BENEFITTING FROM THE INSIGHT OF GENETIC COUNSELORS
The field of genetics is extremely complex and fluid. There are people who have advanced training in genetics. They are extremely important for explaining what the results of genetic tests mean and how to use the information from genetic testing to a person’s best advantage. Hospitals, fertility practices, and genetic testing companies have genetic counselors available for consultation. The internet is also a source of information. The bottom line is that genetics is an expanding part of medicine. Its role will become even more important as more is discovered about the genetic code and how it works.
Chapter 4
Before the Baby: Exploring Lifestyle and Behavioral Factors
IN THIS CHAPTER
Even though you’re probably anxious to get started on baby making, take a little time to make sure that you’re in the best possible condition for conceiving a healthy baby. This means making sure that you’re not carrying an infection that may harm you or your baby and taking a look at your lifestyle habits, good and bad. In this chapter, we tell you how to get in shape physically if you’re trying to get pregnant and discuss some behavior that may be decreasing your odds of getting pregnant. We also take a look at how what you eat could influence your chance of conceiving.
Making Healthy Lifestyle Changes
“Everything in moderation” is certainly a good motto for habits, good and bad. Too much exercise can have a less-than-desirable effect, while coffee, drunk in moderation, can be benign. But, before you say yes to things that are better left in the “no” category, consider that some things are best eliminated entirely, particularly when you’re trying to conceive.
Giving up smoking
Smoking is bad for you. We all know it. Yet roughly 14 percent of women and 18 percent of men in the United States still smoke. While cigarette warning labels tell you they are addictive, they do not tell you that smoking impacts your reproductive health. Need some good reasons to quit? Here are a few:
Women who’ve smoked more than 100 cigarettes in their lifetime have a 14 percent greater risk of infertility.
Smokers take longer to conceive.
Smokers increase their relative risk for miscarriage by 1 percent for each cigarette they smoke a day. So, if you are 35 years old, you have a 20 percent chance of miscarriage (in general). If you smoke five cigarettes a day, you now have a 25 percent chance of miscarrying. But former smokers have the same risk of miscarriage as those who have never smoked, so quitting can really make a difference!
Smokers are two to four times more likely to have an ectopic pregnancy (one that implants in the fallopian tube rather than in the uterus, a topic we discuss in detail in Chapter 13) as smoking alters the structure and function of the tubes.
Smokers go through menopause earlier because smoking increases free radicals. Free radicals are substances that kill all cells, including eggs, decreasing the number of years pregnancy can occur. Smokers go through menopause three to four years earlier than nonsmokers. This could mean that a 38-year-old smoker is more like a 42-year-old nonsmoker, which, based upon age, would represent a significant decline in fertility.Smokers also have lower AMH (anti-muellerian hormone) levels than nonsmokers undergoing IVF. AMH is a protein made by egg units (follicles). More egg units means higher AMH, and in terms of eggs, more is always better than fewer. (We talk more about the impact of AMH in Chapter 11.)
Smokers’ eggs have more genetic abnormalities.
Smokers’ eggs are prone to polyspermy, where two or more sperm enter an egg. The embryos that result are chromosomally abnormal and will not grow.
If you’ve quit but your partner hasn’t, he may want to consider the following:
Men who smoke have a lower sperm count.
Men who smoke have a 20 percent decrease in sperm motility.
Smokers’ sperm have more abnormal shapes. Abnormally shaped sperm have a higher rate of chromosomal abnormalities.
Secondhand smoke exposure during pregnancy increases miscarriage rates by 11 percent.
I’ll drink to that!
A recently published article (Lyhgso, et al. Human Reproduction [2019] 34:1334) addressed the issue of mild to moderate alcohol consumption and infertility. The study asked the question: “Does female weekly alcohol intake and binge drinking impact the chance of a successful infertility treatment?” The study gathered information about the alcohol consumption of 1,708 women and their partners undergoing fertility treatment. The outcome was the achievement of a clinical pregnancy and live birth. The study found “low to moderate average weekly alcohol intake was not statistically significantly associated with the chance of achieving a clinical pregnancy or a live birth.” The study divided that amount of alcohol consumed per week into none, 1–2 (alcoholic drinks), 3–7, and > 7 drinks. The chance for conception and live birth using either IUI or IVF was the same for all groups. The conclusion from the authors was that the results of their study suggest that it is not necessary to abstain from drinking alcohol when undergoing fertility treatments.
Putting this into perspective, once pregnant, there is ample evidence that heavy alcohol consumption can harm the developing pregnancy. So, the advice to abstain from heavy alcohol consumption while pregnant is appropriate. The American College of Obstetricians and Gynecologists (ACOG) guidelines state that all alcohol types are harmful to an established pregnancy even potentially in the early weeks of pregnancy.
Give me my coffee!
What about coffee? Who doesn’t need that morning joe to start the day? Americans drink an average of 2.1 cups of coffee per day. But does that morning cup of coffee decrease the chance for achieving a pregnancy if a person is in treatment for infertility? Remember the alcohol study we talked about in the last section? In a different published study, the same researchers