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Best way to conceive? Start with good health, experts say

December 22, 2014


If youíre among the hundreds of thousands of U.S. couples trying to get pregnant this season ó and December is the most popular month for baby-making ó experts say there are some lifestyle choices that could improve your odds.

Some are fairly obvious: Maintain a healthy weight and donít smoke.

"Good health during pregnancy starts with being healthy before you get pregnant," said Dr. Ranit Mishori, associate professor of family medicine at Georgetown University School of Medicine in Washington.

Others are more surprising, such as avoiding exposure to certain environmental chemicals, including some ultraviolet filters commonly used in sunscreen.

Scientists at the National Institutes of Health recently discovered that men with high exposure to the UV filters benzophenone-2 (BP-2) and 4OH-BP had a 30 percent reduction in their ability to reproduce. There was no similar effect in women.

"Male fecundity seems to be more susceptible to these chemicals than female fecundity," even though women have greater exposure to UV filters overall, said Dr. Germaine Louis in announcing the results in November. Louis is director of the Division of Intramural Population Health Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Md. "Our next step is to figure out how these particular chemicals may be affecting couple fecundity or time to pregnancy ó whether itís by diminishing sperm quality or inhibiting reproduction some other way."

The NIH researchers studied 501 couples who were trying to conceive. The couples were part of the Longitudinal Investigation of Fertility and the Environment (LIFE). Earlier findings from the LIFE study have linked reduced fertility to high cholesterol levels in women and couples and to high concentrations of phthalates in men.

Dr. Sandra Carson, an obstetrician and reproductive endocrinologist from Brown University in Providence, R.I., who now serves as vice president of education for the American Congress of Obstetricians and Gynecologists, said her most important advice for a woman who wants to start a family is to see her doctor for an assessment of current health.

"The best thing she can do for herself is to be in the best shape she can be," Carson said. "Make sure all her immunizations are up to date. Make sure sheís on folic acid. Make sure she knows about ovulation and when to have sex to maximize her chances, and she knows about good health in general."

Christine Proudfoot, a 29-year-old newly married architect in Washington, just had a checkup with her physician, Mishori, in which she mentioned that she and her husband were getting ready to start a family.

Proudfoot is in very good shape ó sheís a runner, she bikes a lot, and she exercises her dog before and after work every day. Mishori ascertained that her weight is in a healthy range and that her diet contains all the necessary nutrients. "The only thing she recommended I do differently was to start taking folic acid," Proudfoot said.

Taking a folic acid supplement both before and during pregnancy is important, experts agree, because it helps prevent defects in the development of the fetal brain and spinal cord. That development takes place in the first three to four weeks of pregnancy, so doctors recommend starting a supplement ó or a prenatal multivitamin containing 400 micrograms of folic acid ó at least a month before conception.

Here are some other tips:

Timing of intercourse ó but not position ó can affect fertility. "Every day or every other day during your fertile period is best," Mishori said. "And you should know when your fertile period is. But you donít have to put a pillow under your hips or hold your legs up for half an hour. Thatís a myth."

You also donít have to abstain during nonfertile times unless the male partner has a low sperm count. In that case, Carson said, the couple may have to restrict intercourse to the two days right before ovulation.

"You can buy a test kit to learn when youíre ovulating," Carson said.

Avoiding cigarette smoke ó her own and her partnerís ó can help a woman get pregnant both now and long-term (because smoking has been linked to earlier menopause) and also protect the unborn child.

Some studies show that women who smoke and women exposed to secondhand smoke have a greater likelihood of being infertile. Smoking by the male partner hurts in another way: It harms his semen.

"But you donít need a study to know smoking is bad," Mishori said.

Alcohol consumption is a little trickier. Some studies have shown detrimental effects on fertility as well as on the developing fetus, but others have shown that a little wine may actually enhance fertility.

"I tell women, if you donít have to drink, donít," Mishori said. "If you must drink, donít have more than two drinks a day."

High levels of caffeine ó more than five cups of coffee a day ó may impede fertility and increase the risk of miscarriage, Mishori said. "But one or two cups a day may be OK."

As for diet, "there are all kinds of myths," Mishori said. "Low fat, low carbohydrate, antioxidants, vitamin-this or vitamin-that. None has any good evidence. Donít buy supplements that promise to increase your fertility. A well-balanced diet is the way to proceed, whether or not youíre intending to get pregnant."

One thing everyone agrees on is the importance of maintaining a healthy weight. "For those who are either very over- or underweight, their fertility is lowered," Mishori said.

"If youíre obese, youíre going to have a harder time getting pregnant," she said. "Youíre more likely to have pregnancy complications that will have negative effects on the fetus. And there is also a higher risk of complications in labor and delivery."

There are no good studies on the link between exercise and fertility, Mishori said, but exercise before pregnancy makes for a healthier pregnancy.

"Being fit makes it easier for you to withstand the delivery," she added. "And sometimes exercise helps to lower weight, blood sugar and blood pressure, all of which can be detrimental in pregnancy."

On the other hand, excessive exercise, such as training for a marathon, can harm fertility by interfering with ovulation.

Carson noted that protecting against sexually transmitted diseases also shields fertility. That means "having a limited number of sexual partners and using condoms in relationships where they donít want to become pregnant," she said.

Surprisingly, there is some evidence that personal lubricants may decrease fertility. "Donít use any at all," Mishori said.

If youíve heard that the way to get pregnant is to relax and take a vacation, you may be disappointed.

"The way to get pregnant is to have sex," Carson said. "Going on vacation only helps if you have more sex."

Reducing stress doesnít work either. "Stress can impair fertility," Carson explained, "because it can stop ovulation. But relieving stress doesnít necessarily restore it."

By the way, no one knows why December is the most common month for conception in the United States (and the United Kingdom). Some have suggested sperm may be healthier in cold weather. According to a 2006 chart compiled by Amitabh Chandra of Harvard University, using U.S. data for each date from 1973 through 1999, the largest number of births occur in September. And in case you were wondering, Sept. 16 is the most popular birthday.

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