Which Choices Actually Impact Fertility?

We are in the midst of our secondary infertility journey, and I am curious to hear your thoughts on the data surrounding acupuncture, nutrition, Mayan massage, etc. on fertility. The practitioners I’ve gone to in this space have made pretty confident claims (“Come to acupuncture once a week and we’ll have you pregnant in three months!” to “Your uterus is leaning left! We just have to massage it into place regularly!”).

My inner skeptic is strong, but of course I want to have hope, and also can’t help feeling guilt when reading some of the literature out there (how much effect does eating gummy bears, or not drinking bone broth, or not practicing yoga regularly, really have on my (in)ability to get pregnant?). As much as I crave control, the assumption that I have some is a slippery slope of guilt and self-blame.

—Lost in Fertility Claims

I’m so glad you brought up this question, as it is one that we fertility specialists get asked about all the time. I like to separate it into two categories: exposures and lifestyle interventions.

Exposures

There is a great deal of research going on in this field; however, by nature, most of it is retrospective. Let me explain what that means.

Think of how you would set up a study on exposure to microplastics from water bottles. The only way to study the effect of drinking water from plastic bottles is to survey patients to get an estimate of how much plastic drinkware they used over the study period. For example, you would take 100 patients who got pregnant after IVF and 100 patients who did not. Then you would ask each group to recall over the past 10 years approximately how many plastic water bottles they used per week. The patients with the negative outcome will always overreport the number of exposures, and the patients with the positive outcome will underreport. This is called recall bias and can significantly overestimate the effect of the exposure (plastic water bottles) on the outcome (pregnant or not). Therefore, many of the studies are flawed.

Nonetheless, there is increasing evidence that some specific classes of endocrine-disrupting chemicals may influence fertility. Two large literature reviews suggested that while phthalates, bisphenol A, triclosan, and organochlorine pesticides had little to no association with the length of time to pregnancy, polychlorinated biphenyls and possibly polybrominated diphenyl ethers and some per- and polyfluoroalkyls (PFAS) may lengthen time to pregnancy.

However, I can’t stress enough how important it is to keep in mind that in many of these studies the way that the “exposure” to the substance is measured is flawed. Therefore, my recommendation is to avoid these substances within reason, but know that complete avoidance is essentially impossible in modern life.

There is one environmental exposure that is easier to measure but harder to control your exposure to, and that’s air pollution. In the U.S., Europe, and China, studies have shown that exposure to higher levels of ambient air pollution are associated with lower fertility rates. One study demonstrated an 11% increase in reports of infertility when the couple lives closer to a major roadway,

Lifestyle interventions

What about lifestyle interventions such as specific diets or acupuncture? There is a huge amount of mixed-quality data on these topics. The take-home point is that many of these interventions fall into what I like to call the “can’t hurt, might help” category. They may have a possible positive impact on fertility outcomes, very little downside, and probable benefits to your overall health.

I advise my patients to adopt the practices that fit into their lifestyle and that make them feel healthy, calm, and in control. If you are frantically running around from appointment to appointment and stressing over iPhone reminders to take supplements, struggling on a strict diet, and ceaselessly avoiding all plastics, then these interventions may not be serving you. So choose wisely, and keep your treating physician apprised of any changes you make.