6 lifestyle factors that contribute to female fertility
Making changes to enhance fertility for women
Ways to improve female fertility is talked about a lot. According to Dr. Wais, (in)fertility is like a big, one-thousand-piece puzzle and we can “see” about 10 to 15% of the pieces. Those are the pieces that we understand and we can see or measure. Lifestyle factors make up a large amount of those pieces and are important so that you can “finish the picture” and find success when trying to conceive. However, it’s not the be-all and end-all of life. For example, you can’t exercise or eat enough kale to reverse the clock on aging!
Let’s talk about things that are under our control that can be modified and how to improve egg quality and fertility for females:
- Nutrition and diet
- Body weight: BMI
- Exercise: physical activity
- Alcohol and smoking
- Stress management
- Environmental toxins
To learn about male lifestyle factors, read about 6 lifestyle factors that impact male fertility.
Working on lifestyle factors can improve fertility outcomes by 5% or 10% but they can also give people a sense of empowerment – “I’m doing something to achieve my dreams”. This lifestyle factor advice is useful while trying to conceive (TTC), to improve female fertility and is also important for pregnancy and healthy living in general.
1. Nutrition and diet
Nutrition is, of course, so important for health in general, and all medical issues overall. Health in general and reproductive health are no different. This is the same advice that we’ve been taught since we were kids, right? Focusing on a balanced, healthy diet, and focusing on nutrients, especially:
- Folate
- Iron
- Omega-3 fatty acids
- Antioxidants
These are going to be vital for supporting optimal fertility.
There was a study in 2007 that found that women with a higher intake of trans fats actually can have increased rates of ovulatory infertility = difficulty ovulating. At the same time, women who adhere to the Mediterranean diet, which focuses on the consumption of fruits, vegetables, whole grains, and olive oil – can actually have improved fertility outcomes. So really it’s all about focusing on fruits, vegetables, whole grains, lean proteins: chicken, shrimp, and healthy fats, like olive oil. These are really the foundation of not only a fertility-friendly diet, so to speak, but a good, healthy diet for your whole lifespan!
2. Body weight: BMI
Weight and general health is such a big topic; it’s so controversial and there is so much information out there, especially on social media right now.
BMI or body mass index is a very controversial measure of body weight and is the ratio of body weight to height. IT IS NOT PERFECT by any stretch. There are many studies out there to show how it’s flawed in certain populations, certain ethnic groups, or people who have certain body types. The tough part is that all the studies looking at weight do talk about BMI – because we don’t really have a better measure out there.
So, even if BMI is deeply flawed, we don’t really have a better way to talk about weight in relation to height and so we’re stuck with talking about BMI. Another issue is that obesity, or being overweight, has such a strong psychological implication, thanks to society and all the pressure on women to look a certain way on social media, etc. So it becomes difficult to talk about weight or BMI without it being an emotionally charged topic.
There are lots of research studies out there that show that underweight individuals, meaning having a BMI under 20, or people who are obese, meaning having a BMI over 30, have higher chances of hormonal imbalances. This can, in turn, impair reproductive function and have a negative affect on female fertility.
The number on the scale is not necessarily something that you can control completely. But, what you can control is focusing on a healthy diet and exercise. I would much rather see patients who are trying to lead a healthy lifestyle – who are getting a good, healthy diet, are exercising and moving their bodies EVEN IF that number on the scale is higher, because I think at the end of the day, that matters WAY more. And that will serve patients better for fertility and then for pregnancy.
We cannot ignore BMI. It’s the number that we’re so stuck with. And, there is a lot of research out there looking at weight and BMI in particular and its impact on fertility. What’s interesting is that for people who are overweight, meaning who have a BMI between 25 and 30, the literature is mixed about whether there is an impact on fertility. This likely depends exactly on those factors mentioned above: diet and exercise and what you’re doing to be at that BMI.
What’s most interesting is that people who are underweight, meaning a BMI under 20, will experience a lot of issues with fertility as well. They can have irregular menstrual cycles and a lot of patients may not realize that that’s an issue.
How else can you improve female fertility?
3. Exercise: physical activity
Regular physical activity is another modifiable risk factor and lifestyle factor that can play a role in reproductive health for female fertility. Exercise has been shown to have numerous benefits across all facets of health, including reproductive health.
What is the recommended amount of exercise while trying to conceive?
Health Canada recommends two and a half hours per week of exercise at an intensity where you can talk /have a conversation, but you do feel like your heart rate increases. So you should be able to talk, but you shouldn’t be able to belt out a full song. Health Canada also recommends two days of muscle-strengthening exercises per week. So it’s not just about getting your cardiovascular fitness: walking or running, jogging, swimming, but also doing some strength training as well.
Circling back to BMI, people who have a BMI under 20 (or who are underweight) are not getting enough calories required to sustain what they’re burning in their physical activity.
This can also lead to hormonal balance and menstrual irregularities, which can cause issues for female fertility. We certainly see this with people who are restricting their diets. Competitive athletes need to be especially mindful of getting enough calories in – we see this more commonly in gymnasts, dancers, and ballet dancers. Hypothalamic amenorrhea is a condition where you can lose your menstrual cycles completely and the endometrial lining can become really thin. Even when they start eating more and working out less it takes a long time to recover.
4. Alcohol and smoking
It’s safe to say that at this point, the vast majority of people know that smoking and alcohol can be bad for their health. We know that smoking has been linked to decreased egg reserve and decreased egg quality and increased rates of infertility and miscarriages as well. Smoking can also increase someone’s risk of early menopause and also leads to several adverse pregnancy outcomes including intrauterine growth restriction related to placental insufficiency.
Smoking includes vaping. A lot of the studies looked at cigarettes, that’s what the literature has been known about for decades, but vaping is a relatively newer thing and it does contain a lot of the same compounds and chemicals as cigarettes. Therefore we are able to extrapolate the data and say that vaping is bad too.
Of course, we know that alcohol in pregnancy can cause problems – we don’t know the exact amount of alcohol in pregnancy that can cause fetal alcohol syndrome, which is why we tend to recommend zero alcohol during pregnancy. However, I don’t think that we have to say zero alcohol while trying to conceive. But definitely excessive alcohol consumption, which is considered more than six drinks a week, can have a significant impact on reproductive outcomes.
So, it’s really about trying to minimize or eliminate as much as possible. Smoking, vaping and minimizing alcohol consumption helps to optimize fertility.
5. Stress management
Stress is a tough one because we all know how incredibly stressful infertility is.
So what came first, the chicken or the egg? And then of course there’s always the classic advice of just relax. There’s nothing more stressful than that, am I right?!?
Stress is part of life. Stress is a constant but it’s the way you choose to manage stress that is key.
Stress is not good for you. Period. It can affect your ability to connect. It can affect your relationships. It can affect your resilience and your ability to have failures and then get back up and keep trying again. So how do we increase our coping mechanisms? How do we increase our resilience? How do we increase our ability to cope with this crazy complicated world? This is what stress management is all about.
Some coping mechanisms include:
- Yoga
- Meditation
- Deep breathing exercises
- Speaking to a therapist or other professional
- Social media outreach; only when in a positive setting/group. Ie fertility awareness groups
- Support groups, such as Oasis Fertility Support Network
6. Environmental toxins
Lastly, another lifestyle factor is environmental exposure to toxins. This is really important because we are exposed to so many toxins that we don’t even realize.
The knowledge around environmental toxins has increased so much over the past few decades and will continue to do so in the future. There is a caveat because the advice is always changing AND some influencers on social media don’t make it any easier!
But it’s just because knowledge is changing and the research is changing; we are also learning and can make our own decisions.
Try to minimize exposure to things called endocrine-disrupting chemicals, which are found in pesticides, plastics and some household products. They can interfere with hormonal balance and reproductive function. For example, try to minimize exposures to these endocrine-disrupting chemicals as much as one can by:
- washing your produce, for instance, there might be a bit of pesticide residue on food
- consider consuming organic foods
- switch to glass containers instead of plastic containers for food storage
- avoiding putting plastic food containers in the microwave
- avoiding products that have pthalates and BPA
- review your cleaning products
Closing thoughts on lifestyle factors to improve female fertility
Don’t let this type of information become a tool that you use to punish yourself or to feel guilty because that’s not fair either.
My general rule of thumb is the 80 – 20 rule. Life is about balance. It means do something 80% of the time and 20% of the time it may not happen. And that’s okay because it’s all about consistency. It’s not about getting it 100% right this week; it’s about being consistent over the years for the long term while still enjoying life.
Remember, you got this.
For more information about female fertility, check out these related article topics:
The menstrual cycle
Egg freezing
An interview with Dr. Aimee AKA The Egg Whisperer
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