Melanie:  Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole, and I invite you to listen as we discuss lifestyle choices and their effect on fertility. Joining me is Dr. William Ziegler. He's a Specialist in Reproductive Endocrinology and Infertility, and he's the Medical Director of the Reproductive Science Center of New Jersey. Dr. Ziegler, it's a pleasure to have you join us today. Welcome back. Tell us a little bit about lifestyle choice and their effect on fertility. What's the connection there?

Dr. Ziegler: We need to kind of take a little step back that, we know that it's estimated that there's 7.4% of women and their husbands in the United States have a diagnosis of infertility and worldwide, this percentage could be as high as 15%, but we have to really keep in mind there are some other factors that can affect a patient's ability to conceive. And one of them is their lifestyle choices or lifestyle factors that can determine their reproductive health and can positively as well as negatively influence fertility.

When we take a look at the reproductive timeline, we have to really take into account maternal age. And when a woman is born, she has 2 million eggs. It is not until they start menstruating that now they're down to 400 to 500,000 eggs, and they're only going to use around 400 or 500 of them during their lifetime. And we know that as a woman gets older, that their chances of conceiving can decrease. And women that are over the age of 36, their probability of conceiving drops down to around 41% and genetic abnormalities actually increase.

So there are some things that patients can do that can help improve their fertility potential. And one of them really has to deal with nutrition. There's been some studies out at this point that have shown that those diets that have increased protein or animal protein to be specific, can actually increase their chances for having an ovulatory problem or ovulatory infertility, as well as increase in trans fats in their diet. So there have been some studies out at this point that talk to what's called a fertility diet that really emphasizes a high amount of mono unsaturated to trans-fat ratio, changing from animal protein to vegetable protein, increasing, to a high fat over a low-fat dairy diet. So as there are some things that patients can do outside of using medication that may actually improve their probability of conceiving.

Melanie: Wow. That's so interesting. Dr. Ziegler, you just totally educated us on something that I imagine many people did not know. So as long as we're talking about women and before we get into some men issues, where do things like stress, exercise, because you spoke about nutrition and where do these other kinds of factors come into play and even environmental factors that some women may experience?

Dr. Ziegler: When we talk about exercise, mild or moderate amount of exercise, doesn't appear to affect fertility. However, excessive exercise can negatively alter a body's energy balance and can affect the reproductive system. We know when patient has excessive exercise, it can actually affect the hypothalamic access to the pituitary gland and menstrual irregularities are seen more often among women, that have increased intensity of their workouts, duration of their workouts.

Women who engage in cardio vascular exercise for more than four hours or more per week, 40% of them can have a decreased live birth rate as well as a high cancellation rate with fertility treatment. So when we are seeing patients, with regard to exercise, we recommend moderate physical activity instead of the strenuous activity, which a lot of women do like the strenuous running that patients will do, or the P90X workouts, those things, we kind of advise patients to avoid while going through fertility treatment. And I know you brought up the concept of stress or psychological effects. That's very hard to pinpoint. However we do know that women who work more than 32 hours a week experience a longer time to conception compared to women who work 16 to 30 hours per week. We do know infertility itself causes additional stress as well as anxiety. And we try to decrease that as best as we can because even from a health maintenance standpoint, that is not a good thing to have.

Melanie: Well, it certainly isn't and I mean, something we all have to learn to control at some point. And what about men? Are there lifestyle factors that affect the fertility of a man? And if so, what are those?

Dr. Ziegler: Well, it's the same thing with men that, we do need take a look and then at their diet, however, diet doesn't appear to be such a big factor with men. Semen analyses can change quite frequently, and we do know that a specimen that a man is producing today was actually made three months ago. So different things that are happening in their life, at that point in time, like cigarette smoking can affect sperm concentration as well as motility. Marijuana smoking can and which that can affect semen parameters. Stress in men that, we do find that, stress plays more of a role in spermatogenesis than what it does in females, in trying to conceive in using their own eggs. So we do look at the couple and then as a whole, and try to identify different things that we can possibly modify to help improve their fertility potential.

Melanie: So then what would you really want people to know? You mentioned age and nutrition and stress. We're talking about lifestyles. What would you like couples to know before they plan to get pregnant? Or if they have a plan in place for the next few years, what would you like them to do right now to increase their chances of getting pregnant?

Dr. Ziegler: I would recommend them looking back and just look at their lifestyle choices. Like we know that cigarette smoking can reduce ovarian function. And even as little as 10 cigarettes per day have been found to decrease the ability to conceive, and it has been shown to increase the risk of an ectopic pregnancy or a tubal pregnancy. We know that caffeine use, excessive caffeine use can actually cause issues. We know that in a 16-ounce bottle of Pepsi or Coke has 50 milligrams of caffeine, or if you go to Starbucks and you get a Pike's Place roasted cup of coffee of 16 ounces that has 330 milligrams. And we know that more than a hundred milligrams of caffeine a day are associated with a miscarriage or even 200 milligrams a day can cause a problem with ovulation. So we need to take a look at that, but also at where patients live. That's also something else that has gotten more publicity recently about air pollution and it has been shown that those that live in bigger cities are more exposed to pollutants that come from car exhaust, carbon monoxide, the nitrogen dioxide particulate matters, and that has been shown to reduce fertility potential as well as increase the risk of preterm delivery.

So when patients are looking at how they can maximize their fertility potential or trying to get pregnant, take a look at these factors in their life and see what they can do to help mitigate their problem in conceiving. These are very simple changes that can be made and again, it may prove to be beneficial and maybe they don't need to come and see a reproductive endocrinologist.

The other part is that they could always come to see a reproductive endocrinologist, and we can put this into perspective in those that may not be ready to have a full workup or may not be ready to go on medication. What can I do outside of having an intervention from a medical specialist that may help improve my chances to conceive? So these are some things that we can take a look at and come up with a game plan for a couple, because a lot of them like to know what is my next step? What can I do? And even from a psychological standpoint, having a game plan in place seems to put a lot of that anxiety or psychological stress kind of at bay.

Melanie: What great advice and so interesting to hear. When you've made your game plan and when you think that it's important that listeners visit a reproductive endocrinologist to get this put into perspective, just as you said, and the lifestyle choices that can affect their fertility. Thank you so much, Dr. Ziegler for joining us. As always, you're such a very informative guest.

That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, please visit fertilitynj.com to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the Reproductive Science Center of New Jersey podcasts. I'm Melanie Cole.