Presentation on theme: "Truths & Myths about Diet In Fertility and Gender Selection Dr. Eeson Sinthamoney Consultant Obstetrician and Gynaecologist Hospital Kuala Lumpur."— Presentation transcript:
Truths & Myths about Diet In Fertility and Gender Selection Dr. Eeson Sinthamoney Consultant Obstetrician and Gynaecologist Hospital Kuala Lumpur
Outline 1.Weight and fertility 2.Nutrients and fertility 3.Gender selection
Weight and fertility In women: raised BMI associated with difficulty in conceiving Overweight and obese women undergoing fertility treatment had significantly lower pregnancy rates and higher miscarriage rates Underweight women had less embryos available
Weight and fertility In men, relationship less clear Many studies indicate high or low BMI associated with significantly reduced sperm quality However some evidence also suggests otherwise Body weight loss may be reasonable in male infertility
Nutrients and fertility - truth or myth? Many studies demonstrate the positive effects of OTC supplementation on female fertility, semen parameters and pregnancy outcomes Conversely, also many studies that demonstrate lack of improvement Gold standard of evidence?
Nutrients and fertility Why is good evidence difficult to find? 1.Infertility often multifactorial 2.Baseline dietary intake 3.Single agent versus multiple supplements 4.Dosages?
Nutrients and fertility in women Several small studies suggest that some nutrients may be essential in female reproduction Current interest focused on vitamin D and anti-oxidants
Nutrients and oxidative stress Cell respirationl Reactive oxygen species Alcohol / tobacco smoke / environmental pollutants Anti-oxidants (example Vitamin C and E) Anti-oxidant co-factors Example: selenium, zinc and copper Production Scavenging, disposing or suppresing
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
Impact of oxidative stress on female fertility Evidence exists supporting the role of oxidative stress in male fertility However, in women, while there is suggestion of the same, relationship not well addressed
Anti-oxidants and female fertility NutrientsImplications in implantation Effect on embryo quality Effect on oocyte quality and maturation Increase in menstrual regularity Higher rates of conception Smoking and alcohol Active and passive smokers have reduced fertility Reduced implantation rates in IVF reduced pregnancy rates 2 alcoholic drinks a day impairs fertility CaffeineHigh levels (>500mg/day = >5 cups/day) delays conception
Nutrients and fertility in women- Vitamin D Involved in female reproduction and improves fertility treatment outcome Some studies show that women with higher serum and FF vitamin D levels have higher pregnancy rates after IVF Replete vitamin D stores predict reproductive success following in vitro fertilization. Ozkan S et al. Fertil Steril. 2010 Sep;94(4):1314-9. Vitamin D and fertility-a systematic review. Lerchbaum E, Obermayer-Pietsch BR. Eur J Endocrinol. 2012 Jan 24.
Oxidative stress and infertility in women - summary Some strong but indirect evidence that oxidative stress affects fertility Best available evidence suggests a varied diet with regular use of multivitamins, limited caffeine and alcohol and a healthy body weight promotes fertility
Nutrients and fertility in men Up to 50% of fertility problems involve a male factor More information available concerning nutrients and sperm characteristics
Carnitines Assist sperm metabolism as an energy source for spermatozoa and effect motility and sperm maturation Also an anti-oxidant Multiple RCT studies demonstrate improvements in concentration, motility, morphology also the converse also shown Primarily meat products Dosage? Up to 3g/day safe
Co-enzyme Q-10 Studies 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, vegetables Dosage: 200-300mg/day up to 12mg/kg/day
Folic acid Important role in DNA synthesis and proper cell function Critical role in spermatogenesis Mixed reports on effect of folate on male fertility Sources: dark green leafy veg, beans, eggs, meats Unsure if additional folate above RDA will improve fertility
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 form Shown to improve sperm motility, improved sperm concentration and decreased sperm DNA fragmentation Source: fresh meat, fruits & veg Up to 3g/day tolerated Poor oral availability IM administration
Vitamin A B-carotene is pre-cursor or vitamin A Anti-oxidant properties Specific benefits on sperm production and function difficult to clearly demonstrate Up to <10000iu/day tolerated However, readily stored and may reach toxic levels
Vitamin C Associated with various improvements in semen quality Supplementation up to 1000mg/day improves count, motility, viability and morphology Protects sperm DNA against oxidative damage May work synergistically with other vitamins and anti-oxidants RDA: 90mg/day; dosage: 500mg/day
Vitamin E Potent anti-oxidant Substantial support for improvement in many sperm parameters Sources: veg oil, meat, poultry Recommended dose: 200-400iu/day Upper daily intake: 1600iu/day May be increased risk of complications (CVS) if >400iu/day and bleeding risk >800iu/day
Selenium Role in maintaining normal testicular development, spermatogenesis and sperm function Studies support use of selenium to improve sperm motility, concentration and morphology especially I combination with vitamin E Optimal dosing: 100-210mcg/day Sources: meat, seafood, eggs; veg is poor source
Zinc Vital role in testicular steroidogenesis, testicular development, sperm O2 consumption and other functions Chronic mild zinc deficiency assoc with oligospermia, decreased serum T2 Zn therapy associated with improvement in sperm motility, reduced sperm DNA fragmentation and other improvements Upper limit: 40mg/day
Gender selection Not new! 1.mother-in-laws advice 2.Nutrients? 3.Sperm sorting mechanisms – varied options, evolving over time post sort purity average 87.9% 4. PGD Flow cytometric sorting of human sperm: MicroSort clinical trial update. Karabinus DS. Theriogenology. 2009 Jan 1;71(1):74-79
Conclusion Lack of good quality evidence However: information available suggests that selective use of certain supplements beneficial but dosage information lacks clarity Certainly- anti-oxidant use may improve live birth and pregnancy rate outcomes for subfertile couples undergoing ART However: avoid doses beyond RDA to avoid complications Blood level assessment?