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Monthly Health Review, August 2003 href="newsletters_archive.php">(View previous newsletterss)

Infertility and Pregnancy

During Pregnancy, any intended supplementation should be discussed with
a GP, midwife or other health professional.

Of all the activities carried out in life, conception, Pregnancy and
giving birth are considered the most wonderful. This issue of Health Review
covers nutrition and lifestyle aspects of Infertility and Pregnancy.

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Infertility

If a couple are having difficulty conceiving, having
established that there is nothing physically wrong, there are a few general
tips worth following regarding fertility:

• Both partners should avoid alcohol as it can affect libido and fertility.
• Avoid caffeine or reduce as much as possible.
• Men may consider taking Vitamin C to keep sperm healthy and prevent
  them from clumping together (agglutination). Zinc may help increase
  sperm count and the motility of sperm, especially where the testosterone
  levels are low. Arginine deficiency can have a negative effect on sperm
  count; supplementation may help address this, unless the count is particularly
  low.
• Women should be taking 400?g Folic Acid every day or eating food rich
  in folate (see box). Folic Acid deficiency can contribute to Infertility
  and is known to be necessary during the early development stages of
  the foetus.
• Men who smoke produce less sperm.
• Smoking while pregnant may restrict the baby's growth and cause problems
  during the birth.
• Men only ~ keep the testicles cool. Tight underwear or tight trousers
  are not advised. Heat raises the temperature of the testicles and can
  reduce sperm production and quality.
• Relax and have fun, enjoy each other and keep the Stresses and strains
  of the world outside the bedroom. Of all the different causes of Infertility,
  some are affected by nutritional factors. Women being either over or
  under weight affect the release of an egg from the ovaries. A diet rich
  in fresh fruit, vegetables, wholegrains, a variety of fish and lean
  meat, that is low in processed foods, alcohol, caffeine, cakes and confectionery
  will go a long way to help create healthy bodies to make babies.

Possible causes of Infertility

In Men... envIronmental pollution is one factor which is being blamed
for a decline in male fertility. Ten years ago it was noted that over
the preceding fifty years the number of sperm in each millilitre of semen
had almost halved, and there was an increase in the number of abnormal
sperm (2). Other factors include:

• Low sperm production through genetics, hormones, radiation exposure,
  injury or Infection.
• Lack of sperm motility or inability of sperm to penetrate the egg.
• Obstruction of ejaculate due to Infection or previous vasectomy.
• Failure to ejaculate due to Impotence or scar tissue.
• Antibodies may be being produced that inactivate or kill sperm.

Certain nutrients may be of benefit to male fertility. These are the
Antioxidants, especially Vitamin E, Vitamin C, Selenium and Zinc and the
amino acid L-arginine. A good multinutrient supplement should help to
balance any nutrient shortfalls in the diet.

In Women... failure to ovulate is the most common cause of female
Infertility. This may be caused by Stress, disorder of an ovary or hormonal
imbalance (3). Other factors include:

• Disorders of the uterus (e.g. fibroids)
• Endometriosis (fragments of the lining of the uterus which travel
  into the pelvic cavity).
• Obstruction of fallopian tubes and/or cervix to prevent the sperm
  from reaching the egg.
• A fertilized egg not being implanted successfully in the uterus.
• Health of the embryo and the hormonal envIronment must be suitable
  to enable the Pregnancy to continue to full term.

Female health in general should benefit from an increase in fresh, colourful
fruit and vegetables; seeds, nuts and wholegrains. These will help provide
the valuable antioxidant nutrients, vitamins C, E, Zinc and Selenium necessary
for a healthy conception. A good multinutrient taken during expected conception
and Pregnancy will supply all of these, together with Iron and other valuable
nutrients, especially if the diet contains a high proportion of convenience
meals or fast food (4).

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Pregnancy

After implantation of the fertilized egg into
the uterine wall, the uterus begins to grow a placenta. The next two weeks
are critical, as development of the cells take place. Very little physical
growth happens at this stage. It is important for Folic Acid to be in
the mother's system to ensure that the DNA is copied correctly. Both mother
and child will benefit from a good supply of nutrients which have not
suffered interference by other materials such as alcohol, smoke, preservatives
and so on.

At eight weeks, the foetus has a complete central
nervous system, a beating heart, a fully formed Digestive System, and
the beginnings of facial features. Each organ is most dependent on an
adequate supply of nutrients during its own intensive growth period.

At 14 weeks, the heart and brain are developed;
therefore malnutrition may affect the development of particular organs.
There is no second chance to provide nutrients at a later stage of development!

During the last six months, the foetus grows
tremendously. Cell division and development occur in organ after organ.
The mother's content changes dramatically too, with the blood volume increasing
by half to accommodate the added oxygen and nutrients needed by the growing
foetus. These nutrients will include:

• The essential fatty acid DHA (derived from Fish Oil). The requirement
  increases due to the rapid development of neural (nerve) and retinal
  tissue, especially after the 30th week (6).
• Vitamin D, as deficiency during Pregnancy has been linked to maternal
  osteomalacia, reduced birth weight and low Calcium levels in the newborn
  (7).
• Zinc is essential for normal foetal growth and development (8).
• A maternal deficiency in Iron may lead to Anaemia and has been associated
  with increased rates of premature birth, low birth weight and mortality
  close to the time of birth (7).
• Vitamin B6. Toxaemia, low birth weight and poor general condition
  of infants have been linked to inadequate maternal status of vitamin
  B6 (7).
• Foetal demand of Calcium in the last few weeks of Pregnancy is high,
  which means that the mother's skeleton has to provide it. Maternal Calcium
  stores therefore decline, despite the increased efficiency of Calcium
  absorption (7).

A developing foetus relies totally on its mother for
the nutrients that it needs to grow properly. Food intake in general is
important during Pregnancy because of the close relationship between maternal
intake and infant birth weight.

Energy and Pregnancy

'Normal' calorie intake is approx. 2000 kcals a day
for a woman. During Pregnancy, approximately 30,000 additional kcals (336MJ)
are needed. On a daily basis this is not a lot of extra calories (approx.
107kcals a day assuming a typical 40 week Pregnancy) because the content
adapts to the increased energy requirements and becomes more energy efficient
through reduced physical activity and a lowered metabolic rate.

The energy is used to increase the size of the placenta
and reproductive organs; create additional stores of fat in the mother
and form the 'new baby' tissues, Lactation requires about 750 kcals (3.1MJ)
a day (9).

These extra calories should come from a healthy diet,
especially oily fish, fresh green leafy vegetables and whole, unprocessed
foods. Oily fish are of great benefit during Pregnancy because they provide
essential omega 3 fatty acids that are needed for the development of membranes
and brain of the foetus. Studies show that Fish Oil consumption increases
birth weight (7).

Folic Acid

The Department of Health (DoH) has recommended that
all women of childbearing age should increase their intake of Folic Acid-rich
foods. Folic Acid is necessary for DNA formation. The development of the
foetus relies on healthy DNA to make a healthy baby. A fault in DNA around
week 12 of development increases risk of neural tube defects including
spina bifida.

All women planning a Pregnancy should take a 400?g
supplement before conception until at least the twelfth week of Pregnancy.

The chance of neural tube defects occurring is higher
in babies of women who are clinically obese (6).

The richest sources of Folic Acid are Brussels sprouts,
asparagus, spinach, kale, black eye beans, liver, fortified cereals and
fortified bread. These provide 100?g per serving. Broccoli, spring greens,
cabbage, green beans, cauliflower, peas, bean sprouts, okra, soya beans,
chick peas, kidneys, yeast and beef extracts provide 50?g a serving.

Other foods are not considered good sources of folic
acid.

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Limits of specific
nutrient intakes

If a woman is taking food supplements during Pregnancy
no more than 800?g Vitamin A should be ingested through both diet and
supplements (CRN, 1999). The herb raspberry leaf has been traditionally
used in Pregnancy, to help ease labour. It should only be taken under
medical supervision (10), for the last two months of Pregnancy (11).

Lactation

Nature intended women to feed their babies themselves.
A general multinutrient to help meet the extra demands of milk production
may be taken by the mother at this time. Aniseed is reputed to increase
milk secretion (10). Zinc is essential for milk production during lactation
(12). Breastfeeding = human milk for baby humans!

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References

1. Healing Through Nutrition, Dr. Melvyn Werbach. Thorsons, 1995.
2. "The Which Guide to Men's Health", Dr. Steve Carroll. Which Books.
   1994.
3. "BMA Complete Family Health Encyclopaedia", Ed. Dr. T. Smith.
   1996. DK.
4. Am.J.Clin.Nutr,2000,72, (1 Supple), 280S-290S.
5. "Nutrition Concepts & Controversies", Sizer & Whitney. West. 1994.
6. JAMA, 1996, Apr 10, 275:14, 1093-6.
7. "Human Nutrition & Dietetics", Garrow, James and Ralph. Churchill
   Livingstone. 2000.
8. Am.J.Clin.Nutr. July 1997, 66:1, 80-8.
9. Food Science, Nutrition and Health, 6th ed. Fox & Cameron. Edward
   Arnold, 1995.
10. "Herbal Medicines", C Newall & L Anderson, Pharmaceutical Press.
    1996.
11. "Bartram's Encyclopaedia of Herbal Medicine". Thomas Bartram FIMH.
    Robinson. 1998.
12. Am.J.Clin.Nutr. July 1997, 66:1, 80-8.

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