Diabetes Mellitus in Chinese Women. Diabetes Metab J. 2020 Dec;44(6):887-896. doi: 10.4093/dmj.2019.0138. Epub 2020 Sep 11. PMID: 33081427; PMCID: PMC7801758.
8. Tadesse SE, Seid O, G/Mariam Y, Fekadu A, Wasihun Y, Endris K, Bitew A. Determinants of anemia among pregnant mothers attending antenatal care in Dessie town health facilities, northern central Ethiopia, unmatched case -control study. PLoS One. 2017 Mar 13;12(3):e0173173. doi: 10.1371/journal.pone.0173173. PMID: 28288159; PMCID: PMC5348124.
9. Diamond-Smith NG, Gupta M, Kaur M, Kumar R. Determinants of Persistent Anemia in Poor, Urban Pregnant Women of Chandigarh City, North India: A Mixed Method Approach. Food Nutr Bull. 2016 Jun;37(2):132-43. doi: 10.1177/0379572116637721. Epub 2016 Mar 23. PMID: 27009090.
10. Stuetz W, Gowele V, Kinabo J, Bundala N, Mbwana H, Rybak C, Eleraky L, Lambert C, Biesalski HK. Consumption of Dark Green Leafy Vegetables Predicts Vitamin A and Iron Intake and Status among Female Small-Scale Farmers in Tanzania. Nutrients. 2019 May 7;11(5):1025. doi: 10.3390/nu11051025. PMID: 31067775; PMCID: PMC6567817.

 
 

In her absolute genius, mother nature has connected all non-essential bodily functions to physiological energy balance so in periods of famine non-essential physiological activity (such as reproduction) can be paused. While reproduction is of course necessary for survival of the species, the body prioritises individual survival… for the same reason flight attendants tell us to put on our own oxygen masks before we help others… that is… we’re no good to anyone, or our species, if we’re not functioning. 

Now, I appreciate that for many of us famine is a rare occurrence… I mean, how many of us live within a five-minute drive of at least 1 supermarket? Not to mention the abundance of corner shops and fast-food joints we pass on the way to aforementioned supermarket. Oh, and who has Uber Eats on their Smartphone?

​Yet, while we intellectually understand that we are not living in famine, our bodies and gut microbes base their definition of ‘famine’ on what passes through the gastrointestinal tract, and the regularity and consistency with which it arrives. So, on those weeks when we find ourselves too busy to schedule in regular times to eat, and it’s grab ‘n’ go at varying opportunistic times of the day (often making up for it in excess in the late evening) … the body is registering that we’re living in times of famine, and food is neither a predictable nor dependable commodity.

The body feels safe shunting energy to fuel reproductive physiology when it knows there’s enough energy and sufficient nutritional diversity, delivered consistently. Let’s explore each of these…
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A reproductive cycle (from cultivating a viable egg, through pregnancy, to eventually weaning the offspring) is the most energetically costly activity female mammals undertake in their lifetime. Thus, the body has safe-keeping mechanisms in place to prevent risk to a mother or any potential offspring in times of caloric deficiency. In short – your beautiful body has totally got your back.

Eating sufficient energy to match your metabolic activity is a must for fertility. Importantly, research suggests that it is not the absolute energy consumed that matters but that energy intake matches energy expenditure (1). Consuming insufficient energy for your needs may manifest as a lack of libido (suspected to be the result of disruption to ovarian steroid release, as well as reduced responsiveness to oestradiol by the part of the brain that controls female sexual behaviour), or manifest as suppressed ovulatory cycles (nil ovulation during your cycle or missing periods), due to a forebrain-controlled dampening of the luteinizing hormone (LH) surge that needs to occur for successful ovulation. This is why we often witness amenorrhea in females who are not meeting their energy expenditure requirements in the context of calorie restriction (e.g. dieting) or exercising without properly nutritionally replenishing themselves.

An important caveat of energy abundance is that energy must be available for cells to use. For example, in the case of untreated diabetes, where there is an abundance of glucose trapped in the blood unable to be used as cellular energy, both sexual behaviours and ovulation are suppressed (1). If there is a risk that you may be living with untreated diabetes, getting help to manage blood glucose levels is important for your overall health, and will also increase your chances of falling pregnant. Similarly, in metabolic syndrome fatty acids are trapped in storage unable to be used for energy, hence infertility is a commonly observed side effect.
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The importance of diversity in the diet for fertility cannot be understated. Diversity (particularly of plants) not only ensures the availability of sufficient nutrients to help keep our human body functioning properly, it also ensures we are delivering a broad diversity of foods to our health-promoting gut microbes, who we know play an important role in supporting healthy sperm and egg development and uterine receptivity.

A dietary pattern rich in different fruits, vegetables, fish, dairy, wholegrains, legumes, nuts, seeds, fish, poultry, and monounsaturated fats increases the probability of pregnancy following IVF (2, 3) and lowers the risk of ovulatory disorders and infertility due to other causes (4). If you would like to know if you are ovulating you can read here.

Dietary patterns containing an abundance of different foods, rather than restrictive diets, positively correlate with biochemical pregnancy, clinical pregnancy, and probability of live birth (5). On the other hand, a Western Style Dietary pattern (low in plant diversity and healthy fats, while high in refined carbohydrates, vegetable oils, and processed meats) is associated with increased inflammation in follicular fluid and less blastocysts, as well as an increase in time to pregnancy, and delays in the female ovulatory cycle (6). 

Consistent nourishment is a powerful signal to the body that the environment is conducive to reproduction. Indeed luteinizing hormone secretion (needed for ovulation) is tightly regulated by the forebrain (hypothalamus), which responds very rapidly to changes in availability of fuel (glucose or fatty acids) (1).

Another note about consistency is the finding by Bavani and colleagues (7) that showed meal irregularity associated with irritable bowel syndrome prevalence. This is an interesting finding for fertility, since we know that IBS aligns with gut dysbiosis, which correlates with increased inflammation and oxidative stress, both of which negatively impact fertility.
 
Consistently nourishing your body with a diverse array of foods sufficient in carbohydrate, protein, and health-promoting fats, rich in vitamins, minerals, phytochemicals, and antioxidants, is a wonderful first step when looking to conceive. If you are looking for support in cultivating nourishing practices for fertility, we would love to be there for you. 

Book in for a complementary call to see if we are the right support for you here.

Blog Written by Emily Hahn APD
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1. Wade, GN & Jones, JE (2004) Neuroendocrinology of nutritional infertility. Am J Physiol Regul Integr Comp Physiol 287: R1277–R1296, doi:10.1152/ajpregu.00475.2004.
2. Vujkovic M, de Vries JH, Lindemans J, et al. (2010) The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril. 94:2096–101. [PubMed: 20189169] 
3. Twigt JM, Bolhuis ME, Steegers EA, et al. (2012) The preconception diet is associated with the chance of ongoing pregnancy in women undergoing IVF/ICSI treatment. Hum Reprod. 27:2526–31. [PubMed: 22593431]
4. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. (2007) Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics and gynecology. 110:1050–8. [PubMed: 17978119] 
5. Sanderman, EA Willis, SK & Wise, LA (2022) Female dietary patterns and outcomes of in vitro fertilization (IVF): a systematic literature review, Nutrition Journal 21:5, https://doi.org/10.1186/s12937-021-00757-7
6. Skoracka, K Ratajczak, AE Rychter, AM Dobrowolska, A & Krela-Kazmlerczak (2021) Female Fertility and the Nutritional Approach: The Most Essential Aspects. Adv Nutr 2021;12:2372–2386; doi: https://doi.org/10.1093/advances/nmab068
7. Bavani, N.G., Hajhashemy, Z., Saneei, P. et al. (2022) The relationship between meal regularity with Irritable Bowel Syndrome (IBS) in adults. Eur J Clin Nutr 76, 1315–1322. https://doi.org/10.1038/s41430-022-01108-3

Your mental health impacts how your body functions. Short term stress can be beneficial for heightening your brain function, mounting immune responses to fight off colds and flu and to help you build resilience. It promotes positive adaptations.

On the other hand, chronic stress can have negative consequences for your health and wellbeing, including your fertility.

Psychosocial interventions to reduce stress and support individuals through fertility treatment have been found to double the chance of pregnancy (19).  Let’s look at a practice that may help bring you calm, and support balance for a positive mind body connection.
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Mindfulness is “paying attention to the present moment with openness, curiosity and without judgement” (1).
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Mindful awareness allows thoughts and experiences, often viewed through the lens of our opinions, preferences, and judgments, to simply be there. Some benefits of practising mindful awareness include:

• learning how to relax and regulate emotions (2, 3)
• creating a sense of calm (3)
• developing a sense of empathy and connectedness (4)
• better health (5)
• improved sleep (5)
• enhanced concentration and productivity (6, 7)
• reduced worries, anxiety, and distress (8, 9).

his all sounds very nice, I hear you say, but what does this have to do fertility? 
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​Dealing with infertility brings emotional and physical challenges. Mindfulness can help foster mental and emotional resilience, helping us to cope with feelings of anxiety, depression, distress, and worry (10).
 
Research shows a correlation between mindfulness-based therapies and quality of life among women experiencing infertility (11-13), as well reduced rates of psychological distress, anxiety, and depression (13, 14).
 
Li and colleagues (10) found that women who received mindfulness-based interventions alongside IVF treatments reported increased quality of life, self-compassion, and coping strategies for stress. They also found that these women had greater pregnancy rates compared to the group of women who did not receive the mindfulness-based intervention. 
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​There are two main types of mindfulness practice: formal mindfulness and informal mindfulness.
 
Formal mindfulness 
Formal mindfulness meditation involves sitting or lying, with eyes closed, focusing the attention on one single thing. This could be the sensation of breathing, or focusing on sensations within the body (1).
 
Daily formal mindfulness meditation has been correlated with decreased depression scores and enhanced sleep quality of women undergoing infertility treatments (15). Mindfulness apps, such as Smiling Mind, make it accessible to cultivate a regular mindful practice, offering free guided meditations that you can listen to at a time and place that suits you.

You can also learn mindfulness from therapists trained in mindfulness-based therapies or attend classes where you can learn mindfulness practices as part of a group.
 
Informal Mindfulness 
As with any skill, the more we practice mindfulness the more automatic it becomes. Informal mindfulness is about bringing the same level of focus and attention of formal mindfulness to aspects of your everyday life (1).
 
That is, directing full, non-judgmental curiosity and attention to whatever it is you are doing in the present moment – be this commuting to work, vacuuming the house, eating, etc. Bringing mindful awareness to mealtimes can be a great way to cultivate regular mindful practice, providing opportunities to connect with your body and experience more deeply the sensory pleasure of appetite and eating.
 
This increased attunement to the body puts us in a better position to nourish our body in a way that is aligned with what it needs in that moment. Because eating includes all 5 of our senses – seeing, smelling, tasting, touching, and hearing – it is a sensory rich context for focusing the attention.
 
Next time you are eating a food, try bringing attention to how the food looks (colours, textures, shape), smells, the sound of picking it up with your utensil, and the mouth feel. Notice, without judgment, your response to the food, and how it feels in your body. Bring awareness to how this eating experience differs from the experience of, say, eating your lunch while checking your email, or snacking while in the car? Does your level of satisfaction improve?

Yoga is a form of physical movement that marries up formal and informal mindfulness; the physical postures and breathing techniques of yoga are designed to bring mindful awareness to the body.
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A recent review found that anxiety scores were improved by yoga as an adjuvant during infertility treatment (16). Gaitzsch et al (17) also conducted a review of studies exploring the effectiveness of mind-body therapies (yoga and mindfulness-based therapies) during infertility treatment and found associations with lower anxiety and depression scores. 
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Cultivating a practice of mindfulness can help build resilience to life stress and enhance fulfilment in everyday experiences. Research suggests that incorporating mindfulness into your fertility journey can help reduce anxiety, depression, and distress, while also helping improve sleep and quality of life.
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If you would like to know more about incorporating mindful awareness in your everyday life, we would love to support you at The IVF Project.
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There is one key diet component that is essential to fuel your fertility: carbohydrates!

This may surprise you, as carbohydrates often get a bad rap. Reminiscent of the ‘low fat’ diets of the 80s and 90s, low carbohydrate diets such as Keto, Whole-30 and Paleo are touted as the panacea of health, promising to reduce inflammation and metabolic disruption.
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Reducing inflammation is positive for fertility, but is lowering carbohydrate the answer? 
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Before we go any further, let’s just clear up what we mean by carbohydrate.

Lots of the confusion surrounding carbohydrate stems from the fact that carbohydrates can be many different things. Carbohydrates are sugars, fibre and starches that can be found in a variety of foods from fruits and wholegrains to lollies.

Carbohydrates are the preferred source of energy for your brain and muscles, and without them your gut microbes don’t have a food source to ferment to provide you with fertility loving metabolites like butyrate.

The fine print: not all carbohydrates are created equal!

We can categorise carbohydrates into two broad groups: simple and complex. 
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Simple carbohydrates (also called simple sugars) are easily broken down by the body and the glucose is rapidly absorbed into the bloodstream. This produces a rapid and large blood sugar spike upon digestion. What goes up must come down, however, so following a blood sugar spike your body will also go through a relative low. A lot of these roller coaster peaks and troughs in blood sugar is correlated with inflammation in the body and the brain (1-3).

Processed sources of simple carbohydrates often have the nutrients such as fibre, vitamins and minerals removed or reduced. You will recognise foods with this type of carbohydrate as they are high in energy, high in refined sugars (like white sugar, honey and fruit juice), high in refined grains (white flour), low in nutrients, low in fibre, high in sodium content and could be high in saturated fat, cholesterol and trans fats. Essentially you get less nutritional bang for your buck with simple carbohydrates.

Examples of simple carbohydrates are sugar, honey, agave nectar, maple syrup, high fructose corn syrup, rice malt syrup, refined (white) flour, fruit juice, soft drinks, biscuits, lollies, cakes, chips, sugary breakfast cereals, white bread and wraps.
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Reducing your intake of refined sources of simple carbohydrate is a win for your fertility.
 
 

Complex carbohydrates are made up of more complex sugars strung together in long chains. Compared to simple carbohydrates, foods with complex carbohydrates are packed with more nutrients, vitamins, minerals and fibre.
 
This beneficial carbohydrate is often found in whole foods - foods that have not been overly processed or turned into something that you don’t recognise anymore. Whole foods with complex carbohydrates (fibre and starches) include: wholegrains, brown rice, vegetables, fruit, nuts and seeds, beans and legumes. You will recognise them as they contain low to moderate energy, have a high nutrient content, have no refined sugars or grains, are naturally high in fibre, low in sodium (salt) and have low to no saturated and trans fats.
 
Fibre and starch are two types of complex carbohydrates. Starches are naturally occurring in breads, cereals, starchy vegetables (peas, corn, beans, and potatoes), legumes and wholegrains. Starches will be found with fibre, although some foods have more fibre than starch. Fibre is naturally found in fruits, vegetables, legumes, nuts, seeds and wholegrains.
 
Complex carbohydrates feed beneficial bacteria in your gut microbiota that can enhance your fertility by lowering inflammation, increasing your gut diversity, and reducing dysbiosis. To achieve a fertile gut you need to include complex carbohydrates in your diet that will feed those bacteria who are responsible for looking after you. They can’t do it without you! 

Wholegrains are one of the most important carbohydrates for fertility. In Australia, wholegrains are grain foods that have not been processed or refined. Wholegrains have not had their outer bran or germ layers removed, and therefore contain an abundance of nutrients that support fertility.​​

They contain more fibre, vitamins, minerals and antioxidants than their refined versions (e.g. white bread).
Wholegrain intake has been associated with better antioxidant defenses and reductions in inflammation, as well as better blood glucose regulation (good news for polycystic ovarian syndrome (PCOS)-related insulin resistance) (4).
 
Wholegrain consumption has also been shown to increase the production of fertility-promoting compounds by the gut microbiota (5) and a higher preconception intake of wholegrains has been associated with thicker endometrium for implantation and increased live birth rates following IVF (4).
 
Wholegrain examples include wholewheat, rice (brown, black), corn (including popcorn), oats, barley, spelt, rye, sorghum, millet and pseudo grains such as buckwheat, quinoa, wild rice and amaranth. 
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Wholegrain foods are not only great for fertility. They have a positive impact on reduced risk of developing type 2 diabetes, certain type of cancers and cardiovascular diseases.
 
Wholegrain intake is associated with a reduction in circulating inflammatory markers like CRP (6). Higher CRP levels can be detrimental to the outcome of assisted reproductive treatments (7) while reducing inflammation improves egg and sperm health and uterine receptivity.
  

 

1. Zhang Z-Y, Miao L-F, Qian L-L, Wang N, Qi M-M, Zhang Y-M, Dang S-P, Wu Y and Wang R-X (2019) Molecular Mechanisms of Glucose Fluctuations on Diabetic Complications. Frontiers in Endocrinology. 10(640). doi: 10.3389/fendo.2019.00640
2. Watt, C Sanchez-Rangel, E Hwang, JJ (2020) Glyemic Variability and CNS Inflammation: Reviewing the Connection. Nutrients. 12, 3906-3919.  
3. Hsieh, C-F Liu, C-K Lee, C-T Yu, L-E Wang, J-Y (2019) Acute glucose fluctuation impacts microglial activity, leading to inflammatory activation or self-degradation. Scientific Reports. 9, 840. https://doi.org/10.1038/s41598-018-37215-0.
4. Gaskins AJ, Chiu YH, Williams PL, Keller MG, Toth TL, Hauser R, Chavarro JE; EARTH Study Team (2016). Maternal whole grain intake and outcomes of in vitro fertilization. Fertility & Sterility. Jun, 105(6), 1503-1510.e4. doi: 10.1016/j.fertnstert.2016.02.015. Epub 2016 Feb 28. PMID: 26926253; PMCID: PMC4894002.
5. De Angelis, M. et al. (2015) Effect Of Whole-Grain Barley On The Human Fecal Microbiota And Metabolome. Applied Environmental Microbiology. 81, 7945–7956. https://doi.org/10.1128/AEM.02507-15 (2015)
6. Xu, Y., et al., Whole grain diet reduces systemic inflammation: A meta-analysis of 9 randomized trials. Medicine (Baltimore), 2018. 97(43): p. e12995.
7. Brouillet, S., et al., C-reactive protein and ART outcomes: a systematic review. Hum Reprod Update, 2020. 26(5): p. 753-773.

 

If you were to peek through a microscope at the omega-3 and omega-6 fats, you’d see some pretty funky shapes, which are the manifestation of ‘kinks’ in their fatty acid structure. These kinky little fats don’t just look groovy, their kinked structure make them vital for health and proper brain, eye, cell, and immune system function (1). They also play an important role in early reproductive events including oocyte maturation and embryo implantation. So yeah, they’re a pretty big deal.
 
The caveat: our bodies cannot ‘kink’ the omega-6 and omega-3 fats themselves, so we must obtain them from our diets, which is why we call them essential. You may have heard them called essential polyunsaturated fatty acids (essential PUFAs for short).
 
Our bodies function optimally with a 4:1 or lower ratio of omega-6 to omega-3 kinky fats in our cell membranes (3,5). With the foods we often consume today, particular in Western cultures,  omega-6 to omega-3 ratio is much higher at 10:1 to 50:1 (2,3). That’s a whole lotta omega-6 and a whole little omega-3.

his is problematic, because omega 6 fatty acids have a strong pro-inflammatory effect, while omega 3 fatty acids are potent anti-inflammatories (4). In short, the further away your omega 6: omega 3 balance is from the optimal ratio, the more inflamed your body.

Chronic low-grade inflammation is associated with infertility. Optimal omega-3 dietary intake dampens markers of inflammation and supports better sperm quality, is associated with improved egg health and increased pregnancy rate (6).

Meanwhile, low intake of omega-3 fatty acids may reduce the chance of pregnancy (7, 8). Dietary omega-3 also has prebiotic effects on the gut microbiota, increasing the abundance of microbes that produce compounds supporting gut health (9), which we know is great for fertility !

These days finding out your omega-6:Omega-3 ratio is simpler than it’s ever been. Laboratories have developed test kits that you can complete in the comfort of your own home.
 
Generally, the procedure looks something like this:

• Wipe your finger with an alcohol wipe (very important – we don’t want the lab test to pick up on contaminates, such as fats from your moisturiser or your last meal).
• Stimulate blood flow to your finger by rotating your arm a few times.
• Prick your finger with a finger-pricker (these come in the test kit).
• Allow a few drops of blood to drip onto the test patch (avoid touching your skin to the patches – we want blood only sent into the lab, not skin cells).
• Leave your test to dry for 10 minutes.
• Pop the test into the envelope, stick on a stamp, and post it.
• Wait 10-20 days and enter your unique test code into the lab’s website to access your results.
• Interpret your results with an Accredited health professional. 

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While your ratio might be higher than expected, you now have greater insight  into your body. With this knowledge you can move towards an optimal omega-6:omega-3 balance for health and fertility. 

Some positive steps you may take include:
 
1. Increase your intake of omega-3 rich foods, particularly those from marine sources.

Animal and Marine Sources: fatty fish (herring, wild-caught* salmon, rainbow trout, sardines), tuna, shrimp, yellow tailed king fish, cod, snapper, trevally, barramundi, dhufish, bream, whiting, squid, rock lobster, mackerel, seabass, mussels, scallops, crab, octopus, oysters, seal oil, omega-3 eggs, marine algae

(*farmed salmon is also rich in omega-6, so this source alone may not provide you with the optima balance of omegas)
 
Plant Sources: flaxseeds (linseeds), chia seeds, walnuts, spinach, brussels sprouts, blueberries, hemp seeds, kidney beans, tofu

These plant sources are weaker sources of omega-3 compared to animal sources and marine algae, as the body’s ability to process them is inefficient. If you are vegan or vegetarian, we recommend supplementing with a quality marine algae oil – read step 3 for a definition of ‘quality’.

2.  Lower your intake of omega-6 rich foods that aren’t balanced with some Omega-3s.

High levels of omega-6 are found in cooking oils such as vegetable, safflower, sunflower, corn, soy bean, sesame and  palm oil; fast food and ultra-processed foods are generally cooked in, and/or include an abundance of these oils. 

3.  Consider supplementing with an omega-3 + polyphenol blend

Sometimes it’s just not possible to consume sufficient omega-3 intake from the diet, especially if wild caught fish is not accessible to you. In these instances, an effective, good quality supplement can be an excellent solution. 

A body able to effectively regulate inflammation supports fertility. Testing your omega-6 to omega-3 ratio provides valuable insight into inflammation and looking forward to healthy pregnancy progression. The World Health Organisation recommends an omega-6 to omega-3 ratio of 4:1 or less. 
 
If you would like to find out your omega-6, omega-3 kinky fat ratio, and receive personalised guidance and support for restoring balance, we would love to see you online or welcome you in the clinic!


Written by Emily Hahn, APD

No, we're not talking about that friend that is so fertile they 'didn't even try and just got pregnant' (this takes me back to the oh so many times I felt that intense mix of emotions you have to internalise while smiling on the outside. We have all been there!).

The fertile friends we are talking about are with you every day. You carry them with you everywhere you go. You are even responsible for feeding them and how happy they are.

Yes, we are talking about your gut bugs! The community of microbes that reside in your gut provide a foundation for your fertility. If you would like to get to know them better, here are four facts about these little guys and some tips to nurture them for pregnancy success!
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Are you often sick, fatigued or stressed? These can be signs that your immune system is not firing on all cylinders.
Our gut microbes are critical to healthy immune function so it’s no surprise that when our gut is out of balance, our immune defences suffer. Did you know our gut houses over 70% of our immune cells?!

If your gut microbes are out of balance for a long time, this has even been associated with the development of autoimmune conditions that impact fertility, such as Hashimoto’s thyroiditis and systemic lupus erythematosus.

Things that disrupt our gut microbiota may make us more susceptible to illness and dampen our viral immunity, while a healthy gut community affords protection against infection. 

Diets rich in antioxidant whole foods that nurture your gut diversity can boost your immune system and dampen inflammatory markers by more than 50%. Exercise is also a powerful anti-inflammatory and this in part is attributed to the beneficial changes at the level of the gut microbiota. 

A healthy gut can help reduce infections and keep your immune system in check, so it is ready unleash its anti-inflammatory defences.
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Our gut microbes are essential in regulating our sex hormones that control ovulation, and sperm production. The metabolic activity of your microbes can increase or decrease circulating concentrations of oestrogen and in males a more diverse, healthy gut community is associated with increased testosterone concentrations.

There are over 60 species of bacteria living in our gut that can regulate estrogen concentration. The collection of these bacteria is called our oestrobolome. One way we get rid of oestrogen from the body is in our faeces. How much oestrogen we excrete from our body, or how much we reabsorb back into our blood stream, is influenced by who is living in our gut, or our oestrobolome.
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If you have lots of bacteria that produce β-glucuronidase enzymes, these bacteria can deconjugate oestrogens in the gut so they are reabsorbed back into the circulation. On the other hand, if you don’t have enough of these bacteria that produce β-glucuronidase, then oestrogen gets excreted and circulating levels can be low.

A diet rich in fat or protein is associated with reduce gut diversity and higher β-glucuronidase activity, whereas prebiotics have been shown to reduce this and rebalance oestrogen. This is one way diet impacts endometriosis, where there is disruption of the gut microbiome and higher oestrogen levels may drive the growth of endometriotic lesions.

In females imbalances in gut microbiota can also contribute to increased androgens, elevating testosterone in conditions such as polycystic ovary syndrome (PCOS). Nurturing gut microbiota supports lowering of androgens and menstrual cycle regularity! It also increases sensitivity to the hormone insulin, which helps regulate blood sugar and is essential for ovulation and implantation.

​One important job of your gut microbes is to produce neurotransmitters such as GABA, which are essential for mood. Beneficial bacteria can calm the mind and lower levels of stress hormones.
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In conditions where the gut microbiome is disrupted such as with endometriosis, PCOS and infertility, there is a greater risk of anxiety and depression.

Have you ever eaten lots of processed foods and sugar and felt really blah (brain fog- cravings - fatigue - mood changes)? Well, there is a science to explain how food can influence your mood!
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Your gut talks to your brain so keeping your gut bacteria fueled with prebiotic foods is a great step to boosting mental wellbeing. Getting microbiota accessible carbohydrates and key gut loving nutrients into your diet has been shown to improve brain health and reduce depression.

Your gut microbes love to be fed. You may have heard that they love fibre - and they absolutely do! But, not all fibre is created equal. Some types of fibre won’t promote the growth of your beneficial microbes (they still have benefits though). Other types of fibres will promote an abundance of anti-inflammatory, short chain producing fertility loving gut bugs and these are known as 'prebiotic'. This is the food your gut bugs need to thrive.
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A healthy, diverse gut microbiome is proven to lower inflammation, balance hormones and boost metabolism providing a foundation for optimal fertility. You also get the bonus of more manageable menstrual cycles, better skin and improved mood!

Have you fed your gut microbes today?

Cells need energy to grow, and the parts of a cell involved in energy production are our little bean-shaped mitochondria - the cell powerhouse. Given the essential function of maternally inherited mitochondria in producing energy for growth and maturation, it is not surprising that poorly functioning mitochondria are key factors in diseases such as the neurodegenerative conditions such as Alzheimer’s, metabolic conditions like diabetes, cardiovascular disease, neuromuscular disease and infertility [1].
 
The health of your mitochondria is a great indicator of the success of fertilisation and embryo development [2]. A mature oocyte will contain ~100,000 mitochondria – that’s more than in any other cell of the body so they are pretty important for your egg quality!

Mitochondria are sensitive to elevated inflammation and oxidative stress but they can also contribute to oxidative stress as they work to produce energy. Conditions impacting fertility that are associated with elevations in oxidative stress and inflammation often go hand in hand with mitochondrial dysfunction. For example, eggs retrieved from females with endometriosis have altered morphology (their structure is different), lower levels of mitochondria (which impact the eggs ability to produce energy), and these eggs are less likely to mature once collected [33].
 
Mitochondrial function is also impaired in PCOS, reducing oocyte quality [4], and eggs from obese females have higher levels of mitochondria damage [5].
 
The ability of mitochondria to produce energy is crucial during the development of eggs and to allow for normal embryo growth development [6]. It is not surprising that the decline in egg quality with ageing is also related to mitochondria health.
 
The things that can damage our mitochondria are many, including a high-fat diet [7]. But once again the good news is that there are ways you can boost your mitochondrial efficiency to improve their functioning for optimal reproductive health.​

here is a relationship between gut dysbiosis, mitochondrial disruption and inflammation [8]. Your gut microbiota can directly influence the health of your mitochondria, not only in your intestinal cells but also in your ovaries.
 
While not a human being, the common fruit fly, Drosophila melanogaster, shares about 75% of disease causing genes that are common to mammals, making it a useful model to help explore inflammatory human diseases and provide opportunities for therapeutic discovery [9]. When the gut microbiota is removed from the fruit fly, the production of energy from mitochondria located in the eggs of the female fruit fly was impaired. This meant that the eggs did not develop as they usually would [10], impacting egg quality. Your gut microbiota is involved in the production of vitamins and co-enzymes that support mitochondrial function making it essential for nurturing your mitochondria and egg quality.
 
Looking after your gut microbes with nutrition and physical activity will help nurture those mitochondria for essential energy production! ​
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1. Exercise: Exercise opposes the detrimental effects of ageing, enhances insulin sensitivity, reduces inflammation and improves efficiency of your mitochondria – all things that benefit fertility!In  animal models where we can more easily look at the mitochondria in retrieved eggs, exercise improves mitochondrial shape and function and reverses the damage of a high fat diet [11]. Talk with an Accredited Exercise Physiologist to ensure you have the optimal balance of strength and aerobic loading in your exercise prescription.

2. Show your Gut Microbiota some Love: Optimising your gut microbiota diversity will provide your mitochondria will all the essential vitamins, minerals and co-factors they need to produce energy. Improving your gut health also dampens systemic inflammation to limit stress on your mitochondria.

3. It Takes Two - Sperm Health Matters: When our mitochondria are impacted by conditions such as endometriosis and PCOS, sperm health matters even more. Watch our video "Help an Egg Out". 
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References
1.           Sorrentino, V., K.J. Menzies, and J. Auwerx, Repairing Mitochondrial Dysfunction in Disease. Annu Rev Pharmacol Toxicol, 2018. 58: p. 353-389.
2.           Martin, W., Supply and Demand of Energy in the Oocyte and the Role of Mitochondria. Results Probl Cell Differ, 2017. 63: p. 373-387.
3.           Sanchez, A.M., et al., Is the oocyte quality affected by endometriosis? A review of the literature. J Ovarian Res, 2017. 10(1): p. 43.
4.           Chappell, N.R., et al., Hyperandrogenemia alters mitochondrial structure and function in the oocytes of obese mouse with polycystic ovary syndrome. F S Sci, 2021. 2(1): p. 101-112.
5.           Si, C., et al., TMT-based proteomic and bioinformatic analyses of human granulosa cells from obese and normal-weight female subjects. Reprod Biol Endocrinol, 2021. 19(1): p. 75.
6.           May-Panloup, P., et al., Ovarian ageing: the role of mitochondria in oocytes and follicles. Hum Reprod Update, 2016. 22(6): p. 725-743.
7.           Boudoures, A.L., et al., The effects of voluntary exercise on oocyte quality in a diet-induced obese murine model. Reproduction, 2016. 151(3): p. 261-70.
8.           Jackson, D.N. and A.L. Theiss, Gut bacteria signaling to mitochondria in intestinal inflammation and cancer. Gut Microbes, 2020. 11(3): p. 285-304.
9.           Pandey, U.B. and C.D. Nichols, Human disease models in Drosophila melanogaster and the role of the fly in therapeutic drug discovery. Pharmacol Rev, 2011. 63(2): p. 411-36.
10.         Gnainsky, Y., et al., Systemic Regulation of Host Energy and Oogenesis by Microbiome-Derived Mitochondrial Coenzymes. Cell Rep, 2021. 34(1): p. 108583.
11.           Boudoures, A.L., et al., The effects of voluntary exercise on oocyte quality in a diet-induced obese murine model. Reproduction, 2016. 151(3): p. 261-70.

​Omega-3 fatty acids are a subgroup of the polyunsaturated fatty acids, one of the "good" fats. Some fatty acids can be made by the body and others cannot - these must be obtained from the diet. These are known as essential fatty acids. Omega-3 fatty acids are a type of essential fatty acid that have been found to have many positive roles in our bodies, including a strong relationship with fertility.
 
Just as trans fatty acids found in many processed foods are related to lower fertility, long-chain omega-3 fatty acids are related to better fertility and higher live birth rates in assisted reproductive treatments.

​Omega-6 fatty acids are another form of polyunsaturated fatty acids which like omega-3 fatty acids, cannot be produced by the body. Omega-6 fats have a different chemical structure and role in the body to omega-3 fats.
 
Omega-6 fatty acids are found in vegetable oils such as sunflower, safflower, maize, cottonseed, peanut, grape seed, as well as in margarines. Most people consume a higher proportion of omega-6 than omega-3 fat. While omega-6 fatty acids are not "bad" fats, including too much omega-6 and not enough omega-3 can lead to an increase in inflammation. For good health the body needs a balanced intake of omega-6 to omega-3.
 
The best sources of omega-3 fatty acids are oily fish. While a great source of omega-3s, they also contain omega-6s you may want to stop and think about where your salmon is coming from.

Farmed salmon is higher in fat and contains more energy than fresh caught salmon. While it does contain Omega-3s, it also contains a higher dose of Omega-6 which may promote inflammation if intake is too high. As a bonus, the mineral and vitamin content of fresh caught salmon is greater than farmed salmon!
 
If you are not including a quality salmon in your diet twice a week (or are not able to access wild caught salmon which can be difficult in Australia), consider including a reputable omega-3 supplement. Recent research is showing that omega-3s combined with olive oil or marine oils offer delivers synergistic benefits. The natural protective polyphenols in olive and marine oils protect the omega-3s from oxidation [4], enhancing their absorption and anti-inflammatory properties.

​The balance of omega-6 to omega-3 can be good indicator of our bodies ability to regulate inflammation (which impacts fertility) and a potential indicator of fertility, not just for women. Fertile men have higher concentrations of Omega-3 fatty acids while infertile men have a higher omega-6:omega-3 ratio [5].
 
A healthy ratio may be considered less than 4:1. The typical omega-6 to omega-3 ratio on a Western diet is 20:1! Reducing this ratio is an effective strategy to support reproductive health and fertility.

​Would you like to find out your omega-6:omega-3 ratio and strategies to improve this? Come and see us!​

​1.           Hammiche, F., et al., Increased preconception omega-3 polyunsaturated fatty acid intake improves embryo morphology. Fertil Steril, 2011. 95(5): p. 1820-3.
2.           Chiu, Y.H., et al., Serum omega-3 fatty acids and treatment outcomes among women undergoing assisted reproduction. Hum Reprod, 2018. 33(1): p. 156-165.
3.           Wanders, A.J., P.L. Zock, and I.A. Brouwer, Trans Fat Intake and Its Dietary Sources in General Populations Worldwide: A Systematic Review. Nutrients, 2017. 9(8).
4.           Mendez, L. and I. Medina, Polyphenols and Fish Oils for Improving Metabolic Health: A Revision of the Recent Evidence for Their Combined Nutraceutical Effects. Molecules, 2021. 26(9).
5.           Safarinejad, M.R., et al., Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr, 2010. 29(1): p. 100-5.

Insulin is a hormone made by our pancreas that helps us transport sugars (glucose) from food into our cells for energy. Without enough insulin circulating, blood glucose levels can rise and this poses a health risk.

While our pancreas might work well to make insulin, there are conditions that lead to our body becoming less responsive to insulin. While insulin levels rise to help get energy (glucose) to our cells, our cells may have stopped responding as they normally would, leading to insulin resistance.

Contributors to insulin resistance, or this loss of sensitivity to insulin, include:

• High levels of fats in the blood
• High intakes of simple sugars and fats in the diet
• Low levels of physical activity
• Disruptions in our resident gut microbiota 

Insulin resistance can lead to type 2 diabetes and this metabolic disruption is also seen in PCOS. In women with PCOS and insulin resistance, implantation (11·6% vs 28·7%), clinical pregnancy (23·5% vs 53·1%), and ongoing pregnancy rates (21·6% vs 46·9%) are reduced when compared to women that have PCOS but do not experience insulin resistance [1]. Even without diabetes or PCOS, women with recurrent pregnancy loss (2 losses before 20 weeks) have been shown to have higher fasting insulin levels (15.24 mIU/L versus 12.83 mIU/L) [2].

Exploring high insulin levels (hyperinsulineamia) and insulin resistance involves diving a bit deeper than a one-off insulin measurement. Insulin levels need to be interpreted in combination with glucose values, and this is something your GP or endocrinologist would assist with. For now though, let’s take a look at the impacts of insulin resistance on achieving pregnancy and healthy pregnancy progression. 

There is a rather short time frame, around 24 hours, when our uterus expresses receptors indicating it is receptive and possible ready for an embryo to implant. The genes expressed in our endometrium change across the proliferative, pre-receptive, receptive and post-receptive stages. Genes related to adhesion, cell differentiation and metabolism (among others) are expressed when our endometrium is receptive.

High levels of insulin have an impact upon receptor expression associated with implantation in the uterus. While maturation, fertilisation, cleavage rates, the number of good-quality embryos, and blastocyst formation rates may not be impacted by PCOS and insulin resistance, implantation may be reduced [2]. Even with good quality blastocysts it is important to nurture the ‘home’ that these embryos will be put back into.
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Studies in mice show that insulin resistance impairs uterine receptivity and impacts pregnancy progression [3]. Other animal models show that insulin resistance leads to an increase in uterine oxidative stress, mitochondrial dysfunction and early pregnancy loss [4]. If changes in how our body responds to insulin can impact pregnancy progression, what can we do about it?

There are effective strategies that make a significant impact upon how sensitive we are to insulin, to help regulate blood glucose levels. Three key regulators include:

1. Exercise.
Insulin sensitivity changes in response to just one bout of exercise! These benefits do dissipate after a few days though, so consistency is key. Incorporating regular physical activity in our life has significant benefits for insulin regulation. In women with PCOS, 12 weeks of increased physical activity upregulates insulin and glucose receptors in the endometrium, creating a receptive uterus.

These changes are also positively associated with improvements in menstrual regularity [5]. Getting the right exercise prescription is important and we can determine if moderate or vigorous exercise, or interval training is the best prescription for you.

2. Nurture your Gut Microbes.
Disruption in your gut microbiota diversity reduces the production of beneficial short chain fatty acids such as butyrate. This may lead to insulin resistance, linked to chronic low grade inflammation.

Diet is one of the most potent modulators of our gut microbes so ensure you are feeding them the foods they love to thrive to benefit your reproductive health. We can help you explore the bacteria that make up your gut microbiome for greater insight into nurturing your fertility.
 
3. Sleep.
Sleep regulates the body’s ability to handle blood sugars by altering insulin levels, and how sensitive our bodies are to insulin. Sleep disruption can have a greater impact on insulin resistance than a high high-fat diet! One week of reducing sleep in healthy males from 10 hours in bed to 5 hours reduces insulin sensitivity by 20%.

Going back to Nurturing our Gut Microbes above, a more diverse gut microbiota is positively correlated with increased sleep efficiency and total sleep time, and reduced sleep fragmentation [6]. This means that you get to sleep quicker once your head hits the pillow, you wake less, and that because you are falling asleep quicker for the same time in bed you get more hours sleeping. 

While it is important to nurture healthy eggs and sperm, there are ways to support the health of your uterine lining and get ready for implantation! Give yourself every chance of pregnancy success!

 References
1.           Chang, E.M., et al., Insulin resistance does not affect early embryo development but lowers implantation rate in in vitro maturation-in vitro fertilization-embryo transfer cycle. Clin Endocrinol (Oxf), 2013. 79(1): p. 93-9.
2.           Ispasoiu, C.A., et al., High fasting insulin levels and insulin resistance may be linked to idiopathic recurrent pregnancy loss: a case-control study. Int J Endocrinol, 2013. 2013: p. 576926.
3.           Li, R., et al., Mice endometrium receptivity in early pregnancy is impaired by maternal hyperinsulinemia. Mol Med Rep, 2017. 15(5): p. 2503-2510.
4.           Chen, M., et al., Uterine Insulin Sensitivity Defects Induced Embryo Implantation Loss Associated with Mitochondrial Dysfunction-Triggered Oxidative Stress. Oxid Med Cell Longev, 2021. 2021: p. 6655685.
5.           Ujvari, D., et al., Lifestyle intervention up-regulates gene and protein levels of molecules involved in insulin signaling in the endometrium of overweight/obese women with polycystic ovary syndrome. Hum Reprod, 2014. 29(7): p. 1526-35.
6.           Smith, R.P., et al., Gut microbiome diversity is associated with sleep physiology in humans. PLoS One, 2019. 14(10): p. e0222394.

In your quest for conception you have most likely come across the word ‘inflammation’, so what is it? Inflammation is an essential process in the body. It helps us repair damaged tissues and is important for immune protection. In response to stress, which may take the form of injury, illness, an unhealthy diet, sleep deprivation, or other physiological stress or emotional stress, the body’s immune system responds by releasing various chemical regulators to restore the normal environment, or ‘homeostasis’. These chemical regulators may be released from the white blood cells of the body which communicate with other cells and tissues.

Some of these chemical messengers are small proteins called cytokines which can be measured and therefore used to quantify the severity of the inflammation or the activation of the immune system. Delving into our immune system is incredibly complex though so measuring one protein will not provide you with the entire picture. We have spent a lot of time in clincial research understanding these processes of inflammation and oxidative stress and we love translating this knowledge into practice!

​Inflammation, and the resolution of inflammation, is usually a tightly regulated process and controlled inflammation is essential for the process of embryo implantation.

​While acute inflammation is a normal, healthy response to short-term stress or injury, chronic low-grade inflammation is implicated in several diseases such as cardiovascular disease, diabetes and most importantly infertility [1].

The cause of higher than normal levels of inflammation is multifactorial. These include a diet missing key micronutrients, carrying excess body fat, hormone imbalances, infections, stress, imablances in exercise and being sedentary.

With increased inflammation, oxidative stress is also elevated. This is also true for increased oxidative stress promoting inflammation, so it is a bit of the chicken and egg scenario.

Oxidative stress is happening within the body all the time. Reactive oxygen species that cause oxidative stress are necessary for many biological processes but just as the name suggests, these reactive oxygen species are unstable. If their levels rise too much, or there is a reduction in the defence systems used to combat reactive oxygen species (eg. antioxidants), they cause considerable damage to DNA and cell membranes, leading to cell death. Inflammation and oxidative stress are inextricably linked.

The main source of reactive oxygen species are mitochondria, a little organelle that sits within most cells. As oxygen is broken down (metabolised) to produce energy, electrons can escape from the energy production chain and these transform oxygen from a stable molecule to one that loses some electrons to become unstable. If your mitochondria are not functioning properly this will generate considerably more reactive oxygen species, leading to greater oxidative stress.

While most reactive oxygen species are produced from processes in the body, they can also come from outside sources including smoke, pollutants, tobacco, certain drugs and radiation. 

Electromagnetic fields from mobile phones, laptops, and other electric devices have been shown to increase the production of reactive oxygen species with negative consequences for both male and female reproductive health (Santini, Cordone et al. 2018).

Inflammation and oxidative stress underlie the pathology of many conditions including metabolic syndrome, cardiovascular disease, rheumatoid arthritis, diabetes, neurological conditions and importantly our reproductive health.
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Unexplained Infertility: Over 70% of females with unexplained infertility have high levels of inflammation and oxidative stress [6]. Antioxidant levels that protect against oxidative stress are lower in females with unexplained infertility (Alam, Khan et al. 2020). Total antioxidant capacity of follicular fluid is lower in infertile women while DNA oxidative damage was dramatically higher than those found in fertile women (Espino, Macedo et al. 2019).
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PCOS: Women with PCOS show chronic low-grade inflammation, characterized by increased circulating levels of inflammatory proteins, which leads to insulin resistance. Levels of oxidative stress are also increased in PCOS (Mohammadi 2019). Our defences against oxidative stress include circulating levels of antioxidants (Vitamin C and E) and other antioxidant enzymes. These defences are lower in women with PCOS (Fatima, Amin et al. 2019).

Endometriosis: For 20% of people seeking fertility treatment it is the sole reason they require assisted reproductive technologies. Endometriosis is an estrogen driven inflammatory condition and women with endometriosis have elevated levels of inflammation and circulating immune toxins (such as lipopolysaccharide). Oxidaitve stress and inflammation are associated with the progression of endometriosis (Yun, Chon et al. 2016).

Recurrent Pregnancy Loss: Levels of inflammatory proteins and circulating immune toxins (such as lipopolysaccharide) are higher in women with recurrent pregnancy loss (Tersigni, D'Ippolito et al. 2018).

Male Factor: Increases in circulating markers of inflammation and oxidative stress play a significant role in male infertility (Haervig, Kierkegaard et al. 2018). It is estimated that oxidative stress may be present in about 56 million males presenting with infertility (Dutta, Majzoub et al. 2019). Inflammation and oxidative stress underlie sperm damage, which has been implicated in recurrent pregnancy loss [5].

The good news is that there are strategies you can adopt to dampen inflammation and oxidative stress! This then translates to enhanced fertility, and increased pregnancy success. 

Diets rich in antioxidant whole foods that nurture your gut diversity can dampen inflammatory markers by more than 50%. Exercise is also a powerful anti-inflammatory and this in part is attributed to the beneficial changes at the level of the gut microbiota. 

Understanding the cellular processes of inflammation and oxidative stress, and how to address these enables us to tailor evidenced based support for better outcomes. 

Take a listen to us on the Beat Infertility Podcast if you would like to find out more.

References
​Alam, F., T. A. Khan, R. Ali, F. Tariq and R. Rehman (2020). "SIRTI and cortisol in unexplained infertile females; a cross sectional study, in Karachi Pakistan." Taiwan J Obstet Gynecol 59(2): 189-194.
Dutta, S., A. Majzoub and A. Agarwal (2019). "Oxidative stress and sperm function: A systematic review on evaluation and management." Arab J Urol 17(2): 87-97.
Espino, J., M. Macedo, G. Lozano, A. Ortiz, C. Rodriguez, A. B. Rodriguez and I. Bejarano (2019). "Impact of Melatonin Supplementation in Women with Unexplained Infertility Undergoing Fertility Treatment." Antioxidants (Basel) 8(9).
Fatima, Q., S. Amin, I. A. Kawa, H. Jeelani, S. Manzoor, S. M. Rizvi and F. Rashid (2019). "Evaluation of antioxidant defense markers in relation to hormonal and insulin parameters in women with polycystic ovary syndrome (PCOS): A case-control study." Diabetes Metab Syndr 13(3): 1957-1961.
Haervig, K. K., L. Kierkegaard, R. Lund, H. Bruunsgaard, M. Osler and L. Schmidt (2018). "Is male factor infertility associated with midlife low-grade inflammation? A population based study." Hum Fertil (Camb) 21(2): 146-154.
Mohammadi, M. (2019). "Oxidative Stress and Polycystic Ovary Syndrome: A Brief Review." Int J Prev Med 10: 86.
Santini, S. J., V. Cordone, S. Falone, M. Mijit, C. Tatone, F. Amicarelli and G. Di Emidio (2018). "Role of Mitochondria in the Oxidative Stress Induced by Electromagnetic Fields: Focus on Reproductive Systems." Oxid Med Cell Longev 2018: 5076271.
Tersigni, C., S. D'Ippolito, F. Di Nicuolo, R. Marana, V. Valenza, V. Masciullo, F. Scaldaferri, F. Malatacca, C. de Waure, A. Gasbarrini, G. Scambia and N. Di Simone (2018). "Recurrent pregnancy loss is associated to leaky gut: a novel pathogenic model of endometrium inflammation?" J Transl Med 16(1): 102.
Yun, B. H., S. J. Chon, Y. S. Choi, S. Cho, B. S. Lee and S. K. Seo (2016). "Pathophysiology of Endometriosis: Role of High Mobility Group Box-1 and Toll-Like Receptor 4 Developing Inflammation in Endometrium." PLoS One 11(2): e0148165.