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4/24/2018THE ROLE OF NUTRITION IN INFERTILITY:EVALUATING THE RESEARCHElizabeth Shaw, MS, RDN, CLT, Co-Author of the FertilityFoods Cookbook, 2017DISCLOSURESOwner of ShawSimpleSwaps.com,Nutrition Communications ConsultingCompany & BumpstoBaby.com, InfertilitySupport CommunityCo-Author: Fertility Foods Cookbook:100 Recipes to Nourish Your BodyCurrent Clients:California Avocado Commission,Alliance for Food & Farming, Halo TopCreameryOBJECTIVES Define infertility and its prevalence. Evaluate the latest research surrounding nutrition and infertility. Discuss specific conditions that may lead to infertility. Identify the basic tenants of a diet conducive to conception,highlighting differences amongst genders and specific diseasestate recommendations. Summarize the RDN role in helping clients struggling withinfertility. List resources for further education surrounding nutrition andfertility.1
4/24/2018WHAT IS “INFERTILITY”? (1-3)Is It Really That Common? (1-5)WHAT ARE SOME CAUSES OFINFERTILITY?Unexplained InfertilityEndocrine DisordersPCOS (Polycystic Ovary Syndrome)Anatomical Abnormalities & AnomaliesEndometriosisUterine Irregularities (Unicornuate, Bicornuate, Septate)Fibroids & PolypsMale Factor Infertility2
4/24/2018UNEXPLAINED INFERTILITYReason of infertility is unknown 1 year trying to conceive, or 6months if 35 years oldConsider recommending testingfor Celiac DiseaseMonitor and asses low bodyweight for concerns related tomalnutrition from an eatingdisorder or disordered eatingtendencies/hyperactivity (femaleathlete triad)ENDOCRINE: PCOS (6, 7)Endocrine disorder that causes analteration of sex hormones in thefemale bodyAffects 5-10% of reproductiveage womenPrimary cause of ovulatoryinfertility related to elevatedinsulin levels and over productionof testosteroneANATOMICAL ABNORMALITIES:ENDOMETRIOSIS (8,9)Condition when uterine tissuegrows outside of the uterusAffects 10% of reproductive agewomenMany women with endometriosisoften struggle with conception, butnot all3
4/24/2018ANATOMICAL ABNORMALITIES &ANOMALIES (10,11)Uterine IrregularitiesUnicornuateUnicorn shaped uterusBicornuateHeart shaped uterusSeptateA tissue wall that lines and separates the uterus into two cavitiesFibroids and polypsMALE FACTOR INFERTILITYInfertility related to spermproduction, morphology, anddelivery7% of men of couples whostruggle with infertility experiencemale factor infertility (2)CAN NUTRITION PLAY A ROLE IN CLIENTS WHO ARESTRUGGLING WITH INFERTILITY?4
4/24/2018A LOOK AT THE RESEARCHFEMALE INFERTILITY:NURSES HEALTH STUDY (12,13)116,000 women between theages of 25-42Evaluated lifestyle patterns &corresponding risk of chronicdiseaseData taken and researched moreclosely by several scientists toexplore reproductive healthWHAT IS A “DIET CONDUCIVE TOCONCEPTION”? (8)5
4/24/2018#1: THE PRODUCE PATCHIncreased consumption of fruits andvegetablesMales: (15)Sperm negatively affected by adiet low in fresh fruits, vegetables,and antioxidantsFemales: (13)Slower digesting carbohydrates,including whole fruits, vegetables)was thought to result in animprovement in ovulation cyclesTHE CASE FOR CONVENTIONALJournal of Toxicology (16)23% of organic food samples tested positive for pesticidesInternational Journal of Food Contamination (17)Dietary exposure to pesticides far below public healthconcern77 specific pesticides tested, of which 3 showed exposurelevels 1% when compared to the Chronic Reference DoseLevels,; majority were under .1%THE CASE FOR ORGANICHuman Reproduction (18) - Male FertilityHigher intakes of pesticide containing produce resulted in decreasedsperm qualityHigher intakes of low to moderate containing pesticide produceproduced an increase in morphologically “normal” sperm comparedto little to no produceJAMA Intern Med (19) - Female Fertility with ART (Assisted ReproductiveTechnology)Higher intakes of F/V with greater pesticide exposure resulted infewer pregnancies and live births6
4/24/2018PCOS/ENDOMETRIOSISRECOMMENDATIONSPCOS Nutrition RecommendationsGo organic, if possible (7,20)Due to the imbalance in sex hormones, lean towards organic produce to reduce exposure to environmentalcontaminants that may further disrupt ovulationEndometriosis (21)Increase green vegetable and fresh fruit consumptionBOTTON LINE: PRODUCEMore produce, not noproduce, is the bestoption!Work with clients toidentify what theirdiagnosis and budgetwarrant.#2: WHOLE GRAINSEncourage consumption of wholegrainsStabilize blood sugar toprevent hormonal fluctuationsthat can disrupt fertilityFor clients with Celiac or glutensensitivity, utilize gluten freewhole grains7
4/24/2018GENDER SPECIFIC RESEARCHFemale Fertility (12) : Higher intakes of whole grains higher rates of conception and livebirths (10)Warranted for IVF success, too (22)-: BioCycle Study, the type of dietary fiber may pose a greater risk foran anovulatory cycle (23)Male Fertility (24)Higher sperm quality seen in men who follow a diet high in whole grains,as well as produce and lean proteins (like chicken and fish)PCOS & GF RECOMMENDATIONSPCOS Nutrition (25)Low GI (glycemic index) foodsHelps to lower circulating insulin levels that usually result with intakes of higher GI foodsCeliac Disease, Gluten-Sensitive Nutrition (26)Tailored plan to include GF whole grainsBOTTON LINE: WHOLE GRAINSBoth families and females,make your grains whole!8
4/24/2018#3: PROTEINFocus on plant forward and cholinerich sources (27)Such as beans, lentils, soy, nuts,seeds, quinoaEggsEncourage 2-3 servings of omega3 rich fish per week (28,29)Follow mercury recommendationsas per pregnancyRESEARCH ON SOYFemale FertilityBioCycle Study: isoflavones from soy based foods do not negativelyaffect ovulation (30)Soy consumption benefits women undergoing ART (31)Male FertilityFertility and Sterility, Beaton32 healthy male adults, semen volume, sperm concentration, count,motility, and morphology were not significantly affected byconsumption of soy protein isolates (32)9
4/24/2018BOTTON LINE: PROTEINMove towards a plantforward eating style.Soy foods, in moderation,are a great addition formales and females!#4: DAIRYFemales2 servings whole milk dairy perday (12,13)IVF patients greater success inthose 35 years of age (33)MalesLow fat dairy to increase spermconcentration and progressivemotility (34)PCOS/ENDOMETRIOSISRECOMMENDATIONSPCOS Nutrition (35,36)2 servings of whole milk dairy a dayLower GI sources, like cheeseLifestyle interventions, including exerciseEndometriosis Nutrition (37)Higher intakes of dairy foods and plasma 25(OH)D levels associated with decreasedrisk of endometriosis10
4/24/2018BOTTON LINE: DAIRYWork with clients on howthey can successfullyincorporate dairy intotheir eating patterns,especially if dual factorinfertility is a concern.#5: HEALTHY FATSTrans-fat negatively affectsfertility (38,39)Focus on unsaturated fatsSuch as avocados, olive oil,nuts, seeds and fatty fishConsume omega-3 rich fish 2times per week (28)GENDER SPECIFIC RESEARCHFemale FertilityOptimal ratio of omega 6:omega 3 varies2013 study reveled higher intakes of omega 6 increased successin IVF cases (40)Caveat, more infertility than in the past with current ratio 10:1concerning omega 6:3 versus 1:1 in the past (41)Male Fertility75 grams walnuts can improve sperm vitality, motility andmorphology (42)11
4/24/2018PCOS RECOMMENDATIONSPCOS Nutrition (43)Omega 3 supplementation may:Reduce serum concentrations of testosteroneRegulate menstrual cycleBOTTON LINE: FATSEducate on including theright type of fat in thediet!SUPPLEMENT CONSIDERATIONSVitamin D (44)Female SpecificCholine (45)PCOS (46,47)Myo-inositol (MI), D-chiro-inositol (DCI)Male Specific (48)Zinc (49)L-carnitine (50)12
4/24/2018THE ROLE OF THE RDNIndividualized approachSmall, manageable changesTailored nutrition intervention toincrease Mediterranean Diet patterns(51, 52)ProduceWhole grainsPlant forward proteinDairyHealthy fatsOTHER CONSIDERATIONSAddress lifestyle factorsSmokingPhysical activityStressEmotional supportUtilize the multi-disciplinary teamRESOURCES - NUTRITIONASRM: American Society of Reproductive MedicineWomen’s Health Dietetic Practice GroupThe Fertility Diet, Chavarro, WillettFertility Foods Cookbook: 100 Recipes to Nourish Your Body, CoAuthored Elizabeth Shaw, Sara HaasPCOS Nutrition Center, Angela GrassiExpect the Best: Before, During & After Pregnancy, Elizabeth WardThe PCOS Diet Plan, Hilary Wright13
4/24/2018RESOURCES - EMOTIONALResolve, Non-Profit OrganizationShine Infertility, Mid-West Support OrganizationBumpstoBaby.com, Infertility Support CommunitySunshine After the Storm, BookBeat Infertility, Podcastpregnantish.com, Support WebsiteTHE ULTIMATE GOAL IS TO IMPROVE NUTRITION, REDUCESTRESS AND HELP OUR CLIENTS NOURISH THEIR BODIES!THANKS FOR JOINING US TODAY.Any questions?14
4/24/2018A SPECIAL THANKSContent Reviewed byKendra Tolbert MS, RDN, CLC. RYTWomen's Health DietitianSpecializing in Reproductive HealthCREDIT CLAIMINGYou must complete a brief evaluation of the program in order to obtainyour certificate. The evaluation will be available for 1 year; you do nothave to complete it today.Credit Claiming Instructions:1. Go to www.CE.TodaysDietitian.com/Fertility OR Log in towww.CE.TodaysDietitian.com and go to “My Courses” and click onthe webinar title.2. Click “Take Course” on the webinar description page.3. Select “Start/Resume” Course to complete and submit the evaluation.4. Download and print your certificate.15
The Fertility Diet, Chavarro, Willett Fertility Foods Cookbook: 100 Recipes to Nourish Your Body, Co-Authored Elizabeth Shaw, Sara Haas PCOS Nutrition Center, Angela Grassi Expect the Best: Before, During & After Pregnancy, Elizabet
