Age-related infertility is something fertility clinics are seeing increasingly, as more couples work on getting pregnant after 40. It is a fact that one cannot change one's biological age. The question is, can anything be done to at least partly reverse the reproductive aging process, and reduce the chances of IVF failure?
Exciting new research has suggested simple changes in diet and lifestyle may improve fertility and increase your chance of conception. Namely, adding more antioxidants to your fertility diet can reduce oxidative stress (OS) and its negative affects on fertility for both men and women, write Dr. David Meldrum and his colleagues in their article in Fertility and Sterility.
What is oxidative stress (OS)?
The oxidant-antioxidant balance in the body is an extraordinarily complex process. OS is an imbalance in this process with the release of reactive oxygen species (ROS), which in turn damage cells. Basically there is release of toxins (peroxides and free radicals), which damage various components of the cells (body proteins, lipids, DNA, telomeres, and mitochondria). The body has defense mechanisms against OS, but when the system is overwhelmed, there is cellular death (apoptosis).
How can you reduce OS?
A fertility diet with antioxidants may be the answer. Great whole-food sources of antioxidants include: blackberries, blueberries, strawberries, pomegranate, cranberries, green tea, dark chocolate, cooked vegetables and spices such as cumin, turmeric, ginger and oregano.
Lower dietary content of antioxidants has been found to be associated with reduced semen quality, and diets containing more antioxidants have been associated with greater pregnancy success in women. The lifestyle habits of many men and women (e.g., lack of physical activity, overeating and high-sugar and high-fat diets) promote oxidative stress.
Overcooking of foods, which creates advanced glycation end-products (AGEs) is also extremely common. AGEs accumulate with age and promote OS.
Overeating leads to the cells (mitochondria) to release more ROS. On the other hand, caloric restriction is one of the most successful ways to counteract the aging process. Obesity increases with age and is commonly associated with a 50%–100% increase of calorie intake, thus offering a partial explanation for the reduced fertility associated with obesity.
What about men? Increased OS in semen correlates with increased male age, with reduced sperm motility and with increased sperm DNA fragmentation. The good news is that high daily doses of antioxidants for 2 months (1 g/d vitamins C and E) may reverse these changes.
Increased OS in follicular fluid correlates with increasing female age, granulosa cell (GC, the cells that surround an egg) apoptosis, reduced egg and embryo quality, and reduced pregnancy success with IVF. One of the most important deficiencies of antioxidant defenses in aging cells is in the production of glutathione, which is reversible with antioxidant. Depletion of glutathione induces GC apoptosis, and increased GC apoptosis has a very strong relationship with reduced embryo quality and failed embryo implantation.
OS and blood flow
Another effect of OS on reproductive functions is by reducing blood flow to tissues. Blood flow to the reproductive organs is determined by the molecule nitric oxide (NO), and NO production and stability are remarkably sensitive to ROS and require extensive antioxidant protection. NO thus plays a key role in erectile and vascular function.
The OS of smoking reduces NO and subsequently blood flow to the reproductive organs. Smoking by both the male and female partners significantly reduces IVF outcome.
High doses of vitamins C and E for almost 6 months, similar to those used for reducing sperm DNA fragmentation discussed above may reverse this effect.
A commercial preparation of antioxidants, pycnogenol (Horphag Research and Natural Health Science), together with a moderate dose of L-arginine (the direct precursor for NO), may improve sperm density, motility, morphology, and circulating testosterone levels.
Omega-3 fatty acids may improve sperm morphology. Omega-3s increase NO, decrease prostanoids (which narrow the blood vessels), reduce OS and increase antioxidant effects.
Fish contain a lot of omega-3s. Fish consumption has been correlated with improved embryo implantation.
According to Bob Casper and his group in Toronto, Coenzyme Q-10 may improve the quality of aging eggs (improving mitochondrial function). This group of investigators is on the verge of defining a way to improve mitochondrial. Coenzyme Q-10 may even correct chromosome misalignments characteristic of the older oocyte.
Dr Meldrum's website is an excellent resource for up to date information on this exciting subject. Here is a summary of his recommendations:
Recommended for all:
A healthy diet with fruits (especially berries) and vegetables, less red meat and no trans fats (doughnuts, French pastries, fried foods)
Omega-3’s (fish oil) 500-1,000 mg daily
For men over age 40 and/or with abnormal semen (low count, motility, and/or morphology) add to the above:
Increase antioxidants- 500-1,000 mg vitamin C, 200 IU vitamin E, green tea (1-3 cups per day); consider adding pycnogenol, 40-60 mg twice daily (this may replace or be added to the other antioxidants already mentioned).
Consider increasing omega-3's to 1,000 to 2,000 mg. In one study of 1840 mg for 8 months all semen parameters improved, particularly strict morphology.
Consider adding folic acid, 400 micrograms and zinc, 15-30 mg per day as some studies have shown benefits for sperm. These are in many multivitamins.
Consider adding 2 gm of L-citrulline
Dark chocolate is another strong antioxidant- use a low sugar brand.
A small amount of vitamin C added to green tea aids absorption of antioxidants
Consider adding Co-enzyme Q-10, 200 mg twice daily. In one study it stimulated sperm motility.
Details on the rationale for these recommendations are available at Dr Meldrum's website.
Note: These suggestions can be progressively added but that will require more time as at least 30 days should be allowed to see an effect (a full effect could take up to 90 days).
Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.