How To Get Pregnant

NUTRITION FOR FERTILITY

In my excitement in write about Nutrition for Unborn , I did not realise that there were many who have been trying to start a family for many years and had not succeeded . Though there are few who believe that Doctors do not know anything about nutrition and some claim that their doctor friends claim that they were never taught nutrition in Medical College ( these must be the first doctors who graduated from planet Mars ) . For those who have been following my articles , are aware about how much importance are given to nutrition in all my health articles . I have always given nutrition a greater importance in line of my treatment . However my articles about supplements clearly indicates that I do not agree with those who encourage people to take supplements with unrealistic promises . Many sales representatives have written to me about my shallow knowledge in nutrition . I do not wish to waste time arguing . You can teach a monkey all kind of tricks but you can teach them to think .

Nutrition for fertility is one of the most challenging topic to deal with . I have many couples who have come to my clinic seeking advise . I always find giving a diet advice for an obese patient is a lot easier . This is how I do my assessment :

1: BIRDS AND THE BEES: I like to know how long the couple has been married . Where each of them are working . How much time they spend together. What are the stress factors ? . I have been surprised many times by young couples . We are living in modern age with internet access yet there were couples who did not know about the Birds and the Bees . I know it will sound funny but I had couple who believed that kissing was enough to get pregnant . I had one couple who could not conceive for 18 months . How could they when each of them sleep in separate rooms . One guy was told when he got married , that a wife is like a mother and he must respect her with dignity and treat her well . That advise put a mental block on him and they could never have a child. I always find this category the most difficult to handle . Another couple , I had the most difficult time dealing was married for 6 years . The girl was from a good education background and the guy was not . This was an arranged marriage. The girl was not happy to be married and wanted to pursue her studies. For 6 years both husband and wife never spoke to each other . They leave notes on the table or the refrigerator door . It took me 6 months to counsel this couple . The couple now have a baby girl who is about 1 year old and they continue not talking to each other .

2. PAST MEDICAL/SURGICAL/FAMILY/DRUG/Menstrual /Social history :

a) Past Medical History : This is important . Many of my patients do not give much importance to this and get offended when I ask strings of question . It is important to know if you had any measles , chicken pox or mumps . Some viral infection are known to cause infertility in man and woman . Other medical problems like asthma , hypertension , diabetes ,thyroid disease, cancer ,anaemia , pituitary disease , any heart disease ( Rheumatic Heart Disease ) and Autoimmune disorder ( Rheumatic Arthritis and SLE ) is also relevant . History of recurrent urinary tract infection in woman is also relevant .

b) Past Surgical History : It is important to know in man if they had undergone any surgery like herniotomy or hernioplasty and if they had any trauma to the groins . Some have history of undescended testis in childhood and later surgically corrected . During the hernioplasty sometimes the spermatic cord is injured during surgery. History of Epedidymorchitis – testicular swelling due to infection . For woman history of any ectopic pregnancy , appendicectomy ( perforated appendix ), ovarian cyst or any other abdominal surgery which might be relevant is necessary .

c)Family History : Any history of diabetes , hypertension , asthma , cancer , psychiatric illness and heart disease is relevant . This helps to anticipate any further complications that might occur during pregnancy like Gestational Diabetes and Pregnancy induced hypertension.

d) Gynaecological History : It is important to know if menses in woman is regular . If your cycle is short or long, menses irregular, heavy, or painful, this may point to endometriosis, fibroids, or other medical conditions. Knowing ones regular menses dates helps to calculate the fertility period . Any white per vaginal discharge needs to be treated . History of ectopic pregnancy , pelvic inflammatory disease( use of IUCD ) . Detail I will try to discuss in the infertility topic .

e) Social history : smoking , alcohol and substance abuse

f) Genetics : I came to be aware the seriousness of this when I was dealing with a patient who had multiple miscarriages. It was only when I saw her with her 2 nephews who were handicap that I realised I missed out something . Her brother married their maternal uncles daughter and she had married her maternal uncle . On further enquiry into the family history , I found there were several miscarriages in the family and some of them were diagnosed to have a disease called Muscular Dystrophy ( Fredrick's Ataxia ) .


INTRODUCTION TO NUTRITION FOR FERTILITY

Before embarking on the twilight of nutrition , I must confess that I am not a specialist in Nutrition and I do not have any PHD as some of you have pointed out . I have just put together what I have learned in Medical College and from all the books that I have read . I am not an expert at writing so please bear with me . I have tried to put together some information which I feel will be useful to you . I am a very impatient guy , I usually rush to finish my articles as fast as possible but in this case , seeing that this subject is important to many of you , I am taking my own time to provide the best information that I can .

If I confine my topic to just nutrition for fertility , I know sooner or later I will have to deal with another subject on infertility too . After a serious consideration I felt it is best I deal with the whole subject of reproductions . I would like to describe briefly on infertility in both man and woman first before we move on to more serious subjects .

INFERTILITY

Infertility is usually defined as the inability of a couple to conceive after one year of unprotected intercourse( minimum 2 times per week during fertile period ). However, younger couples may be encouraged to wait for up to two years by some doctors before seeking treatment, while women over 35 or those with certain medical conditions, such as diabetes, should only wait six months. About one in six couples concerned end up seeking help. Within this group the problem is found to lie with the woman in up to 40 per cent of cases, and with the man about a third of the time. In the remaining cases around 15 to 30 per cent of both partners are found to have reduced fertility and in five to 10 per cent of couples the cause cannot be determined.

INFERTILITY IN MAN

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

To be fertile, a man must be able to deliver an adequate quantity of normal sperm to a woman's vagina, and sperm must be able to fertilize the egg. Conditions that interfere with this process can make a man less fertile.

A number of factors can cause or contribute to male infertility:

• Sexually transmitted diseases, such as gonorrhea or chlamydia

• Fevers and infections, such as mumps occurring after puberty

• Surgery of the reproductive tract, such as that for undescended testes (Cryptorchidism: If the testes do not properly descend into the scrotom this is called cryptorchidsm. Cryptorchidism is fairly common in premature births and occurs in full term births at a much lesser rate. Usually this resolves itself within a few weeks, but sometimes corrective surgery is needed. Cryptorchism can seriously impair fertility rates. If both testes are affected the chance of a successful pregnancy is very small.), hernia repair, disorders of the prostate gland, or cancer .

• Damage to the vas deferens, most often by vasectomy

• Varicose veins in the scrotum (varicocele) . Varicocele is a condition that affects approximately 40 percent of infertile males. It is caused by enlargement of the veins in the scrotum. If these veins are enlarged it can cause the temperature to increase. Increased temperature of the scrotum affects sperm production and sperm quality.

• Use of certain drugs, such as those for depression or high blood pressure . Drugs include androgens (such as testosterone), aspirin when taken for a long time, chlorambucil, colchicine, corticosteroids (such as prednisone), cotrimoxazole, cyclophosphamide, drugs used to treat malaria, estrogens taken to treat prostate cancer, marijuana, medroxyprogesterone, methotrexate, monoamine oxidase inhibitors (MAOIs—a type of antidepressant), nicotine, nitrofurantoin, opioids (narcotics), spironolactone, and sulfasalazine. Use of anabolic steroids may affect hormone levels and thus also interfere with sperm production. Excessive consumption of alcohol may reduce sperm production.

• Exposure of the testes to high temperatures, such as those that result from the wearing of tight, unventilated clothing; excessive use of hot tubs; or conditions in the workplace . Conditions that increase the temperature of the testes (where sperm are produced) can greatly reduce the number of sperm and the vigour of sperm movement and can increase the number of abnormal sperm. Temperature may be increased by exposure to excessive heat

• Use of tobacco, marijuana, or alcohol . Alcohol suppresses the testosterone levels .

• Medical conditions, such as diabetes and hypertension.

• Genetic or hormonal problems . Certain hormonal or genetic disorders may interfere with sperm production. Hormonal disorders include hyperprolactinemia, hypothyroidism, hypogonadism, and disorders of the adrenal gland (which produces testosterone and other hormones) or pituitary gland (which controls testosterone production). Genetic disorders involve an abnormality of the sex chromosomes, as occurs in Klinefelter syndrome.

• Injury to the testes, such as that resulting from physical trauma or exposure to radiation, can also cause infertility in the man.

• Retrograde Ejaculation: Retrograde ejaculation is caused when the nerves or muscles in the bladder do not work properly. What happens is sperm is transported backwards into the bladder instead of forward and out through the penis. Sometimes men will have cloudy urine after an ejaculation because of this.

INFERTILITY IN WOMAN

• Hormone levels that prevent the release of an egg from an ovary or the implantation of a fertilized egg in the lining of the uterus

• Extra weight (more than 30% over her ideal body weight), which may cause problems with ovulation

• Scarring or tumors of the uterus or defects of the uterus present from birth

• Too little or poor-quality cervical mucus, sometimes due to surgery or other treatment

• Endometriosis-a condition in which tissue like that normally lining the uterus (the endometrium) is found outside the uterus • Adhesions-bands of scar tissue from previous surgery, endometriosis, or infections that bind together tissues inside the abdomen

• Infections such as pelvic inflammatory disease (PID), a severe infection of the female reproductive organs that may be caused by sexually transmitted diseases such as gonorrhea or chlamydia; or appendicitis, which can result in scarring of the internal pelvic organs

• Production of antibodies that attack her partner's sperm

• Medical conditions, such as thyroid disease or diabetes

• Genetic conditions such as Turner's syndrome, in which a woman has only one X chromosome and may not completely develop breasts or pubic hair

• Use of tobacco, marijuana, or alcohol

JOINT INFERTILITY PROBLEMS

Of the number of cases of infertility where the problem lies with both partners, some of the causes may be straight forward and quite simple to remedy. As the window of opportunity to fertilise an egg is quite limited in a woman's monthly cycle, the frequency and timing of intercourse may be factors.

• Frequency: A couple may simply not be having intercourse frequently enough to coincide with the woman's most fertile phase. Sperm can live about 48 hours in the woman's reproductive tract and only during this time can they fertilise an egg.

Intercourse every two to three days around the time of ovulation should be the optimum frequency for fertilisation.

• Timing: Equally, the problem could be due to missing the most fertile phase, particularly where the woman's cycle is not regular, or is longer or shorter than the average 28 days.

• Technique: Some cases have been found to be related to technique, where the sperm is not deposited high enough in the vagina to have a chance of passing through the cervix. It is said that missionary position with the womans hip elevated is the best position . After intercourse , the woman is advised to keep the hip in elevated position , with 2 pillows below the hip for 1 hours to increase the chances of fertilisation .

• Age: Fertility is also reduced with increasing age, especially in women. Maximum fertility in women is between the ages of 15 and 24 and by the time a woman reaches 50, most of the remaining eggs she was born with will have been reabsorbed by the body, curtailing the production of oestrogen and progesterone.

In men, testosterone levels can decline with age but not in the dramatic manner seen in women. Men continue to produce sperm, but their motility can reduce with advancing age.

When I started writing this article 4 days ago , I knew it was a challenging topic to write . I realise now that this is not as simple as walking in the park . Nutrition for fertility turned out to be more challenging then discussing about infertility . There were many factors I had to look into when dealing with this subject . There were superstitious believes , myths , traditional means and science . I remember when my wife and I were trying for our second child , we were unsuccessful . We did everything right as planned . It only then I realise that my wife was consuming papaya everyday . During the first pregnancy , my wife was advised not to eat pineapples and papaya by one of my elderly aunts . We decided to stop papaya and were caution on our food intake . I wanted a baby girl to be born in the month of may sharing my zodiac sign " GEMINI " . There were many occasions where my wife and my parents thought I was crazy . According to my mum , the astrologist predicted that we will be blessed with a son and the Ultra Sound were all suggestive of a baby boy . When everyone were busy buying clothes for a baby boy, I was busy shopping for a baby girl . When my wife was wheeled into the labour room , she held my hand , worried that I will end up being disappointed . I laughed at her and told her that I know I won't . As planned we were blessed with a baby girl who was born on the 30th May, one day before my birthday . That was the best birthday gift for my birthday . I had already chose the name 3 years ago prior to her birth . I named her " SHRESTA " . A Nepali name meaning - the best or number 1 .


STARTING A FAMILY

MOTIVATION – State of mind

Inform yourself. Get to know what you need to do to increase your chances of conception. Both partners must be involved in this process; it takes two to make a baby. Both must sit down and plan your family . You have to understand what you will have to go through . There is no such thing as do now and worry later . You have to motivate each other . Eat well, take the necessary supplements, improve your lifestyle, and most of all enjoy the love you share, that is of utmost importance to create another human life. I used to motivate myself by going to the babies section at the supermarkets and plan out what I need to buy and making my budgets .

Don't worry about what other people think about the changes you are making, friends will note things that you may have wanted to keep secret for now.

You will also start to notice everyone else getting pregnant. Try not to get fixated on this. The same happens when you buy a new car, suddenly you see them everywhere.

Try to not lose your sense of humour. Do not isolate yourself socially. Stay an active part of your community, everybody needs to have purpose.

Infertility can be very tough on a relationship. Keep doing things together, stay romantic, do not let sex get too systematized. Remember that this is the person you loved enough to decide to have babies with. Do not force your viewpoints onto each other too strongly. Be gentle, on step at a time.

Relax, breath, enjoy life, and have wonderful sex!

All right . Enough talk . Let's get down to business .

NUTRITION AND FERTILITY

The goal of every dietary prescription is to bring the body back into balance. Here are some general dietary recommendations I make to my patients who are trying to get pregnant.

1. Eat alkaline rather than acidic foods. Many contemporary sources advocate eating alkaline foods like non-citrus fruits, vegetables, sprouts, cereal grasses (wheatgrass, barley grass), and herbs like black cohosh and valerian root to help provide the entire reproductive system with the right pH for conception and implantation. Acidic foods (like meat, dairy products, and most grains) produce acidic environments. Acidic cervical mucus may become hostile to sperm, which requires an alkaline environment to survive. Since saliva can have an alkalizing effect, it is also recommended that you chew your food thoroughly and refrain from drinking liquids with your meal. Let your own salivary enzymes digest the food, rather than washing it down with fluids. I don't advocate strict vegtarian diets, but you should make sure the bulk of your diet comes from organic plant sources. Bioflavonoids, found in many fruits and vegetables , also help in the formation of healthy blood vessels, helping the uterus prepare for implantation and prevent miscarriage.

2. Get plenty of essential fatty acids, preferably from unprocessed plant sources and deep-sea fish. The essential fatty acids , linoleic acid and alpha-linolenic acid are essential to every living cell in the body. They are also key in ovulation, specifically in the process of follicular rupture (releasing the egg) and collapse (allowing the development of the corpus luteum). Good sources of essential fatty acids are fish, fish oil, non-hydrogenated cold-pressed oils such as flaxseed and pumpkin-seed oils, eggs, soy products, raw nuts and seeds, and dark-green and winter vegetables like broccoli, cauliflower, beets, carrots, cabbage, turnips and Brussels sprouts. Be aware, however, that with long-term exposure to heat and light, essential fatty acids found in vegetable oils may become trans fatty acids, which are toxic. Trans fatty acids can impair the proper functioning of the immune and reproductive systems. Other sources of trans fatty acids are shortening, margarine, lard and animal fat, and hydrogenated vegetable oils, which are found in many processed foods. Do your best to stay away from trans fatty acids in your diet. Store oil in a cool, dry place, and once it's open, use the oil within a couple of months.

Another key fatty acid, omega-3, is found in deep-sea fish oil. Omega- 3 fatty acids have been found to clean the blood of fat deposits, reduce clotting, and encourage blood flow to the tissues, including the uterus. Omega-3 fatty acids also boost the immune system and have been found to reduce certain immune cells (NK, or natural killer, cells) which prevent the embryo's implantation in the uterus. The omega-3 fatty acids eicosapentaenoic acid (EPA) and docohexaenoic acid (DHA) are also essential in fetal brain development.

NOTE: Be aware that elevated levels of mercury can be found in many deep-sea fish. Some companies do ensure purity standards for their fish, guaranteeing low or no toxic metals.

3. Eat organic foods and hormone-free meats whenever possible. In natural-food circles, organic foods are touted as necessary for optimum hormonal functioning because many of the pesticides, chemicals, and hormones used to treat produce and animal products contain synthetic oestrogen like substances, which occupy oestrogen receptor sites and have negative effects on our organ and endocrine systems.

The processing most food undergoes eliminates much of the natural nutrition present in the original fruits, grains, and vegetables. When we eat refined pasta and white bread, we are consuming mostly processed leftovers; little of the original substance of the wheat is left. Processed fruit juices consist of mostly sugar, and sugar damages the Spleen, which controls digestion. Frozen meals are packed with sodium, which depletes the Kidneys. Most of the canned, prepared foods that form the basis of the typical American diet contain preservatives and minuscule original food value.

Overall improvements to dietary health can be made by consuming more of a macrobiotic diet, including mostly fresh, organic produce supplemented with small amounts of hormone-free meat and animal products. The typical Asian diet is macrobiotic -- meals consist mostly of fresh, lightly sautéed vegetables, rice, and small amounts of meat for flavouring.

You also might want to consider how you prepare your foods. Traditional Chinese cuisine advocates chopping vegetables and meat to allow for the release of more energy when they are eaten, and lightly cooking vegetables rather than eating them raw to make them more easily digestible. It's also a good idea to stay away from the microwave. Microwaving food affects its structure and, according to some, decreases the energy available in the food. Cooking on top of the stove or in the oven is preferable.

4. Add more cruciferous vegetables like cabbage, broccoli, Brussels sprouts, and cauliflower to your diet. Cruciferous vegetables contain di-indolylmethane (DIM), a compound that stimulates more efficient use of oestrogen by increasing the metabolism of estradiol (one form of oestrogen produced by the body). Excess estradiol is associated with breast pain, weight gain, breast and uterine cancer , moodiness, and low libido. Adding DIM sources to your diet allows the estradiol to break down into the beneficial 2-hydroxy estrogens, which don't have estradiol's negative effects.

5. Supplement your diet with a natural, high-potency multivitamin and mineral complex with iron, folic acid, and B vitamins. The vitamins and minerals important for reproductive health (vitamins A, C, E, B complex, zinc, and selenium) enhance fertility yet are lacking in the usual Western, highly processed diet. If these nutrients were adequately supplied through the diet, many fertility problems could be avoided. Other supplements you might wish to try include the following:

• Bee pollen and/or royal jelly is regenerative and tonifying. Bogdan Tekavcic, M.D., a Yugoslavian gynecologist, conducted a study in which the majority of women who were given bee pollen with royal jelly showed improvement or disappearance of their menstrual problems, while there was no change in the placebo group. Another study showed bee pollen significantly improved sperm production in men. Bee pollen, which is worker bee food, is rich in vitamins, minerals, nucleic acids, and steroid hormones, and improves health, endurance, and immunity. Royal jelly is modified pollen fed only to the reproducing queen bee, whose job it is to produce more infant bees. This nutritive tonic might be considered the bee equivalent of fertility drugs. Rich in amino acids, vitamins, and enzymes, royal jelly helps the queen lay millions of eggs and live longer than the worker bee.

• Blue-green algae is the origin of life-giving nourishment on this planet. Microalgae contains chlorophyll, amino acids, minerals, vitamins, and steroid building blocks. Chlorella is freshwater green algae; spirulina is saltwater blue-green algae. Chlorella and spirulina nourish the endocrine, nervous, and immune systems; Blood, and Essence; regulate metabolism; and repair tissue.

• Wheatgrass is tonifying and curative. It nourishes Blood, and Essence, enhances immunity, and restores hormonal functioning. Other cereal grasses like barley grass function the same way.

• Vitamin B6 helps the body metabolize excess estrogen, produce adequate progesterone, and lower elevated prolactin levels. A Harvard study treated women with galactorrhea (lactation not associated with childbirth or nursing)/amenorrhea syndrome with 200 to 600 milligrams of vitamin B6 daily. Within three months all the women in the study had normal menstrual cycles and had stopped lactating.

• Coenzyme Q-10 assists mitochondrial function, the powerhouse of each cell.

• Folic acid is extremely important in cellular division. I am a proponent of supplementing your diet with folic acid for months before you conceive and throughout pregnancy. If you have a history of abnormal cell division, such as cervical dysplasia, you should eat foods with high folic acid content, like dark-green leafy vegetables and natural orange foods -- oranges, cantaloupe, yams, and sweet potatoes -- in addition to your folic acid supplement.

6. Eliminate caffeine, nicotine, and alcohol. Caffeine, nicotine, and other stimulants should be avoided. The American Journal of Epidemiology reports nicotine is ten times more concentrated in the uterine fluid than it is in plasma. Nicotine ages the ovaries and makes the eggs resistant to fertilization. Alcohol is particularly damaging . One study reported that any alcohol consumed during an IVF cycle reduced its chance of success by 50 percent.

Tea, especially green tea, is not as problematic as coffee. It contains about 20 percent less caffeine, and fewer volatile oils. Coffee constricts vessels while tea opens them. Green tea (and, to a lesser extent, black tea) has an antioxidant benefit coffee does not share.

7. If at all possible, avoid unnecessary medications and drugs, including over-the-counter preparations. Even non-steroidal anti- inflammatories (NSAIDs) like ibuprofen can block the synthesis of prostaglandins and therefore inhibit ovulation.

If you have scanty cervical mucus, you should avoid decongestants, antihistamines, and excess supplemental vitamin C. Avoid vaginal lubricants other than egg whites.

8. Avoid junk food, excessive stress, too little sleep, too much exercise, or anything taxing to the immune system. In general, you should give your body every chance to be at its strongest and healthiest so that it can nourish your child. Late hours, bad food, or excessive stress of any kind means your body has to dedicate its precious resources to keeping you healthy instead of making a baby. Live healthfully until you conceive and carry your child to term.

A SPECIAL NOTE FOR MEN: Men who are having fertility problems should make similar dietary adjustments. Avoid environmental estrogens and dietary sources of free radicals including saturated fats, hydrogenated oils, and trans fatty acids. Stop or reduce all unnecessary medications, especially antihypertensives, antineoplastics, and anti-inflammatory drugs, which can impair sperm production.

Increase consumption of legumes and soya (which is high in phytoestrogens and phytosterols), and include vitamins C, E, and B12, beta-carotene, folic acid, and zinc, and herbs such as ginseng, which increases production of testosterone and helps with sperm production. Supplement with the amino acids L-arginine and L-carnitine, which are especially associated with enhancing sperm production. This regimen will improve not only sperm but overall health. * There is an issue regarding soya consumption . Some studies say that high soya intake reduces fertility in man due to increase in oestrogen. Some studies say that soya consumption improves fertility . I would advice minimal use of Soya for man based on clinical experience. I had few male patients who on high soya diet complaining of feeling very shy when hugging or kissing their wife . Some were even shy to change clothes in the same room with their wife . Some wife noticed that their husband were very emotional . I would advise you guys to change to boxer shorts and start learning to wear sarongs at home .


Nurturing the Ovary

A diet of too many processed foods and not enough fruits and vegetables does not provide the necessary nutrients for fertility. Convenience foods are often low in vitamin B complex and essential minerals such as zinc, magnesium, selenium, and iodine. Fresh foods are always more nutritious. The endocrine glands, ovaries uterus, pituitary, thyroid and adrenals all require nutrients to function. The hypothalmic-pituitary-gonadal axis is very sensitive to vitamin intake. This axis is a highway for all hormonal messages that pass from one gland to another. If the message is garbled, fertility may be shut down. Low intakes of B vitamins slow the maturing of the ova before ovulation.

Proteins and cold-pressed oils from nuts, seeds and oily fish are precursors to hormone and enzyme production. Eating a supply of proteins at each meal and good olive or walnut oil salad dressings may aid fertility. A low protein diet causes fewer ova to ripen or be released. The reproductive system requires all the B vitamins for the pituitary gland to work correctly, i.e. send normal messages. Other research suggest that vitamins C and E are essential, along with the minerals, iodine, selenium, zinc, magnesium and essential fatty acids. Most of these are available from a diet rich in lean meat, fish, eggs, nuts, seeds, peas, beans, lentils and dairy foods.

Womb Needs

The womb produces many different prostaglandins and the rich endometrium lining nurtures the fertilized egg or ova after implantation. The placenta is built from this nutrient rich source. A healthy placenta will lead to a healthy baby as it gathers the maternal hormones and nutrients to feed the embryo via its blood stream. If the mother's nutrition stores are inadequate then the baby will have poor nourishment and may not develop properly. Eating well for 3 months before conception will ensure that adequate nutrients are available to the developing baby.

Dietary Advice

In order to maximise the chances of conception and pregnancy a diet rich in vitamins, minerals, phytochemicals, proteins, complex carbohydrates and natural fatty acids is essential. This is not difficult. It means eating the freshest, healthiest food you can afford for 3 months before conception and for the nine months of pregnancy. Fresh fruits, vegetables, nuts and seeds, beans and lentils, lean meat, oily fish, some dairy products and eggs are suggested. It's actually like eating as your grandparents - fresh foods untainted with chemicals.

Other Recommendations:
• Drink one litre of fresh filtered water each day (8 glasses). • Eat two servings of fresh, green leafy vegetables per day, two servings of red-orange vegetables, salad and two pieces of fresh fruit. (Avoiding citrus fruits as bowel irritation may occur. Berries are anti-inflammatory and diuretic.) • Eat two to three servings of whole grain cereals such as rice, oats, rye, corn, millet, unless you are grain/gluten intolerant.
• Eat 30gms of fibre foods each day including fruit, vegetables and whole grain cereals or nuts and seeds. • Eat complex carbohydrate foods daily, such as, cereals, root vegetables or pulse vegetables (peas, beans and lentils). They supply slow-releasing sugars into the body to sustain energy levels. • Consume one tablespoon of fresh, cold-pressed oils each day from sesame, walnut, sunflower or olives. Or, use one tablespoon of ground linseed with breakfast. Avoid trans-fats in manufactured foods.
• Eat 50-75gm of protein foods per day choosing from a variety of sources. This ensures a wide range of amino acids that are available in peas, beans, lentils, grains, nuts, seeds, tofu, eggs, dairy foods (from goat or sheet) and fresh fish or lean organic meats.

Nutritional Supplements

Nutritional supplements are tools to improve body biochemistry and to correct biochemical imbalances while dietary nutrients from food is being supported. A good multi/vitamin/mineral supplement along with vitamin C and essential fatty acid supplements will help restore the body's nutritional balance. Other supplements that will be supportive while the diet is adjusted include, a digestive enzyme (non- glandular), magnesium malate, iodine, evening primrose, zinc citrate, gluconate or bio acidophilus. Diet, indeed, plays a major factor in fertility and overall health. Three regular meals each day beginning with a nutritious breakfast is a key factor. Remember what our grandmother told us, "eat right, exercise and reflect". However, these items are just general pieces of advice, your chances are improved if you get some personalised advice keyed to your specific needs and deficiencies that you can only get by consulting a nutritionist and preferably one specialising in fertility issues. You need to follow that advice not just to conceive but throughout the pregnancy.

The Baby or the Treats

Some Foods that we eat on a daily basis are not so good for our health. At a time when we are trying to get pregnant they may be detrimental. Many foods contain phyto-chemicals that lock up minerals, making them unavailable to the body. Sugars can have an effect by tying up vital B vitamins in aiding digestion at a time when the ovaries have more need of them. These foods we know as anti- nutrient foods as research shows that they are not helpful to our health, especially at a time when we are trying to create a new life.

Anti-Nutrients

Certain substances which we regard as `foods' have detrimental effects on our intake of nutrients as they can act as diuretics and take them from the body, or they may block their uptake. These are caffeine, alcohol, cigarettes and heavy metals.

Caffeine

"Research has shown that women who were heavy coffee drinkers before pregnancy (7 or more cups per day) had, either before or after adjustment, almost a doubled chance of difficulty in becoming pregnant compared with the women who drank little or no coffee (less than 1 cup)" (16). Caffeine is also found in colas, tea and chocolate and some painkillers. The other chemicals associated with caffeine are theophylline and theobromine, both of which are known to be nervous system stimulants. Caffeine robs the body of thiamin (B1), inositol, biotin, zinc, calcium and iron. It does appear to have an effect on ovarian function.

Alcohol

"The risk of endometriosis was roughly 50 per cent higher in women with any alcohol intake than in control subjects in research. In the body we know that alcohol is converted into fat for storage and that fat cells in turn produce oestrogens. Moderate alcohol use may contribute to the risk of specific types of infertility". Alcohol robs the body of the vitamins A,D, E, K, all the B complex group and magnesium. The latest research suggests that women should give up all alcohol if they want to become pregnant. Women who drank less than 5 units a week are twice as likely to get pregnant as those who consume ten. Dr. Tina Kold Jensen at the National University Hospital in Denmark reported the research in the BMJ. Women had the best chance of conceiving when they did not drink at all. . It was felt that alcohol disrupted the ability of the fertilised egg to implant in the womb. So although women conceived the body would abort the pregnancy.


Smoking

"Current and past smokers have reduced gonadotrophin- stimulated ovarian function. Tobacco exposure is associated with decreased oestrogen , and decreased numbers of oocytes. Smoking has an adverse effect on ovarian function" . . By smoking you may be damaging your future daughters ovaries and her likelihood of a pregnancy may fall or even fail. Nicotine robs cells of vitamin C, B1, calcium and the whole B complex family. For each cigarette smoked the body uses 25mg of vitamin C . New research reported at the American Chemical Society had found a by-product of cancer-causing chemicals known as NNK in the urine of babies born to mothers who smoked. These compounds passed through all the babies cells and were present in 22 out of 31 samples from newborn babies whose mothers smoked, while none were found in the urine of babies whose mothers did not smoke. Knowing the endometriosis cells behave in a similar way to cancer cells women with endometriosis may wish to refrain from smoking before and during pregnancy and lactation.

Heavy Metals

A diet that is rich in calcium, magnesium, selenium, iron and zinc protects us from the bad effects of heavy metals such as lead, mercury and cadmium. Lead is known to be mutagenic causing abnormalities in the foetus. This being the case contact with these metals should be avoided where possible. Lead is found in paints and petrol. Cadmium comes from cigarettes. Dr. Bryan Hallewell, Advisor to the Environmental Health Agency UK on toxic metals warns that "In the face of mounting evidence of danger and an absence of evidence of safety, it is my duty to advise that the use of mercury dental amalgam tooth fillings in the mouths of women who are pregnant should be discontinued". "Mercury is seen to cause birth defects and nervous system disorders and it is best to avoid dental fillings whilst pregnant ". "Copper in excess can also cause problems in the liver and digestive tract " . "The total dietary copper intake by males and females was positively associated with the consumption of chocolate foods" . Eating an excess of chocolate can be a problem for some. High copper correlates to high oestrogen which women with endometriosis and those attempting pregnancy need to keep in balance.

Sugar and aspartame

The brain requires a continual supply of glucose to fuel up the cells. Excess of sugar in the diet ties up essential B vitamins, chromium and zinc, and stops them from working where they are needed in the reproductive system. Low blood sugar levels due to hypoglycaemia, may cause symptoms such as dizziness, tremors, double vision, confusion, incorrect speech and depression. Aspartame sweetener may aggravate hypoglycaemia. Phenylalanine can stimulate the release of insulin, which could provoke a bout of hypoglycaenia. When women are trying hard to lose weight and use more aspartame products in may reduce further their blood sugar level.


DURING PREGNANCY

I have discussed briefly about nutrition during pregnancy in my article " NUTRITION FOR YOUR UNBORN " . I would like to mention again about feel foods that you need to avoid during pregnancy . Some of them are just repetition of what I have already mentioned earlier . It is extremely important to avoid certain foods that you may have enjoyed pre-pregnancy. This is because many foods either contain harmful bacteria or environmental pollutants that negatively affect your baby. Listeria, salmonella, E. Coli and methyl mercury poisoning are among these harmful elements. Be sure to post a copy of our complete guide of foods to avoid during pregnancy on your refrigerator! Lastly, poor food safety preparation can also mean exposure to harmful substances.
Unpasteurized Products : Listeria

Unpasteurized products are made from raw milk; if the milk process was not performed properly and the milk is 'dirty', then it may be infected with listeria. It is therefore advised that pregnant women not consume the following unpasteurized products:
- raw milk
- soft cheeses : feta goat cheese
- unpasteurized juice

Listeria is a serious threat: it has been responsible for 2,500 illnesses and up to 500 deaths a year. Some studies estimate that 30% of those deaths involve pregnant women and their fetuses. Listeriosis can cause miscarriage or premature birth. While 'dirty' milk may be contaminated with listeria, there are many advocates of the health benefits of Grade A Certified raw milk. Talk to your doctor to find out more about the benefits of unpasteurized milk. Raw Eggs : Salmonella
Any dish containing raw eggs is infected with Salmonella. Avoid:
- raw eggs
- Caesar dressings
- homemade ice cream

Undercooked Meats : Salmonella, E. Coli, Toxoplasmosis Pregnant women should avoid all undercooked meats. Remember to take precautions when preparing meats: make sure your steak has an internal temperature of 170 degrees Fahrenheit and heat hamburger and pork to 160 degrees Fahrenheit. Avoid:
- deli meats
- sushi
- hot dogs
- raw seafood, especially shellfish
- undercooked chicken or meat
Hot dogs can be especially harmful, and have even been found to increase the risk of leukemia in children if eaten more than once a month.

Aspartame

Aspartame is a sweetener made by Monsanto found in many diet foods and available in packets to sweeten your foods. Be advised that aspartame has been linked to cancer as well as neuro- and immunotoxicity due to long term ingestion. Because of aspartame's bad press, Monsanto has come up with a new sweetener, Neotame. Neotame has not been sufficiently tested and is thought to be more toxic than its predecessor, aspartame; it contains carcinogenic ingredients, such as formeldahyde. Because aspartame contains phenylalanine, it can be toxic for certain children. Make sure the foods you eat do not contain artificial sweeteners. When sweetening foods, opt for natural sweeteners like honey or fruit juice.

Certain Fish : Methyl Mercury

Fish is an excellent source of Omega-3 fatty acids, integral in the development of your baby's brain and vision. Yet, because of coal plant pollution, most of the world's fish population is contaminated with methyl mercury. Methyl mercury is a neurotoxin and causes neurological damage, developmental delays and learning deficits. Although the FDA has issued warnings on certain fish species. Independent studies have shown a need for more rigorous limitation of certain fish species.
safe
- wild pacific salmon
- farm-raised trout
- farm-raised catfish
- fish sticks
- summer flounder
- mid-Atlantic blue crab
- haddock

restricted consumption
- canned tuna
- eastern oyster
- blue crab from the Gulf of Mexico
- lake whitefish
- blue mussels
- cod

dangerous
- shark
- swordfish
- sea bass
- tilefish
- tuna steaks

Trying to get enough uncontaminated fish in your diet is understandable difficult; You can also get other sources of the nutrients found in fish. You may want to make up for Omega-3s by eating crushed flaxseed with your breakfast or snacking on walnuts. While flaxseed and walnuts have about a fifth of the Omega-3s, it may be the safer option until pressure is put on industries that contaminate our waters. Pregnancy diets deficient in Omega-3s will result in children with behavioral problems and abnormal vision. Farm-Raised Fish : PCBs

Fish farming raises a number of health and environmental concerns. Farm-raised fish have significantly higher levels of PCBs, or polychlorinated biphenyls, for a number of reasons. Because PCBs embed themselves in fat, 'fatter' farm-raised fish are rich in this cancer-causing toxin. And while you may think the nutrients of fish even out the dangerous effects of PCBs, farm-raised fish are considerably less nutritious than their wild counterparts. This is because farm-raised fish don't have the opportunity to fulfill their natural and healthy diets. Therefore, stay away from farm-raised fish at the supermarket. Be sure to ask your fishmonger what waters your fish comes from.

Food Allergies

If you or your family has a history of food allergies, it is advised that you stay away from peanuts and products that may contain traces of peanuts. Your foetus can be exposed to food allergens and may develop peanut allergy if he has a predisposition.

Food Preparation Tips

Even food preparation needs to be handled carefully as improper handling of food can lead to infection or disease. Here are some tips to help you in the kitchen:
- avoid dented cans or jars that leak or don't 'pop' when you open them
- completely defrost foods, especially meats, prior to cooking; thaw foods in the refrigerator or in a plastic bag submerged in cold water; never thaw foods at room temperature.
- do not freeze anything that has been defrosted
- reheat food only once, then toss it
- when food shopping, avoid fish, meat and eggs that are not well refrigerated or kept on ice
- always wash your hands after preparing food, between foods and after the restoom
- avoid contaminating foods with each other
- wash raw vegetables thoroughly, as unwashed vegetables can harbor toxoplasmosis

Common Cooking Herbs

The following may encourage miscarriage (if used in therapeutic dosages):
Basil, Caraway seeds, Celery seeds, Ginger, fresh Horseradish, Marjoram, Nutmeg, Rosemary, Saffron, Sage, Parsley, Tarragon, Thyme, Watercress.
• According to our Indian culture , saffron ( KUM KUM ) is said if consumed with milk everyday , your child will be born with fair skin complexion . A very small amount is safe . Make sure you get the good ones . They are expensive .

Recreational Drugs

Cocaine affects the brains mechanisms for releasing reproductive hormones. It adversely affects the fallopian tubes, causes birth defects, binds to the sperm affecting motility and penetration of the egg.
Marijuana. The chemical THC is structured similarly to testosterone, it fills the receptor sites where testosterone needs to attach. It is shown to accumulate in the ovaries and testes. It can effect the developing egg, disrupt ovulation, cause low sperm counts, poor motility, and increase abnormal sperm. Smoking one 'joint' can lower testosterone and libido for up to 36 hours.

Medical Drugs (prescription and non-prescription) Painkillers. Heavy use of NSAIDs (ibuprophen) may interfere with ovulation. Acetaminophen ( PARACETAMOL or PANADOL )seems to be safe. Beware of fake Panadols sold in the shops . Make sure you get them from pharmacy or from your doctor.
Acne medication. Accutane is linked to miscarriage and serious birth defects.
Antibiotics. Some have major adverse effects to mother and baby. Some affect sperm production and motility. Antidepressants. These interfere with the hormones of reproduction. Antihistamines. Cough, cold, nasal sprays, sleep aids, all may dry up cervical mucus.
Diuretics. May also dry cervical mucus. Expectorants. 'Guaifenesin' may be toxic. These are not suitable for those who have diabetes during pregnancy . Steroids. Cortisone and prednisone if taken in high doses prevent the pituitary from producing enough hormones necessary for ovulation. They also reduce sperm counts.
Motion Sickness pills. Can dry the cervical mucus. Antimalarial drugs. Have been linked to abnormalities in embryos. Ulcer and Gout drugs. Interfere with sperm production. Antidepressants. Some can cause erectile difficulties. Beta blockers. May cause impotence, and decreased sperm counts and motility.
Inhalers, sleeping pills, antiviral drugs, and decongestants, may also affect fertility.

Environmental Hazzards
Nitrous compounds, pesticides, herbicides, fertilizers, and environmental estrogens from plastics. Each year it is said that we consume 11 pounds (5 kg) of preservatives and additives, and 1 gallon (4 litres) of pesticides.

Eat organic and drink from a quality water source.

Lead. Exhaust, industrial pollution, old water pipes, food grown near polluted areas, and some shampoos.
High levels build up if you are low in calcium, zinc, iron, and manganese. Cigarette smoking is said to raise lead uptake by 25%. Lead has been shown to have detrimental effects on almost all aspects of sperm. In women it also shows to be a factor at almost any stage of the reproductive cycle.
Vitamin C, pectin, and sulphur and nitrogen rich foods such as garlic, onions, cooked beans, eggs, and lots of water are all beneficial in the removal of lead from the body. Cadmium. Miscarriage and embryo defects. Cigarettes, processed foods, some drinking water supplies, sewage sludge, and high phosphate fertilizers are the culprits for accumulation in the body. B6, C, D, zinc, manganese, copper, selenium, and calcium are beneficial for this.
Mercury. Neurological and slow cognitive development. Pesticides, fungicides, industrial processes, dental fillings, swordfish, king mackerel, shark, tile fish and tuna are the culprits. No more than 170 grams of tuna should be eaten per week before and during pregnancy.
Aluminium. Destroys vitamins and causes long term mineral loss. Saucepans, indigestion tablets, antiperspirants, food additives, tea, and foods that come wrapped in foil are the items to avoid. Copper. Water pipes, saucepans, jewellery, the contraceptive pill, and copper IUDs are to blame. Zinc and vitamin C can help detoxify your body of copper.
Phthalates. Found in soft plastics and children's toys. They are now banned but are still found in some makeup products, toiletries, and perfumes. They are hormone disrupters.

Electromagnetic fields. Cellular phones, electric blankets, and hydro stations. May cause miscarriages. The most recent trend is the magnetic bracelets . It is best advised not wear them and for man whose wife is pregnant is advised to remove them . These are known to cause miscarriages and spinal defects in newborns .

Tampons. This is a topic every woman needs to research deeper. If you must use these, only unbleached 100% organic cotton should be used. Change them frequently.

Botox. Avoid use until further research is done.

Flying. Do not fly once pregnant, chances of miscarriage is greater, especially long flights. If there is a chance of being pregnant, the choice to not fly is probably the best one.

Other things to avoid...
Raw and undercooked meat
Radiation (x-rays, video display terminals) DES (diethylstilbesterol)
Aspirin
Antihistamines, including Ephedra (Ma Huang), Osha root Most laxatives, including flax seed, senna, aloes, castor oil, rhubarb, buckthorn, cascara sagrada
Antacids
Diuretics, including Buchu, Horsetail, Juniper berries Hair dyes
Hemorrhoid medications
Chemical stimulants and depressants (LSD, psychotropics, phenobarbital, barbituates, tranquilizers) Epinephrine drugs (adrenalin)
Vaccines, anaesthetics, mercury vapours in the dentist's office Steroids and herbs containing steroid-like factors, including Agave, Ginseng, Licorice, Hops, Sage (this herb also decreases lactation) Hormones (birth control, non-organic meats) Excesses of vitamins A, C, D.
Heavy metals: lead, nickel, cadmium, manganese Pesticides, herbicides, and insecticides. These are designs to disrupt the reproductive capacities of their target pest! Fumes from paints, thinners, solvents, wood preservatives, varnishes, glues, spray, adhesives, benzene, dry-cleaning fluids, certain plastics, vinyl cholride, rubber tuolene Lithium, arsenic
Contact with cat feces
PCB's (polychlorinated biphenyl)
Prolonged exposure to extremely high temperatures

Proper Eating and Nutrition for Fertility Unprocessed, organic food that is not preserved. The simplest way to help ensure you are getting what you need and don't need from your food.

Most of the nutrients, vitamins, and minerals we need should come from the food we eat. Although, each person is an individual, therefore the individual needs of each person should be addressed when going through the diet. Lifestyle, metabolism, genetics, geographic location, should all be considered.

The quality of food you eat plays a vital role in the optimal functioning of the body, its hormones, and cellular activities. Do not jump on the 'bandwagon' of fad dieting after reading this. The idea is to understand the importance of acquiring the proper nutrition from your food intake, and to avoid the items that you should not have.

Living food (fruits, veggies, nuts, seeds) are nutritionally superior to packaged processed foods. If these can be eaten organically, even better.

All food is made up of protein, carbs, and fats, vitamins, minerals and phytochemicals. First thing in the morning, room temperature water is impotant to consume before anything else. Then things simple to digest such as oatmeal. Fruit and yogurt or anything else is best left out of the fridge for a little while so it is not physically so cold, this shocks the digestion. Lunch should be a small high protein meal to trigger a rise in dopamine. Too many carbs will release serotonin and make you sleepy. Supper should include your favourite carbs, this is the proper time to wind down and get sleepy. Try not to eat within 3-4 hours of bedtime. You should sleep better and not retain unwanted calories.

Protein repairs and renews cells, transports oxygen and nutrients, produces hormones, helps fight infection, and grow new tissues for muscles, bones, and traumatic injuries. The building blocks of protein, the amino acids, are essential for proper building and functioning of eggs, and reproductive hormones. Men and women both need approx. 60-70 grams of protein per day. Sources include meat, fish, eggs, dairy, lentils, peas, beans, nuts, brown rice, sunflower and pumpkin seeds. Vegetarians must eat more food in general to acquire the daily recommended dose of protein. The supplementation of zinc may also be vital to vegetarians.
Spread out your protein consumption throughout the day for best absorption and useage of the essential amino acids. Do not go overboard with protein, this also can cause problems such as calcium depletion.

Fats. Essential Fatty Acids make hormones, transport cholesterol, help reduce inflammation, keep skin healthy, and reduce PMS. Sources include butter, margarine, vegetable oils, milk products, meats, nuts, and seeds.
Saturated fats found in meat and dairy products should be kept to a minimum.
Unsaturated fats found in vegetable oils, nuts, seeds, and fish, otherwise known as omega 3-6-9, are essential for brain, nervous, immune, cardiovascular, and skin systems development. Good sources are flaxseed oil, pumpkin seeds, evening primrose oil, and fish oils.

Carbohydrates. The body's basic fuel source. Sources include whole grains, sugar, syrup, honey, fruits, and vegetables.
Stay away from refined flours and sugars, these are nutrient void and spike your blood-sugar causing a crash. Fiber is also an important part of carbohydrate intake.

Micronutrients and Phytochemicals. Vitamins, minerals, phytochemicals (bioflavonoids, carotenoids, antioxidants, and phytoestrogens). Enough fruit and veggies in the diet should ensure you are getting enough ofthese vital substances. You cannot get too much of these. Fiber. Less bowel problems, reduced risk of colon and breast cancer, less chance of gall stone formation, diabetes, and cardiovascular disease. Another reason to add plentiful fruits and veggies to your daily diet plan.
Sources. Whole grains, vegetables, fruits, nuts, seeds, and legumes. Too much wheat fiber in your diet can rob your body of estrogen, and block the uptake of essential nutrients. Remember that the bowels get rid of old hormones.

Water. Second to oxygen, water is the most important nutrient in the body. It makes up 70% of the adult body, 85% of blood, 73% of muscle, 25% of fat, and 22% of bone. It is essential for the proper functioning of every body system, absolutely everything from walking to cellular production. Diuretics such as alcohol, coffee, and tea, raise the already large amount of 1.5 litres that we lose of water each day from sweating, breathing, and urinating. Most people are dehydrated. The implications of this span every process of the body. Dehydration increases the production of cholesterol, which surrounds cells to seal in and conserve water. This traps toxins inside the cells, and inhibits nutrients from entering the cells. The ovaries and testes are of the first organs to have the water cut off from them when stores get low in the body. Increase your intake gradually up to 2 litres per day. Drink filtered water preferably not from plastic bottles.

There are too many dos and don'ts which might cause headache to all of us . Just stick to the basics or minimise . There are still many portion in this topic that I am not able to cover . I am also aware that many has been repeated over and over again . This was done so to help in remembering the names instead of forcing ourselves to re read . I am yet to cover another important aspects of pregnancy which is pregnancy complicated by diabetes , hypertension , polycystic ovarian syndrome ( PCOS ) and multiple miscarriages . I will try to discuss about them in my next article . I hope whatever has been covered is useful to all of you . If you have any questions , I will be glad to answer .

For all of you who are planning to start a family or expand family , I wish you all the best . There are few things like psychological aspect of planning a family which I am yet to discuss too . If you are planning to start a family and would like some advise , you can email me .

Oh ya ! For ladies if you are planning to conceive , better have a proper dental check up first .

How to know if you are carrying a baby boy or a baby girl . What is Couvade syndrome . I will discuss this in future . There are more interesting things to write . So keep reading .

WISH YOU ALL THE BEST AND HAPPY VALENTINES DAY.

DR.SREEDHARAN PHF , MBBS, FAGE
ISLAND MEDICAL ASSOCIATES