Caffeine
Studies have shown that small amounts of caffeine are not necessarily detrimental to conceiving. Caffeine intake of up to one-to two cups of coffee per day has not been shown to decrease fertility. However, caffeine consumption greater than five cups of coffee per day has been associated with decreased fertility up to 50%. Also, consumption of 2-3 cups of coffee per day has been associated with an increased likelihood of miscarriage but does not affect risk of congenital anomalies. In summary, women who consume 1-1.5 cups of coffee per day, before and during pregnancy, should experience no adverse effects on fertility or pregnancy outcome.

Alcohol
Small amounts of alcohol prior to conception, up to 3-4 glasses per week, have also not been shown to decrease a woman’s fertility. Greater than two alcoholic drinks per day has been shown to decrease fertility in women. Certainly, once a woman believes she may be pregnant, she should, without question, abstain from all alcohol intake.

Patients who consume more than the above recommended amount of caffeine or alcohol should decrease their intake. However, it not necessary to bring intake of caffeine and alcohol down to zero.

Diet and Weight
Women who are significantly underweight (BMI<19) and women who are significantly overweight (BMI>35) will experience a 2-4 fold increase in time to conception. However, there is little evidence that specific dietary variations, such as low-fat diets, or vegetarianism, affect fertility. Women attempting to conceive should take 400 micrograms of folic acid. This is to reduce the risk of neural tube defects in the fetus. To calculate your own BMI, go to this link: http://www.nhlbisupport.com/bmi/.

Smoking
Smoking (even small amounts) has substantial negative effects on fertility. Women who smoke cigarettes have a 60% increased risk of infertility, as well as an increased risk of miscarriage. Additionally, women who smoke cigarettes go through menopause an average of 1-4 years earlier compared with women who do not smoke.  Smoking cigarettes appears to cause increased loss of healthy eggs. Smoking marijuana seems to have similar negative effects on fertility.

Men
When it comes to men attempting to conceive, small amounts of alcohol and caffeine use do not appear to adversely effect sperm parameters (density, motility, and abnormalities in morphology). However, cigarette smoking and marijuana use have been shown to decrease all sperm parameters. Severly overwight men also have decreased sperm parameters and decreased fertility.

In Sum
As Aristotle  wrote 2,500 years ago, “Everything in Moderation”: there is no need to be an ascetic while trying to conceive.

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Potentially modifiable lifestyle factors can affect your ability to have a baby.  These factors include age, smoking, caffeine consumption, alcohol consumption, weight, diet and exposure to environmental pollutants.  We have previously reviewed the impact of aging on fertility and in this installment we review the adverse effects of smoking and infertility.

SMOKING

Smoking either by men or women can adversely affect the ability to conceive and deliver a healthy baby. In men, smoking can negatively affect sperm production, motility and the way they look (morphology). Smoking can also cause DNA damage leading to chromosome abnormal sperm. Men in couples having In Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI) have decreased success rates if they smoke compared to couples having these fertility procedures in which the man does not smoke.

In women, cigarette smoking can alter hormone levels critical for successful pregnancy. Both active and passive (second-hand) smoking can hinder egg production, fertilization, and implantation. Smoking is also associated with an increased chance of miscarriage. Smoking can reduce your chances for pregnancy even with IVF. Women having IVF who smoke do not respond to ovulation induction medications as well as non-smokers. In smokers where eggs are obtained, their ability to fertilize is decreased and if they are able to fertilize, embryo quality and implantation potential are decreased compared to that in non-smokers. Twice as many IVF cycles are needed to achieve pregnancy for smokers compared with non-smokers. In one large study of 8457 women having their first IVF cycle there was a 28% decrease in having a child in smokers compared with those who did not smoke. Studies from fertility centers across the country have reported that if a woman ever smoked in her lifetime her risk of not becoming pregnant from IVF more than doubled and the risk increased with each year of smoking. Smokers who are pregnant following IVF also have twice the risk of early pregnancy loss compared to non-smokers.