Fertility Foods: Optimize Ovulation and Conception Through Food Choices

iMAGINE THAT YOU could fulfill your dream of having a baby just by changing the way you eat and making a few other lifestyle changes that won’t cost you anything and might even be fun. Now imagine that I’m not kidding! The book you’re holding in your hands right now could provide you with the least painful, least invasive, least risky way to get you from here to parenthood.

It’s easy for most of us to accept that we can decrease our risk for problems like heart disease, diabetes, stroke, and cancer by eating right, exercising, and reducing stress. But some people believe that fertility is a game of chance—conception happens or doesn’t happen, just on nature’s whim. And when it doesn’t happen, we sometimes turn immediately to expensive fertility treatments in a doctor’s office because we assume that something is wrong with us and that we can’t solve the problem on our own.

Let me say one thing up-front: I’m a fertility doctor, and by no means am I telling you that my profession is unnecessary. Indeed, I’m thankful to have helped countless women achieve healthy pregnancies when all the natural methods failed. But even expensive medical treatments are not foolproof; you can vastly increase your chances of conceiving by following the plan I’m about to share with you, whether you use it as your only fertility aid or in conjunction with medical treatment.

Lifestyle issues do indeed affect your reproductive health, in much the same way they affect your risk for heart attacks or strokes. Over the past few years, I’ve been perfecting a fertility program grounded in cutting-edge research and successfully used by the women who come to my clinic. Now that all the pieces of the puzzle are in place, I’m excited to present the program to you: I want to share my secrets with a wider audience so that my patients’ success can be repeated by women all over the country. This is the first book of its kind; it’s a balanced-nutrition diet and exercise program specifically designed for women who are trying to conceive.

The best news of all is that the lifestyle program I recommend can put you on track for better all-around health in addition to helping you achieve pregnancy and a healthy birth.

You’re Not Alone

Problems with fertility seem to be on the rise in the United States. More than 9 million Americans of reproductive age are affected by infertility—men and women in about equal numbers—that is, at least one in every ten couples. And the number of visits to fertility specialists has skyrocketed in recent years; almost no other field of medicine has seen this kind of growth. But according to the American Fertility Association, only 5 to 10 percent of patients actually need high-tech procedures like in vitro fertilization.¹

There are many causes of infertility, and you may find one or more factors that have contributed to your problem. The primary culprits are the following.

Age

Couples today tend to delay childbearing. First, they are getting married much later in life than couples in past years; the average age is now 27 for women and 29 for men, whereas it was 21 and 23, respectively, in 1970. More students than ever go to college and graduate school, and many women prefer to establish themselves in a career before having a baby. About 20 percent of women now wait until after age 35 to start trying to conceive, according to the American Society for Reproductive Medicine.²

Unfortunately, there’s no getting around the fact that age is a major factor in fertility. Women are born with all the eggs they’re ever going to produce; and over time, these eggs lose their quality and eventually the supply runs out. A woman’s fertility starts to decline when she is in her late twenties, takes a stronger dip in her mid-thirties, and takes a severe downturn when she’s about 39.

For men, age isn’t as big a factor. Senator Strom Thurman was 81 when he fathered a child; and a 94-year-old currently holds the record for the oldest man to become a father.³ However, according to a study published in the Journal of Reproduction and Fertility that compared men age 21 to 50 with men age 51 to 80, the latter group had 30 percent lower sperm production.⁴ Sexual function in men also declines over the years, so it may be more difficult for men to achieve and maintain an erection. That can’t be good for the chances of conceiving a baby!

Problems with Body Weight

Americans are getting fatter, and we all know it. From 1971 to 2000, the prevalence of obesity in the United States increased from 14.5 percent to 30.9 percent.⁵ It’s well documented that overweight and obese women have more reproductive problems than women in the normal weight range. Being overweight impairs ovulation, increases the risk of a miscarriage, and increases the risk of congenital defects. It also makes insulin resistance worse, and as you’ve about to learn, insulin resistance plays a major part in infertility. If your BMI (body mass index) is over 30, your fertility is definitely compromised. If your BMI is 28 or higher, weight is probably playing a role in your infertility.

On the opposite end of the spectrum, being underweight is a problem, too. You need at least 17 to 22 percent body fat to ovulate normally. Women who exercise excessively or whose bodies are deprived of proper nutrition tend to have irregular menstrual periods or no periods. This condition obviously has a poor effect on fertility.

The good news is that even a modest weight loss or gain, whichever is necessary, can greatly improve your chance not only of getting pregnant but also of having a healthy baby.

Pelvic Infections

You may have a sexually transmitted disease (STD) and never even know it. Chlamydia, for example, has surged in the United States and can be completely asymptomatic. It can also steal your fertility.

Four million new cases of chlamydia are expected this year, with some reports estimating that up to 20 percent of all sexually active female teenagers are infected. Most of them have no idea, and that is why chlamydia is often called the silent STD. About 70 percent of chlamydial infections present no symptoms.⁶ If symptoms do develop, they typically appear within three weeks of infection and may include genital discharge or bleeding, fever, genital itching, and abdominal pain. These symptoms are sometimes so mild and vague that women don’t seek medical help, although at other times chlamydia results in full-blown pelvic inflammatory disease (PID), which may require hospitalization or surgery.

Gonorrhea has very similar symptoms, often exists alongside chlamydia, and can also harm fertility. About half of all cases of gonorrhea are asymptomatic, and an infected man is more likely to show symptoms than an infected woman.⁷ Both of these diseases can be cured with antibiotics; but if they are not successfully treated, they can travel into a woman’s fallopian tubes or a man’s urethra and cause scarring and more serious infections.

Pelvic infections, which occur in the ovaries, fallopian tubes, and uterus, can usually be traced to STDs; but STDs are not necessarily the cause of such infections. Other possible culprits include gynecological surgery, insertion or removal of an intrauterine contraceptive device (IUD), and abortion. A recent study actually found that as many as 30 percent of upper genital infections are due to bacteria that are normally found in the vagina, thus resulting from no particular inciting factor.

Pelvic inflammatory disease is a severe form of pelvic infection. It’s likely to start right after a woman’s menstrual period and may cause abdominal tenderness, fever, and abnormal vaginal discharge and bleeding. The risk of infertility grows greater with each infection; it’s estimated that a woman’s risk of infertility is 11 percent after one PID episode, and then the risk doubles with each further episode. Women with PID are also 10 times more likely to have an ectopic pregnancy,⁸ where the fertilized egg implants outside the uterus.

According to the Centers for Disease Control and Prevention (CDC), if not adequately treated, 20 to 40 percent of women infected with chlamydia and 10 to 40 percent of women infected with gonorrhea may develop PID.

What Do We Have to Gain?

Lifestyle changes can improve your pregnancy forecast in several ways: improved ovulation, decreased miscarriage, and lower likelihood of birth defects.

Right now, 10 percent of women who have regular menstrual periods have ovulatory problems. You’d never know it if your eggs were being released at the wrong time in your cycle, or if your eggs were damaged in some way But both problems are often correctable with changes to your diet and daily routine.

The Insulin Crisis

A few years ago, my wife inadvertently changed my entire outlook on fertility. She and I were on vacation in Texas with our kids, and Lorie was venting about her inability to lose that last 10 pounds after the birth of our son. Dr. Atkins’ New Diet Revolution and Protein Power topped the bestseller charts at the time, and Lorie was investigating the merits of these plans to figure out whether or not to try one of them.

As she described the science behind the plans to me, my eyes lit up. The plans were all based on improving insulin resistance, thereby decreasing insulin secretion, which allows for easier loss of fat—and easier pregnancy.

First, a few definitions are in order.

After you eat a meal, some of the food is converted into glucose, which is the simple sugar that provides energy to the cells in your body’s organs. But your body doesn’t use that glucose well unless your pancreas produces the hormone insulin. The insulin acts as a chaperone, helping your body deliver the glucose into your cells to use for energy. This keeps your blood sugar from getting too high.

The problem is that many people are insulin-resistant: their cells don’t respond properly to the insulin. In turn, the pancreas tries to produce more and more insulin to compensate for the fact that not enough insulin is getting through to where it’s supposed to go.

In time, the pancreas becomes unable to keep up. Eventually, extra glucose builds up in the bloodstream. This condition can lead to diabetes, a primary cause of heart disease, blindness, and nerve and kidney problems. The extra insulin stays in the bloodstream, too, promoting fat deposition, hindering fat breakdown, and causing a variety of metabolic effects that hinder fertility. This becomes a cycle, because extra fat makes it harder for muscles to process insulin, and that difficulty further adds to insulin resistance.

As you might suspect, we seem to be in an insulin crisis in this country. According to the CDC, the number of diagnosed cases of diabetes has risen 61 percent since 1991 and is expected to nearly double by the year 2030. The latest study by the World Health Organization (WHO) reports that 30.3 million Americans will have diabetes by then, compared with the 17.7 million who had it in 2000.⁹ Of all the countries in the world, we have the third highest rate of diabetes both now and in future projections.

Some of the cause may be genetic, but this high rate is also a result of our lifestyle, including our diet. Recent studies conducted by Stanford University found that as many as 75 percent of Americans may be predisposed to developing insulin resistance. Normally, even if you have health conditions (such as diabetes, polycystic ovary syndrome, hypertension, or obesity) that make you a very likely candidate for insulin resistance, your doctor won’t test you for insulin resistance, because it’s very complicated to measure and diagnose. But our lifestyle choices can prevent this problem, just as people who are predisposed to alcoholism can stop the problem by never taking a drink.

Now, here’s why Lorie’s discussion sparked my excitement.

Insulin and Fertility

We took our vacation right after I had presented a lecture about much of the recent groundbreaking research on polycystic ovary syndrome (PCOS), a common problem that brings women to fertility clinics. The InterNational Council on Infertility Information Dissemination estimates that 5 to 10 percent of women have PCOS, but most of them haven’t even heard of this disorder—at least until they visit fertility clinics trying to figure out why they can’t conceive.

Most women with PCOS are overweight, and their symptoms may include excessive hair growth on the face or body, missed or irregular menstrual periods, acne, dandruff, skin tags, and dark patches of skin. Some women have all these symptoms, and some have none. Unfortunately, PCOS stops women from ovulating and often leads to infertility.

My lecture focused on how insulin resistance contributes to the syndrome. But even if you don’t have PCOS, it’s very possible that you have insulin resistance. High insulin levels stimulate the ovaries to overproduce the male hormone testosterone, which wreaks havoc on normal ovulation. I’m sure you can imagine what this means for fertility: if a woman isn’t ovulating properly, her chances of conceiving a baby are slim.

As Lorie talked about the various diets meant to alleviate insulin resistance, I realized that it was possible for us to come up with a diet that would not only improve the way a woman’s body uses insulin but, in so doing, also bring back her fertility!

That’s when I began formulating my plan: a diet and exercise program meant specifically for women who are trying to conceive. I used concepts similar to other reduced-carbohydrate approaches, but I altered the programs to suit ovulatory function and women’s reproductive needs in particular, on the basis of cutting-edge research. If you’re already on a low-carb diet, you’re probably already on the right path. We’ll just tweak the diet a little, showing you what you can change and add to make it optimal for fertility.

What’s more, you don’t have to have a diagnosis of PCOS to benefit from this plan. PCOS led us to the connection between insulin and fertility, but whereas PCOS is found in 5 to 10 percent of women of reproductive age, as much as 75 percent of the population is prone to develop insulin resistance. This means that, for three out of four of us, insulin insensitivity is affecting our health to some degree. Regardless of the underlying problem hindering your fertility, in order to overcome it you must ensure the ability to produce a mature egg and to have the resulting embryo attach properly to the uterus. We will show you how adhering to our plan will optimize these processes and help achieve a successful pregnancy no matter what the obstacles may be in your own case.

First Success

It all started with Nicole. Once I had made the connection between an insulin-reducing diet and fertility, I needed to find out if the diet would be effective. Nicole was a 28-year-old woman who had been trying to conceive for two years. Her menstrual cycles were irregular, occurring every two or three months.

I spoke to her about my nutritional recommendations: a diet that would enable her to keep her insulin levels on an even keel and lose some weight. She lost eight pounds within two months, and achieved a successful pregnancy on the second cycle after starting the program.

We were on to something. I could barely contain my excitement as I congratulated Nicole. It was at this point that I knew we were going to help a lot of people, maybe even some people who had already tried all the usual infertility treatments and failed—people who thought they would never be able to have a child of their own. And we were going to do it in a way that was low-cost, painless, and free of detrimental side effects.

The Test

After a few more successes like Nicole’s, I knew it was time to do a wider-scale randomized clinical trial. The Surgeon General’s Office was excited about my idea, too, and gave me a $10,000 grant for a study to test the effectiveness of an easy-to-follow, balanced-carbohydrate weight-loss plan for infertile women.

In this clinical investigation, I enlisted a group of overweight, infertile women, of whom some had PCOS and some didn’t. For six months (or until they achieved pregnancy), each woman either followed the standard diet recommended by the American Diabetes Association (ADA) (not low-carbohydrate) or my balanced-carbohydrate diet. All patients received individual counseling.

This study is ongoing, but the early results look wonderful. The women following my plan showed improved insulin resistance and ovulation, with a few pregnancies achieved, whereas the women on the ADA diet did not. Both groups lost a modest amount of weight.

Carbs and Insulin

Mine