Presentation on theme: "Truths & Myths about Diet In Fertility and Gender Selection"— Presentation transcript:
1 Truths & Myths about Diet In Fertility and Gender Selection Dr. Eeson SinthamoneyConsultant Obstetrician and GynaecologistHospital Kuala Lumpur
2 Nutrients and fertility Gender selection OutlineWeight and fertilityNutrients and fertilityGender selection
3 Weight and fertilityIn women: raised BMI associated with difficulty in conceivingOverweight and obese women undergoing fertility treatment had significantly lower pregnancy rates and higher miscarriage ratesUnderweight women had less embryos available
4 Weight and fertility In men, relationship less clear Many studies indicate high or low BMI associated with significantly reduced sperm qualityHowever some evidence also suggests otherwiseBody weight loss may be reasonable in male infertility
5 Nutrients and fertility - truth or myth? Many studies demonstrate the positive effects of OTC supplementation on female fertility, semen parameters and pregnancy outcomesConversely, also many studies that demonstrate lack of improvementGold standard of evidence?
6 Nutrients and fertility Why is good evidence difficult to find?Infertility often multifactorialBaseline dietary intakeSingle agent versus multiple supplementsDosages?
7 Nutrients and fertility in women Several small studies suggest that some nutrients may be essential in female reproductionCurrent interest focused on vitamin D and anti-oxidants
8 Nutrients and oxidative stress Cell respirationlProductionAlcohol / tobacco smoke / environmental pollutantsReactive oxygen speciesScavenging, disposing or suppresingAnti-oxidant co-factorsExample: selenium, zinc and copperAnti-oxidants(example Vitamin C and E)
9 Which are anti-oxidants? Main nutrients: vitamin C, vitamin E, selenium, and the carotenoids (vitamin A precursor)A multitude of other nutrients, including minerals such as copper, manganese, zinc, flavonoids (such as grape seed extract and phenols found in green tea)Co-enzyme Q10, also possess antioxidant properties
10 Impact of oxidative stress on female fertility Evidence exists supporting the role of oxidative stress in male fertilityHowever, in women, while there is suggestion of the same, relationship not well addressed
11 Anti-oxidants and female fertility NutrientsImplications in implantationEffect on embryo qualityEffect on oocyte quality and maturationIncrease in menstrual regularityHigher rates of conceptionSmoking and alcoholActive and passive smokers have reduced fertilityReduced implantation rates in IVF reduced pregnancy rates 2 alcoholic drinks a day impairs fertilityCaffeineHigh levels (>500mg/day = >5 cups/day) delays conception
12 Nutrients and fertility in women- Vitamin D Involved in female reproduction and improves fertility treatment outcomeSome studies show that women with higher serum and FF vitamin D levels have higher pregnancy rates after IVFReplete vitamin D stores predict reproductive success following in vitro fertilization. Ozkan S et al. Fertil Steril Sep;94(4):Vitamin D and fertility-a systematic review. Lerchbaum E, Obermayer-Pietsch BR. Eur J Endocrinol Jan 24.
13 Oxidative stress and infertility in women - summary Some strong but indirect evidence that oxidative stress affects fertilityBest available evidence suggests a varied diet with regular use of multivitamins, limited caffeine and alcohol and a healthy body weight promotes fertility
14 Nutrients and fertility in men Up to 50% of fertility problems involve a male factorMore information available concerning nutrients and sperm characteristics
15 CarnitinesAssist sperm metabolism as an energy source for spermatozoa and effect motility and sperm maturationAlso an anti-oxidantMultiple RCT studies demonstrate improvements in concentration, motility, morphology also the converse also shownPrimarily meat productsDosage? Up to 3g/day safe
16 Co-enzyme Q-10Studies in infertile men demonstrate positive co-relation between higher seminal fluid CoQ10 concentrations and sperm motility and fertilization potential in couples undergoing IVF pregnancy rates?Source: oily fish (sardines), organ meat, whole grain, vegetablesDosage: mg/day up to 12mg/kg/day
17 Folic acid Important role in DNA synthesis and proper cell function Critical role in spermatogenesisMixed reports on effect of folate on male fertilitySources: dark green leafy veg, beans, eggs, meatsUnsure if additional folate above RDA will improve fertility
18 Glutathione One of the most abundant anti-oxidant produced in the body Important role in maintaining exogenous anti-oxidants (Vitamin C, E) in its active formShown to improve sperm motility, improved sperm concentration and decreased sperm DNA fragmentationSource: fresh meat, fruits & vegUp to 3g/day toleratedPoor oral availability IM administration
19 Vitamin A B-carotene is pre-cursor or vitamin A Anti-oxidant propertiesSpecific benefits on sperm production and function difficult to clearly demonstrateUp to <10000iu/day toleratedHowever, readily stored and may reach toxic levels
20 Vitamin C Associated with various improvements in semen quality Supplementation up to 1000mg/day improves count, motility, viability and morphologyProtects sperm DNA against oxidative damageMay work synergistically with other vitamins and anti-oxidantsRDA: 90mg/day; dosage: 500mg/day
21 Vitamin E Potent anti-oxidant Substantial support for improvement in many sperm parametersSources: veg oil, meat, poultryRecommended dose: iu/dayUpper daily intake: 1600iu/dayMay be increased risk of complications (CVS) if >400iu/day and bleeding risk >800iu/day
22 SeleniumRole in maintaining normal testicular development, spermatogenesis and sperm functionStudies support use of selenium to improve sperm motility, concentration and morphology especially I combination with vitamin EOptimal dosing: mcg/daySources: meat, seafood, eggs; veg is poor source
23 ZincVital role in testicular steroidogenesis, testicular development, sperm O2 consumption and other functionsChronic mild zinc deficiency assoc with oligospermia, decreased serum T2Zn therapy associated with improvement in sperm motility, reduced sperm DNA fragmentation and other improvementsUpper limit: 40mg/day
24 Gender selection Not new! mother-in-law’s advice Nutrients? Sperm sorting mechanisms – varied options, evolving over timepost sort purity average 87.9%4. PGDFlow cytometric sorting of human sperm: MicroSort clinical trial update. Karabinus DS. Theriogenology Jan 1;71(1):74-79
25 Conclusion Lack of good quality evidence However: information available suggests that selective use of certain supplements beneficial but dosage information lacks clarityCertainly- anti-oxidant use may improve live birth and pregnancy rate outcomes for subfertile couples undergoing ARTHowever: avoid doses beyond RDA to avoid complicationsBlood level assessment?