Watch the recording of the webinar with Antonio Rodrigues, MBBCh, FCOG, MBA
, a Reproductive Medicine Specialist and the Founder and Director of Medfem Fertility Clinic in the Republic of South Africa, who discussed infertility and lifestyle.
Dr Rodriguez during his presentation tried to answer one of the questions on why we need to focus on lifestyle to improve our outcomes both in terms of normal infertility and in vitro fertilization. Several factors are important, and according to Dr Rodriguez, the most important one that he and his team researched over the last 21 years is stress.
The rest of the things like diet, smoking, recreational drugs, alcohol and poor nutrition often follow their whole concept, and the type of stress that the team have recognized as major comorbidity of infertility is what we call time urgency perfectionism stress.
Anything that leads to a higher level of carbohydrates in your diet and, unfortunately, all those normal things that taste good causes raised insulin levels. Normally if you wake up in the morning your insolence should be low as you have your first meal, the insulin goes up, and then you are maintained until your next meal. However, Dr Rodrigues and his team found that a lot of women have raised insulin levels, and this is not diabetes, this is high insulin levels which is a pre-diabetic state. Some patients have had overweight, but a large percentage of them have normal weight. Common symptoms are fatigue, sugar cravings, weight gain, and high cholesterol levels. A lot of patients have hypertension, some have a history of heart problems, and it’s a worldwide trend that there’s a very high incidence of a polycystic ovarian syndrome (PCOS) or a spectrum of polycystic ovarian syndrome, meaning that some women might have normal cycles, but, when monitoring the ovulation and the way the uterus responds, they behave exactly like a polycystic ovary. Some of those patients have very high insulin levels, and if they have high insulin levels, they need to pay attention to their diet. All those patients are treated with Metformin to bring that insulin down. There are also some natural products called inositol, which is used to bring insulin down as well. Metformin is a drug that will help egg quality.
What about the male? There was a general tendency to blame poor-quality embryos on the egg, but we should remember that paying more attention to the male is crucial. Some men may have normal semen analyses, but on the other spectrum, they can have very low sperm counts and very abnormal sperm. If they have high insulin levels, they could have played a big role in embryo quality. Therefore, when we’re looking at IVF, it’s very important to check the male as well. A lot of research showed that if a male has high insulins and we check things like thyroid and prolactin levels in the male, and if any of those are abnormal, we need to focus on the male. It’s not all about eggs.
If your weight is normal, your insulin is normal, you need a balanced eating plan, and you need to eat a combination of vegetables, and fruits in the right amounts and not overdose on refined carbohydrates. If you have high insulin levels, you’ve got two options, you need to look at a low glycaemic diet, which means you need to eat your sugars and carbohydrates in such a way that they don’t create these big high insulin levels and that works well in the female population. Then there is also a diet called the Banting diet or the carbohydrate-free diet, and that particular diet has a very specific benefit but seems to do better in the males in controlling insulin levels. It’s very important to focus on eating habits and to keep them simple in such a way that you’re eating healthy.
In the modern type of foods and modern diets, nutrition intake plays a role. If you’re having very good food, eat vegetables and fruits that are organic, those types of foods will be full of nutrients, and there’s no necessity to look at your nutrient intake. However, sometimes in patients, there is increased demand for nutrients through what is called mitochondrial stimulation. Mitochondria are little parts of the cell cytoplasm, and they’re very significant in creating the division in the egg at the end of its development. The mitochondria need to have the right doses of vitamins, minerals, amino acids, antioxidants, and growth hormone factors.
A stress factor called time urgency means the feeling that you’re always chasing time from the moment you go to sleep at night, even chasing time in your sleep, in your nightmares, in your dreams, waking up before the alarm clock goes off and never getting enough time. Another very important factor is perfectionism, where you would go on and on in a normal situation to get something perfect. When these two are joined, perfectionism and time and urgency, start to create certain hormonal changes in the body. This group of people, in terms of these symptoms, are angry, irritable, hostile, often cynical, and blame other people, etc. It’s all related to the stress of not having enough time to do things right. Another thing that was found in the research was personalizing personality. The person takes things personally concerning this time urgency, perfectionism, and that group of people have a much higher incidence of being depressed.
What is this time urgency? We look at a situation where we get hooked on a stressful situation. Any situation that causes a negative reaction, like running late, you’ve been criticized, you’re standing in a queue, or someone moaning at you, are all hooks that will pull you into a situation and start to create a negative reaction in your body. The whole principle of managing those negative reactions is to learn how to break that vicious circle.
We also need to recognize that there’s good stress, unlearned stress that happens out of nowhere. Stress releases adrenaline, you feel good, for example, you put a project in a work, and you get rewarded for that. Learned stress happens all day, every day, from the time you wake up to the time you sleep, and secretes hormones such as cortisol and noradrenaline. Cortisol is an immune suppressant type of hormone, so that leads to a lot of things like infection, chronic immune diseases, and autoimmune diseases, it plays an important role in the entire process. Noradrenalin has a lot of symptoms that it can bring up.
Another research done on a group of women with infertility problems revealed that a lot of them had endometriosis. There was a large group of symptoms that they had. Once they managed that stress, those symptoms went away, such as hot burn, chest pains, headaches, muscle pain, joint pain, diarrhoea, and irritable bowel syndrome, those things disappeared, and there was a lower rate of depression after managing it.
There’s a value for the patient not in terms of just falling pregnant but in terms of their pregnancy because there’s a lot of work that shows that if you fall into this type of stress, it has a negative impact on the baby as you go through pregnancy. Lifestyle management can improve not only the pregnancy rate, but also shortens the time of pregnancy.
IVF cannot just be repeated over and over again, every single failure needs to be looked at carefully, so we bring this type of optimization or fertility into our programs very early, and we do it by what we discussed stress management trying to get balanced eating managing insulin problems in males and females and dieting males. We mustn’t neglect the male, they need to understand that they need to be fit and healthy to create a good embryo. Smoking has been extensively studied both in males and females, and if you do smoke there’s going to be a reduction in your IVF pregnancy rate, recreational drugs have an effect, and if you’re not drinking too much alcohol, it sometimes tends to play a role in diet especially if it’s wine and things like that. That’s very high in carbohydrates, but alcohol in excess is a problem. In summary, it’s very important as an added benefit to all fertility patients to focus on these things to optimize their fertility.