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.
​
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).
​
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.
 

We are excited to collaborate with the fabulous Kristen from @ilikemyeggsfertilised. Kristen is an Accredited embryologist and has teamed up with our Accredited Exercise Physiologist and Accredited Dietitian to discuss what DNA fragmentation is and steps you can take to reduce it for better quality sperm!

DNA is essentially the genetic instruction book for how we grow and function that is contained in every living cell. Breaks, or fragmentation, of the DNA will affect how the cell functions. A small amount of DNA damage is always present but when this damage is high, fertility can be impacted.
 
If your sperm viability is low (<50%), then it is likely that you have high DNA fragmentation rates. Even with a normal semen analysis, 15% of men can have high levels of DNA damage to the sperm. Read on to find out more about DNA fragementation and importantly steps you can take to reduce this for better fertility outcomes.

​Fragmentation of the Sperm DNA may occur while sperm are stored in the epididymis of the testes. Some causes may be short term illness, injury, lifestyle factors or chemical exposures, but sometimes, no cause is identified.

Semen quality and DNA fragmentation are likely to vary somewhat, but when sustained, it is associated with reduced natural conception and increased chance of miscarriage. While infertile men possess substantially more DNA damage (Zini et al., 2008), a semen analysis may show normal parameters when high levels of DNA fragmentation are present (Robinson et al., 2012).

​Fertilisation rate in IVF may, or may not, be impacted by higher levels of DNA fragmentation. While some studies show a negative correlation between the integrity of DNA in ejaculated sperm and fertilisation rates (Bronet et al., 2011), sperm with DNA damage can fertilise oocytes successfully (Alvarez Sedo et al., 2017). Despite successful fertilisation that may give rise to good grade embryos, these may fail to implant or result in early pregnancy loss (Robinson et al, 2012). Indeed, male factors do contribute to early pregnancy loss.
 
With ICSI, sperm with high DNA damage are more likely to fertilise than with conventional IVF, but miscarriage can still occur (Robinson et al, 2012). 

​A study by Alvarez Sedo et al. (2017) found that while fertilisation was not affected by high DNA fragmentation, there was a negative correlation with blastulation rate. They found that high levels of DNA damage promote embryonic arrest and induce activation of apoptosis, or cell death and observed a much high pregnancy rate in patients with low DNA damage.
 
The affect of DNA fragmentation may be more severe in older patients as oocyte quality is strongly associated with age and the ability of an egg to repair sperm DNA damage may decline in older eggs (Robinson et al., 2012).

1. Keep Them Cool
One common cause of high DNA fragmentation may be anatomical. If veins near the testicles are enlarged as with a varicocole, temperature of the testicles may be too high, impacting sperm health. This is found in 35% of patients with male infertility and can be surgically repaired (Kim, 2018).
 
Keeping testicles cool is a good idea in general. Avoid having a laptop on your lap, wearing tight clothing like cycling shorts for prolonged periods and choose cotton boxers over briefs. Also avoid high temperature environments such as saunas.

2. Boost Your Antioxidant Defenses
Exercise has been shown to improve sperm quality and DNA integrity by reducing markers of inflammation and oxidative stress (Maleki et al, 2017). 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 chances. If you have not exercised regularly before and are planning to undergo IVF, the right exercise prescription will benefit your sperm health.
 
Twelve weeks of structured jogging sessions (70-85% VO2max 3 x week) in infertile males significantly reduces inflammation, boosts antioxidant capacity, reduces sperm DNA fragmentation (Maleki & Tartibian, 2017). These benefits are also seen in slightly overweight males (average body mass index >25) undertaking aerobic exercise (Hajizadeh et al, 2013).  Six months of moderate exercise in males with low sperm counts with or without DNA fragmentation increased live birth rates by over 90% (Hajizadeh et al, 2017). Now that's an impressive outcome!
 
Progressive resistance (strength) training over a period of 12 and 24 weeks has also been shown to improve sperm quality and pregnancy rates (Hajizadeh et al, 2018). The mechanisms for this relate to the reduction in inflammation, boost in antioxidant defences and increase in circulating testosterone concentration that comes with strength training. In males taking part in structured resistance training, the chance of live birth increased 2 to 15 times.
 
Getting the balance of exercise right though is important. In high level triathletes (VO2max 70 ml/kg/min) with 5 years racing history and training, semen parameters were at the lower end of the ‘normal’ reference range set by the World Health Organization (ranges used in laboratories to determine sperm quality), and DNA fragmentation was high (Vaamonde et al., 2017). This supports similar studies that suggest that high volumes and intensities of endurance training may have negative effects on sperm quality (Hajizadeh et al., 2013; Vaamonde et al., 2017).

You can take a listen to us on the Beat Infertility Podcast to find out more about exercise and sperm health.  Seeing an Accredited Exercise Physiologist will ensure you get the right exercise prescription to optimise your sperm health.

3. Nourish Your Sperm
A healthy diet correlates with better quality sperm parameters, and lower DNA fragmentation. (Skoracka et al, 2020). Inflammation and oxidative stress contribute to DNA fragmentation but these can be modulated by your diet. A diet that focuses on reducing refined sugars, saturated fats and animal proteins, and includes fruits, vegetables, nuts, whole grains, fish, and healthy oils will reduce inflammation.
 
Saturated fats and sugar lead to disruption of our gut microbiome causing dysbiosis which promotes inflammation (Guevara-Cruz, 2019). Eating to nurture the diversity of your gut microbiota reduces inflammation and immune toxic compounds such as lipopolysaccharide (LPS) that damage sperm DNA (Pearce et al, 2019).
 
While it may be tempting to reach for an antioxidant supplement we first recommend a comprehensive dietary analysis to identify what micronutrients you are missing out on so that if you do require a supplement, it is specifically targeted for a better outcome. Only 17% of ingredients found in male fertility supplements have published evidence showing a positive effect on semen parameters (Kuchakulla et al, 2020). Consult with an Accredited Dietitian so you get to look at your diet as a whole and establish the best strategy for optimising sperm health so you are not throwing your money down the drain! 

If you are after evidenced based, clincial dietetic guidance to reduce sperm DNA fragmentation join our next Fertile Gut Masterclass starting January 2021! 

4. Time to Quit?
Cigarette smoking negatively affects fertility, compromising nearly every system involved in the reproductive process. Heavy smoking, and heavy drinking, significantly increase sperm DNA fragmentation (Boeri et al, 2019). Knowing that the quality of sperm at the time of conception can have a lasting impact on the future health of your unborn child, seek support by contacting quitline or check out quit.org.au for some great resources to help you on your journey to better sperm health.

​There is no doubt that our gut microbiota, the populations of mainly bacteria, have an impact upon our ability to get and stay pregnant. We talk so much about our gut microbiota, but now it is time to find out more about another important ecosystem in our body: our reproductive tract microbiota.

A healthy vaginal microbiome is associated with an increased chance of conceiving and successful pregnancy. So what does a healthy vaginal microbiome look like?

The microbiota of a healthy, non-pregnant woman contains a variety of Lactobacillus species. These bacteria are thought to provide a healthy supportive environment that is conducive to conception.

The Lactobacillus bacteria produce lactic acid to maintain the pH of their environment and they dominate the microbiota of the vagina protecting it from harmful intruders. Lactobacillus love to use glycogen for energy and once they metabolise glycogen to glucose and maltose it is then further broken down to lactic acid. Lactic acid decreases the pH of the vagina to around 3.8-4.4 which creates a protective environment against the growth of pathogenic bacteria. This is one way that the body prepares for the impending pregnancy. Lactobacillus are very important in maintaining the pH of the vagina and consequently its microenvironment.

Some of the main bacteria in the vagina are L. crispatus, L. gasseri, L. iners and L. jensenii. Other bacteria that could cause a problem in the vagina if Lactobacillus are overrun include Gardenella, Atopobium, Mobiluncus, Prevotella, Streptococcus and Ureaplasm (just to name a few). The good news is that with a healthy level of Lactobacillus, these bacteria remain almost inactive or dormant.
​
Unlike the gut microbiome where diversity is key, in the vagina you want to have the genus Lactobacillus dominating. Lactobacillus know their job and are very protective of their environment. If Lactobacillus are threatened, they have the ability to promote antimicrobial defences which would kill other microbes that don’t belong. They are great at protecting and defending their territory.

Contraception, ovarian stimulation and hormone manipulation can have an effect on the health of the vaginal microbiome. These mostly decrease the number and types of Lactobacillus species in the vaginal microbiome and can cause an increase in bacteria such as Escherichia coli and Gardnerella both of which can be detrimental to the conception process as they cause infection.

There is a link between the success of assisted reproductive treatments and the health of the vaginal microbiota [1]. Lower abundance of Lactobacillus, and higher abundance of pathogens Gardnerella and Prevotella are identified in women that do not fall pregnant following IVF, compared to those that have pregnancy success [2].

In 130 women undergoing IVF at a Danish Clinic, an abnormal vaginal microbiota was found in 28% of women. ‘Abnormal’ was categroised by the presence of high levels of Gardnerella vaginalis and/or Atopobium vaginae. Following IVF, women with a normal vaginal microbiota had a pregnancy rate of 35% while those with an abnormal microbiota had rates of only 9% [3]. Almost half (45%) of women experiencing repeated implantation failure have a non-Lactobacillus dominant endometrial microbiota [4] [1].
 
Early and late miscarriages have also been linked to the composition of the vaginal microflora. A lower abundance of Lactobacillus [5], and an increasing presence of Mollicutes have been found in the vaginal microflora of women experiencing preterm premature rupture of membranes [6]. Microbial disturbances such as bacterial vaginosis have also been associated with preterm birth [7].

​Our reproductive tract microbiomes impact the chance of conception, and healthy pregnancy progression so nurturing this is important for positive pregnancy outcomes.

While our gut and reproductive organs may seem far apart, what happens in our gut can influence what goes on in our reproductive organ ecosystem. Bacteria have been shown to ascend from the rectum to the vagina and diet which manipulates the gut microbiota can be an effective treatment strategy for bacterial vaginosis [8].

Composition dynamics of the vaginal microbiome are influenced by changing levels of sex hormones which can be regulated by our gut. The health of our immune system, psychological stress, antibiotics and smoking all play a role in shaping the diversity of our gut microbiota but these are also linked to the health of our vaginal microbiota [9].

The gut and female reproductive tract are in constant communication with each other via microbial metabolites, our immune system and our circulatory system [10].

Studies exploring the gut microbiome and vaginal microbiome in the same population are few, but those in women with endometriosis show that where gut dysbiosis exists, vaginal dysbiosis is present [11]. reduced [12]. Nurturing our gut health is connected to the health of our reproductive tract. Compounds that increase the diversity of our gut microbiota have been shown to boost Lactobacillus abundance in the vaginal microbiota.

Want to get your Microbiota on track for conception. Come and see us for evidenced based strategies to optimise your chance of pregnancy success! 

Book a free 10 min phone call to find out if you could benefit from our expertise.  ​

References
1.           Fu, M., et al., Alterations in Vaginal Microbiota and Associated Metabolome in Women with Recurrent Implantation Failure. mBio, 2020. 11(3).
​2.           Kong, Y., et al., The Disordered Vaginal Microbiota Is a Potential Indicator for a Higher Failure of in vitro Fertilization. Front Med (Lausanne), 2020. 7: p. 217.
3.           Haahr, T., et al., Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Hum Reprod, 2016. 31(4): p. 795-803.
4.           Kadogami, D., Y. Nakaoka, and Y. Morimoto, Use of a vaginal probiotic suppository and antibiotics to influence the composition of the endometrial microbiota. Reprod Biol, 2020. 20(3): p. 307-314.
5.           Verstraelen, H. and A.C. Senok, Vaginal lactobacilli, probiotics, and IVF. Reprod Biomed Online, 2005. 11(6): p. 674-5.
6.           Paramel Jayaprakash, T., et al., High Diversity and Variability in the Vaginal Microbiome in Women following Preterm Premature Rupture of Membranes (PPROM): A Prospective Cohort Study. PLoS One, 2016. 11(11): p. e0166794.
7.           McGregor, J.A., et al., Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. Am J Obstet Gynecol, 1994. 170(4): p. 1048-59; discussion 1059-60.
8.           Neggers, Y.H., et al., Dietary intake of selected nutrients affects bacterial vaginosis in women. J Nutr, 2007. 137(9): p. 2128-33.
9.           Moosa, Y., et al., Determinants of Vaginal Microbiota Composition. Front Cell Infect Microbiol, 2020. 10: p. 467.
10.         Amabebe, E. and D.O.C. Anumba, Female Gut and Genital Tract Microbiota-Induced Crosstalk and Differential Effects of Short-Chain Fatty Acids on Immune Sequelae. Front Immunol, 2020. 11: p. 2184.
11.         Ata, B., et al., The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls. Scientific Reports, 2019. 9(1): p. 2204.
12.         Hong, X., et al., Association between polycystic ovary syndrome and the vaginal microbiome: A case-control study. Clin Endocrinol (Oxf), 2020. 93(1): p. 52-60.

Fertility Week is wrapping up for 2020! This year's theme is age. If you are a female heading north of 35 years you no doubt have heard that age is a factor that impacts fertility. As we age the production of high quality eggs (oocytes) reduces. While we can’t do much about our chronological age, let’s take a look at what underlying mechanisms impact egg quality with age and an effective strategy that may reduce the impact of ageing on fertility. 

As our oocytes divide, the chromosomes inside segregate but with age there are more errors in this process. An oocyte with an incorrect number of chromosomes is a condition known as aneuploidy. In most cases this oocyte if fertilised will not lead to an ongoing pregnancy. We are beginning to understand more about the mechanisms that contribute to this aneuploidy. 

Mitochondria Dysfunction
​Mitochondria are little bean shaped organelles are found in almost every cell. They are involved in energy production and important players in the ageing process.

As we learn more about these little energy factories (our mitochondria), it appears that the health of your mitochondria is a great indicator of the success of fertilisation and embryo development.

The decline in egg quality with ageing has been related to mitochondria. The ability of mitochondria to produce energy is crucial during the development of eggs (oocytes) and to allow for normal embryo growth and development.

In aged oocytes, metabolic activity and energy production are reduced. This may in turn impair processes such as cell division, embryo development and implantation. 

Telomere Shortening
Telomeres are essentially little caps on the end of our DNA that protect our chromosomes. While Each time our cells copy themselves, telomeres get a little shorter.

While telomeres shorten as we age, they can also shorten in response to stress, smoking, lack of exercise, daily alcohol consumption and a poor diet. Inflammation and oxidative stress are key processes that have been shown to shorten telomeres.

Telomere length in cumulus cells at the time of oocyte collection is predictive of highly competent oocytes and good-quality embryos. In women that experience IVF failure or recurrent miscarriage (Mania et al, 2014), or aneuploid embryos (Treff et al, 2011), oocyte telomeres have been found to be shorter.
 
Spindle Instability
During cell division, an internal cell skeleton (spindle) has the job of keeping chromosomes in place for accurate segregation. With advancing maternal age nearly 80% of oocytes have some abnormalities in spindle formation. The proteins in the cell that help ensure correct spindle formation change with age.
 
This process requires lots of energy. If our mitochondria are low in number or are not functioning well, it is likely that spindle formation will be impacted.

There are strategies that we know that may slow down cellular ageing. In this post we are going to talk about the incredible benefits of exercise to put the brakes on ageing, and in some cases even turn back time.

Exercise opposes the detrimental effects of ageing. It enhances insulin sensitivity, reduces inflammation, dampens reactive oxygen species, and improves efficiency of our mitochondria.

Engaging in regular activity has also been shown to improve the activity of an enzyme that protects our telomeres, and in some cases may even increase telomere length! With the close connection between oocyte quality and telomere length who wouldn’t want to lengthen their telomeres for optimal fertility.

With discussions of age and fertility you may have heard of AMH. Anti-Mullerian Hormone or AMH is secreted from cells within antral follicles and has been used as a marker of ovarian reserve. While it may be useful in predicting pregnancy rates in older females, AMH does not appear to predict pregnancy rates in women <36 years.

Women who exercise more than two times per week have higher AMH levels than women not exercising (Maslow et al 2019). Another study supports the benefits of exercise on AMH levels, where women that are physically active have higher levels of AMH compared to inactive women. The increase in AMH levels was irrespective of age (Kiranmayee et al., 2017).

Exercise can also improve how your oocyte spindles function, chromosomes align and healthy cell division. In a mouse model of ageing, exercise improves both ovarian follicle reserve and oocyte quality (Faraci et al., 2018). Exercise maintained normal mitochondrial distribution and improved spindle and chromosome alignment. This means that in the mature oocyte, the chromosomes were organised properly inside the cell. 

​Seek out the ideal exercise prescription for you. Your medical background, fertility journey to date and previous activity will all influence what type of exercise and how much is right to optimise your fertility!