Evidence based Role of Dietary Exercise including Role of Yoga in Infertility and IVF

1. DIET AND EXERCISE
IN INFERTILITY/ IVF

2. “
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‘‘Victorious warriors win first
and then go to war, while
defeated warriors go to war
first and then seek to win.’’
▫ —Sun Tzu, The Art of War

3. 3
Diet can influence pregnancy
▫ Eggs and sperms require certain nutrients for their proper health,
which can be fulfilled with the right foods.
▫ The foetus requires some nutritional supplements that help its
growth without any birth defects.
▫ Many fertility issues including PCOS in women can be controlled
with the right fertility diet.
▫ Infertility can be due to hormonal imbalances. These imbalances
can be corrected with the right diets.

4. 4
DIETRY RISK FACTORS
•High intake of saturated fats and
Sugar
DIETRY PROTECTIVE
FACTORS
•Healthy Eating Pattern(Medit diet
•High intake of poly and mono
unsaturated fats,omega
3,vegetables iron or fish
OTHER LIFESTYLE
FACTORS
•BMI<20 OR>30 Kg/m2
•Physical Inactivity
FERTILITY OUTCOMES
•Viable pregnancy
•Time To Conception
•Spontaneous Ovulation
•Semen
Quality(morphology,motility,conc
•Embryo Development
•Treatment Success outcome
using ART
•Live Birth

5. ROLE OF DIETRY INTERVENTION IN INFERTILITY
▫ Obesity and Anovulation
▫ Malnourishment and Anovulation
▫ PCOS
▫ ENDOMETRIOSIS
▫ MALE INFERTILITY
▫ UNEXPLAINED INFERTILITY
▫ POF/POR
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6. 6
▫ Diet and Fertility

7. 7
Trials focussed on alcohol or smoking cessation/reduction, micronutrient supplementation, and
diabetes control.

8. 8
▫ Lower intakes of fruit and higher intakes of fast food were both
associated with modest increases in TTP and infertility.
▫ Absolute differences between the lowest and highest categories of
intake for fruit and fast food were in the order of 0.6–0.9 months for
TTP and 4–8% for infertility

9. 9
▫ RESULTS
Fast Food
Consumption
Decreased TTP
>2-<4 times/day 11%
>0-<2 times/week 21%
No Fast food 24%
Fast Food
Consumption
Decrease Risk
Infertility
>2-<4 times/day 18%
>0-<2 times/week 34%
No Fast food 41%
Fruits Consumed
Frequency
Increased TTP
>1-<3 times/day 6%
1-6 times/week 11%
<1-3 times /month 19%
Fruits Consumed
Frequency
Increased Risk
Infertility
>1-<3 times/day 7%
1-6 times/week 18%
<1-3 times /month 29%

10. ▫ The study covered the intake of six main food groups (fruits, vegetables, meat,
fish,whole wheat products and fats).
▫ Preconception Dietary Risk score (PDR), providing an estimate of nutritional
habits. Dietary quality increases with PDR score
▫ Result: Study showed an association between the PDR of the woman and the
chance of ongoing pregnancy after IVF/ICSI treatment (odds ratio 1.65,).
▫ A one-point increase in the PDR score was associated with a 65% increased
chance of ongoing pregnancy
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11. 11
Goal Of PreIVF Treatment
Optimizing
▫ Weight
▫ Fertility
▫ Obstetric &
▫ Fetal outcomes

12. 12
Obstetrical Benefits of Preconceptional
Modifications
▫ Multiple lines of evidence now support the concept that most
complications of pregnancy emerge from disorders that have
their origins in early pregnancy, at the time of implantation and
placentation
▫ Abnormal decidualization underlies the predisposition to
preeclampsia and other obstetric complications, such as preterm
labor and fetal growth restriction

13. 13
Developmental
Programming
▫ Period around conception is critical in the
processes mediating parental influences
on the next generation’s health
▫ From the maturation of gametes to early
embryonic development, parental lifestyle
can adversely influence long-term risks of
offspring cardiovascular, metabolic,
immune and neurological morbidities

14. 14
Is there a so called “Fertility Diet”?
▫ Fertility diet was first suggested by research from the Nurses' Health
Study – which began in 1976 and grew to include 238,000 female
nurse participants aged 30 to 55
▫ It showed that dietry, modifications can increase ovulation and
improve chances of getting pregnant
▫ It also identified developmental and nutritional risk factors for
pregnancy loss and endometriosis

15. CONCLUSIONS OF NURSES HEALTH STUDY
ANOVULATORYINFERTILITY
Intakes of trans fats, low-fat
dairy foods, animal
protein, soft drinks, and
a higher dietary
glycemic load were
associated with a
higher risk of
anovulatory infertility
Higher intakes of folic acid,
nonheme iron, high-fat
dairy, and vegetable
protein were
associated with a lower
risk of this condition
ENDOMETRIOSIS
Positive relationship with
trans fat and risk of
endometriosis
.Inverse relationship
between dietary
omega-6 fatty acids,
total diary, low-fat
dairy, thiamine, folate,
vitamin C, vitamin E,
circulating vitaminD
,
PREGNANCY LOSS
Higher intakes of folic
acid, nonheme iron,
high-fat dairy, and
vegetable protein
were associated
with a lower risk of
this condition
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16. 16
“FERTILITY DIET” BASED ON NHS
▫ High intake of folic acid
▫ Low intake of trans-fat, with a simultaneous
greater intake of monounsaturated fat
▫ Low intake of animal protein with greater
vegetable protein intake
▫ High intake of high-fiber, low glycemic
carbohydrates
▫ Greater preference for high-fat dairy
products
▫ High non-heme iron intake (mostly found in
plant foods)

17. 17

18. Mediterranean Diet-The NEW FERTILITY DIET
▫ 225 men recruited in cross sectional study. Diet questionnaire conducted
▫ Men in lowest tertile for Med diet score had 2.6 times higher likelyhood of having
abnormal sperm conc, total sperm count ,motility compared to men in highest
tertile
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19. 19
▫ Compared with women in the highest tertile of the MedDietScore women in the
lowest tertile had significantly lower rates of clinical pregnancy and live birth rates
▫ MedDietScore was positively related to clinical pregnancy and live birth among
women <35 years old but not among women>35 years
▫ Improves embryo yield in IVF

20. Effect of a 6-week “Mediterranean” dietary intervention on in vitro
human embryo development: the Preconception Dietary Supplements in
Assisted Reproduction double-blinded randomized controlled trial
Alexandra J. Kermack, Fert Stert 2019
▫ 55 couples received the 6-week study intervention of a
daily supplement drink enriched with omega-3 fatty acids
and vitamin D plus additional olive oil and olive oil–based
spread, and 56 couples received the control intervention.
▫ Result : Embryo cleavage kinetics were improved indicating
improved embryo quality
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21. 21
PRINCIPLE OF MEDIT DIET
• Decrease, hyperinsulinemia and IR,free
IGF-I and androgens
• Promotes hormonal balance
LOW GI
• Reduce Hyperinsulinemia
• Decrease testosterone levels
High Protein
• Promotes progesterone synthesis
• Decreased risk of Anovulation
• Decreaed inflammatory markers & ROS
• Delays ovarian aging
HEALTHY FATS
ώ3 fatty acids
VEGETABLES&FRUITS
Source of iron,micronutrients ,folates,fibreand
antioxidants

22. 22
MEDIT
DIET
LOW
GI<55
HEALTHY
FATS
LEAN
PROTEIN
GOOD
CARBS
LOW GI ATTA-
JAU,CHANA,RAG
I,AMARANTH,

23. 23
FLAXSEED
HIGHEST
OMEGA 3 f/b
CANOLA &
SOYABEAN
OIL

24. 24

25. 25
CHOOSE ONLY ORGANIC FOOD
PRODUCTS HAVE ADDED HORMONE & PESTICIDES LINKED TO
HORMONAL IMBALANCES,ENDOMETRIOSIS,PCOS,FIBROID,POOR
OVARIAN RESERVE AND ADVERSE OBSTETRICS
OUTCOME,ABORTION,PRETERM BIRTH,IUGR
Environmental Contaminants Affecting
Fertility and Somatic Health
•Catheryne Chiang 2017,SEMINARS IN
REPRODUCTIVE MEDICINE

26. 26
Increased Oxidative Stress

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▫ Shorter TTP was observed among women with BMI<25 kg/m2 with
increasing vitamin C
▫ Women with BMI>25 kg/m2 with increasing b-carotene
▫ Women <35 y with increasing b-carotene and vitamin C
▫ Women >35 y with increasing vitamin E.

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29. 29
NATURAL SOURCES OF ANTIOXIDANTS

30. 30
ORAL
ANTIOXIDANTS

31. Conclusion
▫ Very low-quality evidence suggests that antioxidants may
be associated with an increased live birth and clinical
pregnancy rate. there is limited evidence in support of
supplemental oral antioxidants for subfertile women.
▫ Oral supplementation with antioxidants may improve
sperm quality by reducing oxidative stress improves live
birth rates
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33. 33

34. 34
MICRONUTRIENT
COPPER

35. 35

36. Imp preconceptional Advice
▫ Regular moderate intensity exercise and a balanced, nutritious diet
▫ Folic acid 400 mcg and iodine 250mcg supplementation
▫ Limit caffeine intake to less than two cups of coffee per day
▫ Avoid smoking and alcohol- negative effect on ovarian reserve ,increased
abortions
▫ Fruit and vegetables to be washed before eating
▫ Avoid eating soft cheeses, unpasteurised milk, paté, raw eggs, hot dogs,
delicatessen meats, undercooked meats or re-heated left over meat TO
avoid salmonella and listeria infections
▫ Avoid exposure to pesticides, lead, fumes from welding and household glues
▫ Vaccination Rubella,,chicken pox 1month prior
▫ Avoid high intensity exercises during IVF treatment
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37. Some Controversial Foods
▫ SOY
▫ Soy appears to
▫ have no adverse
effects on female
fertility, and may
be beneficial for
ART outcomes.
▫ Meat
▫ Vegetable protein
better than animal
protein,favourable
outcomes in ovulation
▫ Animal- Go for lean
protein.
▫ Go ORGANIC to avoid
contamination with
antibiotics,pesticides
FISH
ACOG recommends that
▫ pregnant women and those
planning pregnancy are
▫ encouraged to eat 2-3s of a
variety of fish/week with no
more than 1s/week of fish
such as albacore tuna,
▫ Avoid fish (e.g., bigeye tuna,
▫ king mackerel, swordfish)
with the highest mercury
concentrations
▫ Benefits outweighs the risk 37

38. 38
DAIRY FRIEND OR FOE?
▫ No conclusive evidence showing that dairy is helpful or
harmful to fertility. However, based on some studies
there seems to be a benefit of consuming full fat dairy
over low fat dairy when trying to conceive.
▫ If able to tolerate dairy, enjoy it in moderation.
▫ Dairy consumption is linked to insulin resistance, and
has been associated with endocrine disrupting
chemicals
▫ Best to limit intake to 1-2 servings per day
▫ Avoid combining with sugars

39. ENDOMETRIOSIS
SPECIAL DIET CONSIDERATIONS
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40. FOOD AND RISK OF ENDOMETRIOSIS
▫ Endometriosis is a chronic inflammatory condition
▫ The current scientific evidence suggests that the diet and lifestyle may
influence the presence of inflammation in the body, estrogen activity
▫ Omega-6 fatty acids are the precursors of the proinflammatory
prostaglandins increase uterine cramps and cause the painful symptoms.
▫ Omega-3 fatty acids were linked to reduced inflammation and thus, lesser
pain
▫ Food such as fruits and vegetables can be contaminated with pesticides like
polychlorinated biphenyls (PCBs).
▫ Such compounds also tend to accumulate in lipids contained particularly in
meat, liver, and dairy products.
▫ Phytoestrogens – have both estrogen agonist and antagonistic activity
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42. 44

43. NEGATIVE EFFECT
▫A diet high in trans fat.
▫Red meat consumption
▫Gluten
▫Coffee
▫Alcohol
EFFECT OF DIET IN ENDOMETRIOSIS
POSITVIE EFFECT
▫Fibrous foods
▫Iron-rich foods
▫Foods rich in essential
fatty acids
▫Antioxidant-rich foods
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44. 46
Role of Vit D in Endometriosis

45. 47
ENDOMETRIOISIS
DIET

46. 48

47. 49
AVOID ADDED SUGARS,DAIRY,GLUTEN

48. 50

49. 51
ENDOMETRIOISIS DIET

50. PCOS DIET
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51. 53

52. DIFFERENT DIETS SUGGESTED IN PCOS
▫ Moderately Low Carb diet 40-45% carbs
▫ Low GI Diet
▫ High Protein Diet
▫ KETO DIET(substitution of carbohydrates for MUFA or
PUFA in the diet),
▫ DASH DIET-high carb 53%,low fat 12-13%
▫ Mediterranean Diet-low carb 38%,high MUFA diet 28%
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▫ Conclusion: small-to-moderate weight loss of 5–10% with any dietary pattern of
choice, depending on the individuals’ preferences, culture,habits and metabolic
needs
▫ Negative energy balance (with a deficit of 350–1000 kcal/day) is the key factor
▫ Weight loss improves menstrual cycle,ovulation,lipid profile,hyperandrogenesim,
insulin sensitivity, quality of life irrespective of the adopted dietary pattern
▫

54. 56
▫ The adoption of healthy dietary patterns such as DASH or the
Mediterranean-style diets should be encouraged among women with PCOS
▫ Rich in dietary fiber, antioxidants and anti-inflammatory nutrients, lead to
greater satiety and have anti-hyperlipidemic, antihypertensive and
antidiabetic properties
▫ 30 MINS OF MODERATE INTENSITY EXERCISE DAILY
▫ Avoid eating very late in day,light dinner, majority of consumption day time

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56. 58
▫ SAMPLE NORTH
▫ INDIAN DIET
▫ CHART PCOS

57. MALE INFERTILITY
SPECIAL DIET CONSIDERATION
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58. ▫ idiopathic male infertility is diagnosed in the
presence of altered semen characteristics
without an identifiable cause and the
absence of female factor infertility
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60. 62
Nutritional Causes of Male Infertility

61. 63

62. 64
LIFESTYLE FACTORS

63. ROLE OF ANTIOXIDANTS IN SPERM FUNCTION
Lycopene/
Caretenoids
Most efficient oxygen & free radical quencher and prime carotenoid in
plasma / other tissues.
Omega-3 fatty
acids
Abundant in the sperm tail , significant effect in sperm motility.Its
deficiency is linked to low sperm count and motility.
L CARNITINE Provide energetic substrate for spermatozoa. Maturation,Concentration
and progressive motillity
ZINC found in high concentration in sperm, deficiency is associated with
decreased testosterone levels and sperm count
5/8/2020

64. VITC concentration in the seminal plasma is about 10 times higher than in blood
serum.
has high antioxidant potency
VITE Fat soluble,quench lipid peroxidation
SELENIUM Normal testicular development,Spermatogenesis, Motility and function and
formation of mitochondrial capsule.
Deficiency leads to seminiferous tubule atrophy, Defective
motility,morphological abnormalities
ROLE OF ANTIOXIDANTS IN SPERM FUNCTION

65. 67

66. Exercise and Weight loss
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67. 69
Classification Acc to BMI(WHO 2000)

68. 70
▫ Increased female and male BMI independently and
combined negatively effects LBR after IVF

69. Preconceptional Weight Loss
Benefits:
▫ Spontaneous Ovulation
▫ Decreased Insulin Resistance
▫ Improved sperm count and morphology and increased testosterone
levels
▫ Higher percentage and number of metaphase II oocytes in IVF
▫ Decreased anesthesia related morbidity associated with oocyte
retrieval
▫ Decreased pregnancy complications relate to obesity
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70. 72
▫ Patients randomly allocated to 2 groups an
intervention group (n = 21), underwent an
individualized diet and physical exercise for
12 weeks, and a control group (n = 20), who
started IVF with no previous intervention
▫ .Mean wt loss was 5.4 kg
OUTCOME

71. 73
EXERCISE BENEFICIAL FOR ALL OBESE OR NON OBESE
Regular physical activity carried out before a assisted reproduction cycle is significantly related
with improved reproductive performance in obese infertile patients, irrespective of bodyweight
loss

72. 74
Recommended Exercise Regimen
▫ Intense,
vigorous or
high-impact
exercise
should be
avoided
during IVF
treatment

73. 75
YOGA FOR FERTILITY(YOGA FERT STERT OCT
2003)

74. Can yoga affect ivf outcomes?
P. Nayar.Fert Stert Sep 2017
, ▫ RCT on 105 patients
▫ Group A (N=52) attended 3 months of YOGA sessions- involving
asana (exercises) and pranayama (regulated breathing) before
undergoing FETand group B (N=53) under went FET without Yoga
therapy.
▫ Conclusions: The Pregnancy rate and clinical pregnancy rate were
significantly better in Group A compared to Group B There was a
significant reduction in depression and anxiety after YOGA therapy
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75. A prospective study using Hatha Yoga for stress reduction among women waiting for IVF
treatment
GaliaOron RBM ONLINE 2015
▫ In this single-centre study, 49 infertile women were recruited to participate
in a 6-week Yoga class while awaiting their IVF treatment.
▫ Study participants were asked to complete standardized questionnaires
assessing fertility-related quality of life (FertiQoL), marital harmony state and
trait anxiety and depression before commencing and after completing the
Yoga workshops.
▫ Result: Anxiety, depression and fertility-specific quality of life showed
improvement over time in association with participation in a 6-week Yoga
programme in women awaiting their treatment with IVF.
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76. Yoga Can Improve Assisted Reproduction Technology Outcomes in Couples
With Infertility.
Darbandi SAltern Ther Health Med. 2018 Jul
▫ The study examined the effects of yoga-including asanas (yoga poses),
pranayama (proper breathing), shavasana, and meditation-on male and
female fertility and ART outcomes.
▫ Result: The reviewed studies showed that yoga can provide stress
management for patients with infertility, with beneficial effects on fertility,
helping couples give birth.
▫ They found that yoga also could, decrease depression, anxiety, and stress;
reduce the rate of assisted vaginal delivery; and improve fetal outcomes.
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77. TAKE HOME MESSAGE
▫ IVF has emerged as a boon for couples struggling to conceive a
child
▫ Because of the financial and emotional challenges associated with
IVF, it is important to maximise their chance of success by
focusing on the identification of modifiable factors, such as diet
and lifestyles preIVF, that may affect fertility and their evidence
based modulation to strengthen the outcomes
▫ The ultimate success of IVF depends upon the reason for
undergoing treatment
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78. “
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"Let food be thy medicine

79. DR SHIVANI SACHDEV GOUR
MD DNB MRCOG (UK)
DR NUPUR GARG
MS, FNB
www.sciivf.com
New Delhi and Noida, India
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