What is infertility?

The National Institute for Clinical Excellence (NICE) define infertility as failing to get pregnant after two years of regular unprotected sex. It is estimated that around one in seven UK couples have difficulty conceiving. Young, healthy couples who have been trying for a baby for 18 months to 2 years without success should consult their GP initially. Women who are over 35 years of age or those who are aware that their fertility is already reduced, should seek help after six months. Primary infertility refers to women who have never conceived a child, and secondary infertility is when a woman has conceived in the past but is having difficulty doing so again. Anovulation and ovulatory disorders are estimated to cause 25% of female fertility problems. Polycystic ovary syndrome (PCOS) where numerous small cysts develop on the ovaries, and ovulation is erratic, accounts for 90% of anovulation.

What changes can I make to boost my fertility?

If you have been trying to start a family without success, making some simple lifestyle changes may increase your chance of conception and help to ensure a healthy pregnancy. However, there are some factors, such as age, ovulation problems, sperm disorders and damaged fallopian tubes that you can't change.

Body weight

Both high and low body fat levels are related to infertility and alternations in hormone levels. Specific levels of body fat have not been identified for fertility but a critical mass of body fat determines the onset of menses and regulates gonadotropin secretion. Obesity is becoming more common, and while many people know that being obese is not good for their health, far fewer people know that it can affect your fertility. Men and women who are obese may find it more difficult to conceive and women who are obese run the risk of more pregnancy related complications. Surprisingly it is not only obesity that can adversely affect your fertility, having a Body Mass Index that is too low, has also been shown to make conception more difficult.

Diet

Women

A nutritious, balanced diet will help improve your general health and wellbeing, and ensure your body is able to nourish a baby. The Eatwell Plate provides simple advice on food groups, and amounts of foods that will help you to achieve a balanced diet. Choose a varied diet containing fresh fruit and vegetables, bread, potatoes, rice and other cereals (wholegrain, where possible), milk and dairy products, lean meat, fish and other sources of protein such as beans and lentils. Other important dietary considerations:

• Eat a rainbow of different coloured fruit and vegetables every day, five portions is the target
• Consume fibre-rich, lower GI foods
• Try to choose wholegrain varieties of bread, rice and pasta to boost your intake of antioxidants and B vitamins from wholegrain
• Temporarily trade low or fat free products for full fat varieties e.g. drink a glass of full fat milk everyday as opposed to semi skimmed milk
• Fill your body's iron reserves before you get pregnant by consuming iron-rich foods such as red meat, fortified cereals, dried apricots, beans and pulses
• Consuming foods high in omega-3 fatty acids can help to optimise your fertility, oily fish is the best source
• Avoid fad diets they are nearly always nutritionally inadequate
• Consider taking multivitamin supplements containing folic acid and other B vitamins (once you are pregnant women are also advised to take a vitamin D supplement). However it is important to remember that there is no evidence of the benefits of taking ‘high' or ‘mega' dose supplements and, in some cases, these may actually do harm. Eating a balanced diet is the safest and most effective way of ensuring you have everything that you need.
• When you are trying to conceive, it may be better to stop drinking alcohol altogether. But if you do drink, have no more than 1 or 2 units of alcohol per day and try to have several alcohol free days in any one week
• Drink tea and coffee in moderation

Men

Eating a healthy diet and being the right body weight is equally as important for men who are hoping to become dads. There have been many studies looking at specific nutrients such as zinc and selenium and male sperm quality. The key messages for men are:

• Aim to be the right weight for your height by eating sensibly and exercising on a regular basis
• Follow the principles of healthy eating set out by the Eat Well plate. Eating a variety of foods will help ensure you have all the nutrients you need such as zinc, selenium, folate and vitamin C
• Drink alcohol moderately, 3 to 4 units of alcohol a day is the UK maximum recommended for men

Other important lifestyle factors

Exercise

It is important to exercise as part of a healthy lifestyle and evidence suggests that it maximises your chances of conceiving. If you are not physically active start planning an exercise program, this could be playing a sport or just being more active in your daily life, like walking instead of taking the car, helping with the housework or doing some gardening. If you exercise already pick up the pace of your workouts aiming for thirty minutes on most days of the week, this is the recommendation for general health.

Smoking

Avoid smoking and passive cigarette smoke, contact local NHS smoking cessation services to help you, and those around you quit.

Environmental factors

Evidence indicates that exposure to environmental hazards may lead to decreased fertility. The exact mechanism of the impact is unclear but experts suggest trying to avoid or limit your exposure to the following environmental toxins while trying to conceive:

• Pesticides and herbicides
• Volatile organic compounds
• Heavy metals such as arsenic, lead, mercury
• Air contaminants
• Cigarette smoke
• Persistent organic pollutants