Does Lifestyle Affect the Outcome of Infertility Treatment?
Infertility is estimated to affect up to 15% of American couples and is a diagnosis that is often not covered by third party reimbursement. It is therefore especially important to understand the available and current information that certain lifestyle habits may adversely impact fertility, including the success of IVF/ICSI treatments. This brief report is based upon an article by Kristen Rooney and Alice Domar of the Domar Center for Mind/Body Health, Boston IVF, Beth Israel Deaconess Medical Center and Harvard Medical School.
The authors performed an extensive review of the medical literature of this summary article and focused on six aspects of lifestyle: body mass index (BMI) – high and low, exercise, diet including supplements, caffeine, alcohol, smoking, and antidepressant medications.
BMI: Obesity is a universal problem with increasing prevalence. Obesity, defined as a BMI of 30 or greater, affects 14% of women in the world, and almost 300 million women over the age of 20 are obese. It is well known that obesity is associated with hypertension, heart disease and diabetes but it is also strongly associated with infertility (68% less chance to have a birth in the first IVF cycle than women who e not obese), miscarriage, preterm birth. Underweight women, usually defined as a BMI of less than 19 also have increased fertility problems and miscarriage rates.
Although most research on the impact of weight loss does not show a positive relationship between weight loss and pregnancy in IVF patients, weight loss is associated with a higher spontaneous pregnancy rate. In morbidly obese women, bariatric surgery increases egg quality and quantity relative to obese women who do not undergo surgery.
Exercise: Moderate daily aerobic exercise is associated with the highest pregnancy rates, no matter what the BMI.
Diet/Supplements: Vitamin D supplementation may normalize the serum anti-Muellerian hormone (AMH) levels. Vitamin D, a steroid hormone, itself, may modulate testosterone activity, thereby having a positive influence on pregnancy outcome.
Caffeine: The evidence on the relationship between caffeine and fertility is inconsistent but, in general suggests that higher caffeine intake may be linked to lower egg number, fewer good embryos, lower pregnancy rates in IVF patients and increased miscarriage rates.
Alcohol: Alcohol should be avoided in IVF. Alcohol usage resulted in fewer eggs, lower pregnancy rates, and more than a twofold increased risk of miscarriage.
Smoking: Smoking should also be avoided and is associated with infertility, pregnancy loss, and IVF failure. In general, smokers add 10 years to their reproductive age.
Antidepressants: This class of medications increases risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome as well as other physical and neurological abnormalities in the baby.
The authors concluded that lifestyle habits may have a significant impact on pregnancy rates in infertile women. Although adequate research in this area is lacking, there is evidence to support the above lifestyle modifications in infertile women. However, despite patient education efforts, studies in the U.S. and Europe have indicated that infertility patients do not follow the recommended lifestyle modifications.
 Current Opinion in Obstetrics & Gynecology: June 2014 - Volume 26 - Issue 3 - p 181-185