One of the most challenging parts of infertility is that patients have little control over the disease. Once diagnosed, patients frequently scrutinize everything they do and have done (or not done) that may have caused this diagnosis.
When it comes to fertility treatment – we (both the patient and doctor) have no control over your age, tubal status or ovarian reserve. We do, however, have control over your lifestyle. This blog post is going to address how caffeine, alcohol, smoking. marijuana and diet can impact fertility treatment success.
The effect that caffeine has on infertility treatment is a discussion I have almost daily and one that does not have a definite answer.
Of the handful of studies that have been published, most (but not all) have not reported a significant negative impact on caffeine intake and IVF success.
At this time, there is no data to show caffeine consumption the year before treatment will negatively impact the egg retrieval, embryo transfer or implantation.
One study did show a lower live birth rate in women who consumed ANY caffeine before and during the IVF cycle. This finding has not been confirmed in other studies.
There is evidence to suggest sugared sodas will decrease the number of eggs retrieved, fertilization rate, high-quality embryos and live birth rate.
Importantly, not specific to IVF, there are two meta-analyses that have shown a higher miscarriage rate with a high caffeine intake.
1- A small amount of caffeine (<200mg/day, 1 small cup ☕️ of coffee or tea) is likely safe in pregnancy and during the IVF cycle.
2- If you can completely eliminate caffeine during your treatment cycle, it will not hurt and may slightly improve your outcome.
3- If you need caffeine, I recommend coffee or tea, NOT sugared sodas while TTC, doing treatment or while pregnant).
Alcohol has been repeatedly shown to have negative impact on our general health. It is also well-established that alcohol can severely impact a growing fetus. The research on how alcohol impacts fertility treatment is not quite as conclusive.
When it comes to alcohol consumption BEFORE an IVF cycle, one study noted a lower number of eggs retrieved (but no other outcomes were affected). These findings have not been confirmed in other studies.
When looking at alcohol consumption immediately before and during the cycle, there is more data to dissuade its use. Multiple studies have shown a combination of poorer embryo quality, lower fertilization rate, lower pregnancy and live birth rates, as well as an increased risk of miscarriage in those women who consume alcohol. Now, these studies did report on varying quantities of alcohol consumption (between 5-25gm/day; an avg drink has about 14gm).
Take home points:
1- Alcohol consumed well before your IVF cycle is not likely to adversely impact your success rates.
2- Alcohol consumed immediately before and during your IVF cycle has a high likelihood of reducing your success, so abstain if possible.
3- There is no safe amount of alcohol while pregnant, so abstain during pregnancy.
Smoking has been shown to have serious detrimental effects on your health and can cause serious pregnancy complications. Smoking has also been shown to increase the amount of time to pregnancy when trying to conceive (TTC) spontaneously.
The research on smoking and IVF is some of the strongest out there specific to lifestyle. It has been repeatedly shown to reduce the odds of clinical pregnancy and live birth per cycle to almost half that of non-smokers. There is also an increased risk of miscarriage and ectopic pregnancy (15x higher) in smokers.
It is important to also address smoking cessation before the IVF cycle. Unfortunately, there are far fewer studies on this, but most have seen improved pregnancy rates in former smokers over current. Perhaps the most important factor is cumulative smoking history – meaning those that have smoked the most and for the longest have poorer IVF outcome parameters.
Take home point:
Smoking has long-term negative effects on your health, your reproductive potential and your future treatment success. My recommendation is to never start and if you have then stop immediately.
The data on marijuana and fertility is limited. In women and men who are TTC, a prospective study did not show an increase in time to pregnancy in those that smoked.
When researchers look specifically at semen analysis parameters in males that smoke marijuana, there is a significant decrease in sperm concentration in smokers compared to non-smokers.
Unfortunately, there is no data on how it affects an IVF or a fertility treatment cycle.
At this time I encourage all of my female and male patients to stop using marijuana if they are TTC, are in treatment or are pregnant. This is similar to the recommendation made by the American College of Obstetricians and Gynceologists in 2017.
First, I always remind people that I am not a nutritionist. I absolutely love food myself and I think it is vital to our health, as well as sense of community. So, take this information as it is, it is a recommendation, not a strict code to follow.
Most important points about diet:
1- Carbohydates are an important component of a healthy diet. The best ways to get your carbohydrates are in whole grains (higher live birth rate in an IVF cycle) and fruits and veggies (although no studies specifically show a positive affect in IVF success)
2- Omega-3 fatty acids have been shown to improve embryo quality, the probability of pregnancy and live birth rate in IVF. These fatty acids are frequently found in fish.
3- Animal protein can be divided into red meat versus fish. Higher red meat consumption has been correlated with decreased blastocyst formation. Fish consumption was shown to improve blastocyst formation.
My final recommendation:
Of all the diets out there, the Mediterranean diet has been shown to have a higher probability of pregnancy in an IVF cycle. What is this? A diet rich vegetables, vegetable oils, fish and legumes. This is not surprising, because it does parallel a lot of the findings I already discussed above.
As a side note, one of the more recent concerns about protein from animals is possible environmental contamination. The same can be said about a lot of our non-organic fruits and vegetables. Unfortunately, we do not always know what is on our food, or given to our animal to eat. If possible, eat organic meats, fruits and vegetables (especially the dirty dozen) and wash everything well.
I hope you find this information on lifestyle and fertility beneficial. Just a reminder this is not medical advice. Always speak with your physician for specific recommendations.