Struggling to become pregnant?

You’re not alone. One in 6 Australian couples experience infertility. Infertility is defined as the inability to become pregnant after a year of unprotected sex.

Infertility can be caused by physical or medical conditions such as damage to the fallopian tubes or early menopause, however, nutrition, lifestyle habits and weight play a critical role. In fact, research tells us that for every point higher you are on the BMI scale, your chance of falling pregnant decreases by 4% (over a BMI of 29). That means that a healthy woman with a BMI of 45 has a 60% chance of being infertile! As diet and weight play such an important role in getting pregnant, so many women are referred for help these days that I’ve started a baby photo wall in my office. So, let’s look at why your weight and what you eat are so important for getting pregnant…

How does being overweight affect your fertility?

Our menstrual cycles, and ability to ovulate (produce an egg) are regulated by hormones. Our stored body fat (called adipose tissue) also increases the production of a hormone called estrogen. When our hormone production becomes out of balance, it can affect our ability to ovulate. As such, many women who are overweight don’t have regular periods, making it much more difficult to conceive. In fact, about 30% of infertility is caused by hormone imbalance. Unfortunately, even if your periods are regular, we know that a woman who is overweight is still much more likely to struggle to get pregnant than a woman of a healthy weight.

Common medical conditions which may reduce fertility

You may have heard of medical conditions such as Poly cystic Ovarian Syndrome or Insulin Resistance. These medical conditions and many others are common in women who are overweight and play havoc with your hormones making it more challenging to conceive. If you’re struggling to get pregnant, the first step is to have a thorough assessment with your doctor to check for medical conditions such as these, then find a good dietician who can help you work on your diet and weight to reduce the effects of these medical conditions as much as possible.

Insulin resistance
Insulin is a hormone which is involved in digestion (amongst many other important functions). Like a condom to sperm, women who have Insulin Resistance find excess body fat forms a barrier to insulin trying to get through to the blood stream so that it can’t get through and work effectively. As a result, women with Insulin Resistance produce more and more insulin (hyperinsulinemia) as their body tries to produce enough of it to get it to the glucose calling out for it in the blood stream. In turn this leads to carbohydrate cravings, excess body fat and difficulty losing weight. The excess body fat will then produce higher levels of estrogen, resulting in hormone imbalances as we discussed before.

Poly cystic ovarian syndrome (PCOS) is caused by insulin resistance in approximately 75% of women. In women with PCOS, high insulin levels result in development of cysts on the ovaries. These cysts produce another hormone called testosterone which, in excess, then has a domino effect on other hormones and results in reducing your ability to ovulate.

Diabetes is a condition where the body has trouble keeping glucose levels within the recommended ranges in the blood stream. Women with diabetes have an increased risk of infertility. They may go through menopause earlier than women who don’t have diabetes. A very high percentage of women with diabetes also have insulin resistance and those who don’t have well controlled blood glucose levels have an increased risk of spontaneous abortion, foetal abnormalities and pregnancy complications. So, if you have diabetes, it’s essential that you work with a dietician to get your blood glucose levels under control.

Thyroid conditions
Disorders of the thyroid gland such as hypothyroidism (too little thyroid hormone) or hyperthyroidism (too much thyroid hormone) can disrupt the menstrual cycle which reduces fertility.

Cushing’s Syndrome
This is a hormonal condition where the body produces too much cortisol hormone. It also results in rapid weight gain and irregular or non-existent menstrual periods, making it challenging to become pregnant.

Endometriosis is a condition where the cells lining of the uterus grow outside of the uterus. Approximately 35% of women with endometriosis struggle to conceive. Although there are many theories about what causes this condition, the truth is still unknown. Although endometriosis does not cause weight gain, nor is it caused by being overweight, some of the common treatments for endometriosis can result in weight gain as a side effect. Furthermore, research suggests that there may be a link between diet and endometriosis. For example, a study by Britton and colleagues in 2000 found that those who had a high intake of fruit and vegetables were less likely to have endometriosis.

What should you do if you’re overweight and struggling to conceive?

As I mentioned before, the first step is to find a good GP and ask him to give you a health check. Any medical conditions like PCOS, insulin resistance or diabetes need to be diagnosed, and treated medically. Next, you need to make a concerted effort to try to lose weight to help optimise your hormone production. Weight loss can be more difficult in women who have medical conditions such as PCOS or insulin resistance, so be patient. You’ll need to find a good dietician who can tailor a meal plan to your specific medical and nutritional requirements and also fits your lifestyle. However, optimising your ratio of carbohydrates, proteins and fats is essential for fertility.

Optimise carbohydrate intake
Try to focus on low glycemic index carbohydrates, such as wholegrain bread, milk or citrus fruits which break down slowly and won’t impact your insulin levels as much. However, you will also need a dietician to calculate the correct portions of carbohydrate foods that you should consume. Too much carbohydrate will lead to increased insulin production.

Optimise protein intake
If you are overweight, your protein requirements will be increased. Your body needs protein on a daily basis to make new hormones, so if you’re not getting enough protein from your diet, your body will break down muscle to access the protein that it needs. The problem is, the less muscle mass that you have, the slower your metabolic rate (how quickly your body burns fuel) becomes….and a slow metabolic rate leads to weight gain! Speak to your dietician to find out exactly how much protein you should be consuming.

Optimise fat intake
Although it’s important to have a diet which is low in fat, you still want to make sure that you are consuming a small amount of healthy fats each day. Healthy fats are found in foods such as fish, nuts, seeds and olive oil. The body uses fat in the production of hormones…so too little fat can also inhibit your body’s ability to conceive.

Limit alcohol
The Australian Alcohol Guidelines recommend that women who are pregnant should avoid alcohol as it may affect the embryo; as such it is wise to limit alcohol if you’re trying to fall pregnant as well. Additionally, alcohol is high in kilojoules and contributes to weight gain, so keep it to special occasions for the time being. If you are going to drink, it is recommended that women trying to fall pregnant limit their alcohol intake to a maximum of two standard drinks per day.

Being underweight

Did you know that being underweight can decrease your fertility as much as being overweight can? Being underweight also affects the production of hormones, making ovulation more challenging. I often see women who are elite athletes, or who have had previous eating disorders with low levels of body fat who struggle to get pregnant. This can be an extremely challenging time for these women as although they desperately desire a baby, the thought of gaining body fat is confronting. Contrary to the images that we see in the media, women are designed to have higher levels of body fat than men. We need a bit of extra body fat to protect our reproductive organs, produce estrogen to regulate our hormones and store energy for breast feeding. If you have a low percentage of body fat, try to increase it by increasing your portion sizes and the intake of healthy fats such as avocado, nuts and olive oil in your diet. This additional body fat will help to optimise your hormone levels and enable you to ovulate.

Other important dietary considerations

Ensure adequate folate
Folate is a type of B vitamin which helps to prevent neural tube defects. Neural tube defects are birth defects of the brain or spinal cord which occur during the first few weeks of foetal development. Adequate folate intake is essential for the prevention of neural tube defects, so it is recommended that women trying to conceive take a daily pre-pregnancy multivitamin and eat plenty of fresh fruit and vegetables.

Moderate your caffeine intake
Although the research about caffeine and infertility is divided, if you’re trying to conceive, it is best to moderate your caffeine intake to less than 300mg per day (2 cups of coffee). There’s no need to cut it out altogether, although once you become pregnant, you may not feel like it any more.