Lifestyle modification to tackle obesity, tobacco smoking and alcohol consumption, have been proposed as crucial in influencing the outcome of both natural and assisted conceptions. A recent statement released by the European Society of Human Reproduction and Embryology (ESHRE) further substantiates this association.
Some of the key statements published in the online issue of the journal Human Reproduction are as follows:
Obesity: The reduced ovulation frequency and chances of conception observed in obese women could be attributed to the negative influence of obesity on hormonal and metabolic mechanisms. Such patients undergoing IVF possessed reduced chances of pregnancy (around 30%) as they required increased doses of gonadotropins for ovarian stimulation compared to women with recommended body mass index (BMI). The literature study reported enhanced risks for the following during both natural and assisted conceptions in obese patients:
In pregnant women:
• Increased miscarriage rate of around 30%
• Gestational diabetes, with the risk ranging from 2-fold in overweight patients to 8-fold in those suffering from morbid obesity (BMI =40)
• Birth complications and perinatal death
• Congenital abnormalities, including 80% increase in neural tube defects and 30% rise in cardiovascular anomalies
Smoking: The study identified a strong association between the number of smoking years in a woman’s lifespan and the enhanced risk of conception failure after IVF. The adverse effect of smoking on IVF outcome was quite significant; and comparable to an increase in 10 years of female age. Additionally, the number of IVF cycles needed for successful conception was found to be two times more in women smokers than in nonsmokers. The study also reported an increased risk for the following in offspring born through spontaneous and assisted conception to smoker mothers:
• Preterm birth, growth restriction, stillbirth, and early neonatal death
• Low birth weight, oral facial clefts, and sudden infant death syndrome
• Adverse impact on the seminal parameters of male offspring
Alcohol consumption: There is limited data substantiating an association between female alcohol use prior to the IVF cycle and adverse pregnancy outcomes, and male consumption and higher rate of miscarriages and reduced live births. Also, these associations were reported to be dose-dependent and considerably higher when the time of intake was close to the treatment cycles.
The study linked prenatal alcohol consumption with enhanced risk for the following adverse effects:
• Reduced chances of conception, low pregnancy rates, and increased miscarriages
• Physical anomalies to behavioral and cognitive deficits in offspring, which can be included under the broad term, Fetal Alcohol Spectrum Disorders (FASD)
• Fetal death, fetal growth restriction, and preterm birth
Considering the negative impact of these lifestyle factors, the ESHRE task force has put forth five key recommendations for the physicians practicing in the ART field.
• Fertility treatment should not be provided to women whose alcohol consumption is more than moderate levels, and to those unwilling or unable to reduce their consumption.
• Special justification is needed to treat women who are severe or morbidly obese. Weight loss is reported to exert a positive effect on the reproductive potential. However, further data are mandatory to make the IVF treatment conditional to prior lifestyle modifications in obese and smoking women.
• If the ART treatment is made conditional upon lifestyle changes, the physicians should assist the patients in achieving the required results.
• Before initiating the treatment, physician counseling should be directed towards insisting patients to take serious efforts to reduce weight and stop smoking. However, this is not recommended in the case of women approaching the end of their reproductive years, due to implied time delay in attaining these results.
• Further evidence and increased contribution from fertility specialists involved in scientific research are mandatory to substantiate the reproductive effects of alcohol consumption, obesity, smoking, and other lifestyle-related factors.
Lifestyle modification should be the preferred initial treatment of infertility.
Author of the article is an IVF Fertility infertility specialist and runs fertility centre provides the best affordable quality infertility,fertility treatments with advanced reproductive technologies like IVF,ART, GIFT, ZIFT, TET, ICSI,donor egg,surrogate and surrogacy services for all nationalities.
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