Truths & Myths about Diet In Fertility and Gender Selection

Dr. Eeson SinthamoneyConsultant Obstetrician and Gynaecologist

Hospital Kuala Lumpur

Outline

1.Weight and fertility2.Nutrients and fertility 3.Gender selection

Weight and fertility

• In women: raised BMI associated with difficulty in conceiving

• Overweight and obese women undergoing fertility treatment had significantly lower pregnancy rates and higher miscarriage rates

• Underweight women had less embryos available

Weight and fertility

• In men, relationship less clear• Many studies indicate high or low BMI

associated with significantly reduced sperm quality

• However some evidence also suggests otherwise

• Body weight loss may be reasonable in male infertility

Nutrients and fertility - truth or myth?

• Many studies demonstrate the positive effects of OTC supplementation on female fertility, semen parameters and pregnancy outcomes

• Conversely, also many studies that demonstrate lack of improvement

• Gold standard of evidence?

Nutrients and fertility

Why is good evidence difficult to find?

1. Infertility often multifactorial 2. Baseline dietary intake3. Single agent versus multiple supplements4. Dosages?

Nutrients and fertility in women

• Several small studies suggest that some nutrients may be essential in female reproduction

• Current interest focused on vitamin D and anti-oxidants

Nutrients and oxidative stressCell respirationl

Reactive oxygen species

Alcohol / tobacco smoke / environmental

pollutants

Anti-oxidants (example Vitamin C and E)

Anti-oxidant co-factorsExample: selenium, zinc

and copper

Production

Scavenging, disposing or suppresing

Which are anti-oxidants?

• Main nutrients: vitamin C, vitamin E, selenium, and the carotenoids (vitamin A precursor)

• A multitude of other nutrients, including minerals such as copper, manganese, zinc, flavonoids (such as grape seed extract and phenols found in green tea)

• Co-enzyme Q10, also possess antioxidant properties

Impact of oxidative stress on female fertility

• Evidence exists supporting the role of oxidative stress in male fertility

• However, in women, while there is suggestion of the same, relationship not well addressed

Anti-oxidants and female fertilityNutrients Implications in implantation

Effect on embryo qualityEffect on oocyte quality and maturationIncrease in menstrual regularityHigher rates of conception

Smoking and alcohol

Active and passive smokers have reduced fertilityReduced implantation rates in IVFreduced pregnancy rates 2 alcoholic drinks a day impairs fertility

Caffeine High levels (>500mg/day = >5 cups/day) delays conception

Nutrients and fertility in women- Vitamin D

• Involved in female reproduction and improves fertility treatment outcome

• Some studies show that women with higher serum and FF vitamin D levels have higher pregnancy rates after IVF

Replete vitamin D stores predict reproductive success following in vitro fertilization. Ozkan S et al. Fertil Steril. 2010 Sep;94(4):1314-9.Vitamin D and fertility-a systematic review. Lerchbaum E, Obermayer-Pietsch BR. Eur J Endocrinol. 2012 Jan 24.

Oxidative stress and infertility in women - summary

• Some strong but indirect evidence that oxidative stress affects fertility

• Best available evidence suggests a varied diet with regular use of multivitamins, limited caffeine and alcohol and a healthy body weight promotes fertility

Nutrients and fertility in men

• Up to 50% of fertility problems involve a male factor

• More information available concerning nutrients and sperm characteristics

Carnitines

• Assist sperm metabolism as an energy source for spermatozoa and effect motility and sperm maturation

• Also an anti-oxidant• Multiple RCT studies demonstrate improvements

in concentration, motility, morphology also the converse also shown

• Primarily meat products• Dosage? Up to 3g/day safe

Co-enzyme Q-10

• Studies in infertile men demonstrate positive co-relation between higher seminal fluid CoQ10 concentrations and sperm motility and fertilization potential in couples undergoing IVF pregnancy rates?

• Source: oily fish (sardines), organ meat, whole grain, vegetables

• Dosage: 200-300mg/day up to 12mg/kg/day

Folic acid

• Important role in DNA synthesis and proper cell function

• Critical role in spermatogenesis• Mixed reports on effect of folate on male

fertility• Sources: dark green leafy veg, beans, eggs,

meats• Unsure if additional folate above RDA will

improve fertility

Glutathione

• One of the most abundant anti-oxidant produced in the body

• Important role in maintaining exogenous anti-oxidants (Vitamin C, E) in its active form

• Shown to improve sperm motility, improved sperm concentration and decreased sperm DNA fragmentation

• Source: fresh meat, fruits & veg• Up to 3g/day tolerated• Poor oral availability IM administration

Vitamin A

• B-carotene is pre-cursor or vitamin A• Anti-oxidant properties• Specific benefits on sperm production and

function difficult to clearly demonstrate • Up to <10000iu/day tolerated• However, readily stored and may reach toxic

levels

Vitamin C

• Associated with various improvements in semen quality

• Supplementation up to 1000mg/day improves count, motility, viability and morphology

• Protects sperm DNA against oxidative damage• May work synergistically with other vitamins

and anti-oxidants• RDA: 90mg/day; dosage: 500mg/day

Vitamin E

• Potent anti-oxidant• Substantial support for improvement in many

sperm parameters• Sources: veg oil, meat, poultry • Recommended dose: 200-400iu/day• Upper daily intake: 1600iu/day• May be increased risk of complications (CVS) if

>400iu/day and bleeding risk >800iu/day

Selenium

• Role in maintaining normal testicular development, spermatogenesis and sperm function

• Studies support use of selenium to improve sperm motility, concentration and morphology especially I combination with vitamin E

• Optimal dosing: 100-210mcg/day• Sources: meat, seafood, eggs; veg is poor

source

Zinc • Vital role in testicular steroidogenesis,

testicular development, sperm O2 consumption and other functions

• Chronic mild zinc deficiency assoc with oligospermia, decreased serum T2

• Zn therapy associated with improvement in sperm motility, reduced sperm DNA fragmentation and other improvements

• Upper limit: 40mg/day

Gender selection

Not new!1. mother-in-law’s advice2. Nutrients?3. Sperm sorting mechanisms – varied options,

evolving over time post sort purity average 87.9%4. PGD

Flow cytometric sorting of human sperm: MicroSort clinical trial update. Karabinus DS. Theriogenology. 2009 Jan 1;71(1):74-79

Conclusion

• Lack of good quality evidence• However: information available suggests that

selective use of certain supplements beneficial but dosage information lacks clarity

• Certainly- anti-oxidant use may improve live birth and pregnancy rate outcomes for subfertile couples undergoing ART

• However: avoid doses beyond RDA to avoid complications

• Blood level assessment?

Thank you