Diet and lifestyle

Jing

Jing is considered to be very precious; it is the life spring sourced in our deepest origins, a substance or energy inherited from our parents. In that sense, it is a finite bundle which must be conserved because it is not so easy to replenish it once spent. Healthy Kidney Jing is vitally important for fertility.

Previous generations of Chinese people were very aware of conserving their energy reserves. They were taught early in life to pace themselves, to move gently through life, not rush at it all at once, as we tend to do in the West. For Chinese people a long life is a desired goal and something they actively foster. This means they must look after their Jing and use it sensibly like a steady drip feed, which gets topped up on a regular basis. In so many parts of modern Western culture we adopt the philosophy of ‘live hard and die young,’ rather than thinking and planning, while we are still in our 20s, to be well and healthy in our 80s or 90s. Observing patients in the clinic of a well-known, elderly and wise Chinese doctor in New York in the 1980s, I had the opportunity to see these differing approaches to life. Every day, New Yorkers, driven by ambition and circumstance, would come to the clinic complaining of myriad different disorders. They were often young people who were working 70 or 80 h a week just to keep their feet on the bottom rung of the Big Apple ladder. The old Chinese doctor would look at their faces carefully, take their pulses and say ‘can’t you rest a little more?’ Usually, he was met with squawks of protest or looks of blank incomprehension. Slowing down or resting was just not part of the script for success. But if such a lifestyle persists, then the price is paid – in Jing and Yin currency.

It is the balanced path through life which helps to conserve Jing. Life doesn’t have to be quiet externally if our internal environment is quiet, i.e. if the mind can remain stable and still, but for most of us this is difficult when living in the midst of so much stimulation and stress. Likewise, rushing all the time doesn’t just make us stressed, it exhausts us. And if we keep going on an empty tank, the Jing is consumed.

Jing can also be depleted in a more sudden and dramatic way if there is a major crisis, e.g., recovery from an accident or serious illness draws deeply on life reserves. People in terrifying and dangerous situations like war and famine may also need to drain Jing supplies rapidly just to survive.

There are many ways that Jing is used up in the normal course of living and this is, of course, the nature of life. Jing is intimately related to reproductive processes and one of the more obvious expenditures of Jing is the semen and sperm spent with every ejaculation. The Chinese were strong believers in conserving the Jing by practicing semen conservation techniques, i.e. having sex without ejaculation. However, this book is about achieving pregnancy, so further discussion of semen conservation techniques will have to be sought elsewhere. In a man with poor Jing and low Kidney energy, however, it is always wise to limit sexual activity (including masturbation) and focus on spending Jing reserves only at the fertile time of his partner.

The sexual secretions of women are not considered to be so depleting to the Jing as is the loss of semen. Since these secretions do not contain gametes, they do not have such a direct connection to the Jing. Rather, they reflect Kidney Yin reserves; these too can be drained somewhat by excessive sexual activity. However, every menstrual cycle in which an ovulation occurs requires contribution from the Jing. It is when no more Jing contributions can be made (i.e., there are no more viable eggs) that menstrual cycles cease and menopause has arrived. Thus, women spend their Jing too in the normal processes of the menstrual cycle during the reproductive years. Celibacy in a woman cannot preserve Jing in the same way it can for a man. Stopping ovulation altogether, as happens, e.g., in women taking the oral contraceptive pill, may preserve some aspects of Jing, although it does so at a price.

The production of a whole new baby human during pregnancy draws heavily on the Qi, Blood and Jing resources of the mother. Anything which damages the DNA in the chromosomes (such as X-rays and mutagenic chemicals) is said to be damaging to the Jing. Some of the epigenetic effects of assisted reproduction technology (see Ch. 10) could also be of concern as far as Jing is concerned.

There are some ways Jing can be nourished, although clearly even the most careful lifestyle and nourishing diet cannot replace the Jing that must necessarily be spent in living. Some Taoist and Qi Gong practices can protect and nurture the Jing; similarly, there are Ayurvedic and Buddhist practices that aim to do the same.

Yin

Yin cannot exist or be described except with reference to Yang, its opposite force. The Yin energy of the body is the internal, quiescent, restorative, and moistening force to balance Yang’s more outward, active, stimulating, and warming force. When we try and make parallels with our understanding of physiology from the Western point of view, it is sometimes said that Yin reflects anabolic activities (synthesizing and storing) and Yang reflects catabolic (energy-producing) activities. Or that Yin reflects the function of the parasympathetic nervous system that controls internal homeostasis, whereas Yang reflects the activity of the sympathetic nervous system that controls our responses to stimuli.

Yin is essentially an internal and quiet energy. An overly stimulating and rushed lifestyle damages it by not allowing time for rest and regeneration. It is such a lifestyle which turns up our slow drip feed of Jing, draining it more rapidly than is healthy and at the same time creating an imbalance between Yin and Yang by indulging in more Yang active times than Yin ‘resting’ times. Such a lifestyle depletes both Jing and Yin, which spells doom for fertility. Those fortunate people born with plentiful and strong Jing energy may sustain quite some Yin deficiency without the Jing being depleted but eventually a frantic life catches up with everyone – lucky are those for whom it doesn’t happen until old age, when fertility is no longer an issue! Yin deficiency in the absence of Jing deficiency can still compromise fertility. Restoring damaged Yin energy, although not quite so difficult as dealing with deficient Jing, is still not an easy clinical task. Yin-deficient women, especially older ones (speaking from the ovary’s perspective) find getting and staying pregnant a challenge. Their juices are dried up, i.e., they have little fertile mucus to carry the sperm safely into the uterus, and the lining of the uterus can be thin. The development of the egg too is compromised if the Yin is inadequate. And men are not immune from the damaging effects of the Yin-hungry lifestyle; internal Heat which develops as a result of Yin deficiency can have very dire repercussions for the development and maturation of sperm.

Yin can be nourished and rebuilt by attention to inner calm. Meditation, Tai Chi, and regular walks in serene natural environments recharge Yin. Modifying those habits or behavior patterns which increase mental stimulation excessively and heat or dry the body will also help Yin. For example, trying to fit too much into one day and skimping on sleep and meal times undermines the Yin and should be avoided or limited in those with a tendency to be Yin-deficient or in those wishing to preserve their Yin.

Modern work places may be hazardous for the Yin. Long hours in front of computer screens, or around other electrical machinery such as photocopiers, drains and dries the body, as does the stale air in the air conditioning of large sealed office blocks. Antidotes to such influences need to be sought out on a regular basis in areas of naturally high negative ions such as rainforests, river banks, and the ocean.

Toxic fumes associated with some trades and professions (e.g. manufacturers of glues, paints and solvents, photographers who develop their own photos in darkrooms, cleaners and dry cleaners) appear to have a damaging effect on the Jing and Yin. Under these conditions, the developing eggs or sperm become less able to create viable embryos (see Environmental pollutants, below, and Ch. 8).

Severe or recurrent febrile illnesses or the loss of large quantities of blood can deplete and damage Yin.

Yang

Yang deficiency often develops out of a Yin deficiency, but can also be provoked by certain environments, behavior, and diet. Living and working in icy climates or even damp cold ones can damage the Yang. The external Cold can enter the body, through specific channels or organs and inhibit or weaken the inner Fire of Yang. If the Yang of the body (and therefore its Wei Qi or natural defences) is weakened, Cold can enter even more easily. For example, in the first days of a woman’s period, her body is slightly Yang deficient (because she is losing body heat with the blood loss) and is more vulnerable to direct attack of Cold to the Uterus because the Chong channel is open. It is for this reason that Chinese women (and Asian women in general) are advised not to swim in cold water during their periods. If the Cold restricts or inhibits the rapid and easy flow of the blood it can ‘stagnate’, setting the stage for many gynecological problems later, including infertility.

When Kidney Yang is damaged, so is fertility in both men and women. Libido will be poor in both sexes, and in women, the function of the corpus luteum and the processes of implantation of a newly fertilized embryo into the uterine lining will be compromised. Kidney Yang deficiency in men can lead to impotence and/or low sperm counts and motility.

A Yang-deficient body is one without enough driving or warming energy, so that metabolism and mental processes become sluggish. The body and limbs easily feel cold and lethargic, and motivation and assertiveness diminish. As much as Yin needs rest and a quiet mind to regenerate itself, Yang needs movement and stimulation to feed it. Providing there is a good Yin base, and activity and stimulation are appropriate for the circumstances, Yang will benefit from activity and physical exercise. When the Yang is already weak and motivation is very low, the first few steps are difficult. In cases like this, the use of strong Yang tonics (like deerhorn and ginseng capsules) and the appropriate diet will help to motivate a Yang-deficient person into initiating the appropriate changes in their life. This may be as simple as beginning a gentle exercise program, or it may be as challenging as being assertive in an unfavorable work situation.

Qi and Blood

The vitality and actions of the internal organs can be described not only in terms of Jing, Yin, and Yang but also in terms of their Qi and Blood. While Qi is an immaterial substance which we translate as energy, the TCM concept of Blood includes the material substance we can see (the red stuff in our veins) and many aspects of nourishment of the body. Plentiful Blood and Qi makes us more substantial and resilient in both physical and emotional ways. When the Blood and Qi is adequate and moves well, all the tissues are well nourished and the complexion appears to be a good color. A pale tongue is a sure sign that the Blood reserves are low.

Healthy Qi requires rest, movement and flexibility. Exercise builds Qi and the capacity for producing Qi, providing it is done in an appropriate way. For some people this means aerobic workouts or athletic training. For people at the other end of the spectrum, this means gently stretching the limbs or walking slowly around the block. For most of us, an exercise program somewhere in the middle is appropriate. As the lungs work more, so does the Qi. The nature of work in the city, often sedentary, often stressful, combined with eating too much or in a rush does not help the Qi move smoothly; rather, a regular routine plus a sensible exercise program will help the Qi build and move.

Spleen Qi is important for the absorption and metabolism of food and the production of Blood. Just as important is the patency of the Liver and Heart Qi (see also Stress, below).

Phlegm-Damp

When we discussed the various TCM patterns of infertility, we mentioned three categories other than Kidney weakness, these were: Liver and Heart Qi stagnation, Blood stagnation, and Phlegm-Damp accumulation. Of these three, it is Phlegm-Damp accumulation which is most related to diet.

Phlegm-Damp creates an internal environment of congested and stagnant fluids. Excess mucus forms in the gastrointestinal tract and bowel movements become sluggish and unformed. The lungs and other parts of the respiratory tract can also become congested with fluid or mucus. The urine becomes cloudy if the bladder is affected. Obesity, diabetes, and heart disease can develop. In terms of fertility, we are concerned mostly with congested or stagnant fluids blocking the cervix (pathologic vaginal discharges or inflammation), or the tubes (mucus and inflammation), or affecting the ovaries (cysts), or the uterine lining (excess secretions). Damp in men can contribute to impotence, prostatitis, discharges from the penis or thick congealed semen – all of which have an affect on sperm. Phlegm-Damp in both men and women can manifest as fatty deposits around the abdominal organs. If a person has a tendency to Damp or already manifests pathologic manifestations of it, then Damp-clearing herbs will be prescribed. Such therapy must be supported by the appropriate diet.

Choose whole grains and other unrefined carbohydrates rather than highly refined carbohydrates that quickly boost blood sugar and insulin.

Eat more vegetable protein, like beans and nuts, and less animal protein.

Avoid trans-fats, found in many commercial products and fast foods. Use more unsaturated vegetable oils, such as olive oil, and cut back on saturated fat from red meat and other sources.

Get plenty of iron from fruits, vegetables, beans and supplements (not from red meat).

Drink coffee, tea and alcohol in moderation and skip sugared sodas.

Drink a glass of whole milk or eat a dish of full-fat yogurt every day.

Take a multivitamin with folic acid and other B vitamins.

If you are overweight, lose 5 to 10 percent of your body weight. Start a daily exercise plan (if you are already quite lean, don’t overdo it).

Arginine – supplementation with this amino acid has been examined in several small studies which show conflicting results, arginine supplementation being associated with both better IVF outcomes in earlier trials but worse outcomes in more recent studies.^27–29

Melatonin (N-acetyl-5-methoxytryptamine) – this hormone is secreted during the night by the pineal gland to regulate a variety of pathways related to circadian rhythms and reproduction. It has been shown in one study to reduce intra-follicular oxidative damage, and increase fertilization and pregnancy rates in IVF poor responders at a dose of 3 mg per night for 5–6 weeks leading up to egg retrieval.^30,31

Inositol – a naturally occurring carbohydrate that is found in phospholipids which function as cellular mediators of signal transduction in metabolic regulation and growth. One recent trial claimed that using Inositol 4 g/day, and Melatonin 3 mg/day together, improved oocyte quality and pregnancy rates.³²

Losing weight

A Damp condition often causes weight gain or even obesity because the body’s metabolism is severely hampered by the congestion of stagnant fluids. Treatment consists of clearing Damp generally, so that metabolism improves and specifically so that ovulation proceeds. The weight loss that follows is usually accompanied by a return of fertility.

It is encouraging for your overweight patients to know that a little bit of weight loss goes a long way to improving fertility. Losing just 5 kg is a manageable target for most and once the Damp starts to mobilize reproductive health quickly responds. Just moving the metabolism a little bit in the direction of burning off fat stores can stimulate ovarian activity, improve egg and sperm quality, and increase fertility.

Chinese herbs are often prescribed to help weight loss. They regulate bowel transit time, reduce fluid retention, encourage efficient metabolism and increase energy levels. Herbs which specifically boost the function of the Spleen in transforming and transporting foods and clearing Damp are a good support to metabolism.

Formulas such as Xiang Sha Liu Jun Zi tang whose function is to Harmonize the Digestion, are a good basis from which to start.

For poor sleep add:

For poor digestion from overeating or food stagnation add:

For fluid retention add:

For constipation or sluggish bowels add:

There are some further additions that can be made, in the short term, to stimulate digestion and movement in the digestive tract, i.e., remove food stagnation and phlegm.

These include the following seeds and fruits:

(Other citrus peels such as Chen Pi, Qing Pi, Ju Pi and Fo Shou can also be used for this).

Adding herbs such as those below, when cooking a pot of porridge, provides a nourishing meal with the recommended fiber to help control insulin resistance and also helps to clear Phlegm-Damp

• You need to move. And make moving enjoyable.

• If you are highly motivated, go to the gym three times a week to do aerobic classes

• or walk daily and briskly for 30 min in a pleasant green environment

• or engage regularly in some other strenuous activity you enjoy.

• For men, choose swimming rather than cycling or long distance running.

• If you are less enthusiastic about exercise, get a personal trainer who will tailor exercise to your needs and provide the motivation to keep going. Or join a boot camp exercise group which meets several times a week, or set one up with your friends.

• A small time investment of high intensity training helps reduce insulin resistance (a personal trainer is useful for this sort of exercise program).

• For those people for whom this level of activity is not possible or advisable, then gentle movement like Tai Chi or yoga is appropriate. These forms of movement can still help weight loss, albeit more slowly – Tai Chi, e.g., burns as many calories as downhill skiing! And as the Qi recovers, the capacity to metabolize more efficiently increases.

Sleep and sex hormones

Lack of sleep affects ovulation, causing menstrual irregularity and delaying conception. A large proportion (50%) of women who work in notoriously sleep-deprived professions, e.g., flight attendants, nurses, and other night-shift workers experience irregular and erratic periods and in some cases, infertility.^69,70

In many cases, these women stop having periods altogether. Sleep disrupted by night-shifts at the time of ovulation and conception may also increase the odds of miscarriage. In general, getting <8 h a night sleep is considered a risk factor for 1st trimester miscarriage.⁷¹ In an ideal world, men and women trying to conceive should avoid shift work, or skimping on sleep, or if this is impossible, they should make a concerted effort to catch up on sleep when they can.

Lack of sleep can also cause a slump in sperm production. Testosterone production in men occurs during the night, normally increasing by 20–30% and cutting back on sleep drastically reduces testosterone levels.⁷² This may be one of the reasons for the observed decline in male fertility in modern times.

One of the main functions of sleep in TCM physiology is to allow the Liver Blood to gather and build. This is important for normal Liver Qi movement and in maintaining sufficient Heart Blood. Lack of sleep and insufficient Liver and Heart Blood resources create a vicious cycle where maintaining sleep becomes more and more difficult. When Heart Blood is deficient, the Shen becomes unsettled and deep sleep is illusive. This creates the stage for Bao Mai dysfunction, menstrual irregularities, and risk of miscarriage. Additionally, chronic lack of sleep draws on Kidney reserves, depleting Kidney Yin, Yang and Jing and compromising potential fertility.

Conversely, levels of sex hormones have a profound effect on sleep patterns, especially in women, which in turn has an effect on neuroendocrine functioning. Since the same part of the brain that regulates sleep–wake hormones also stimulates daily pulses of reproductive hormones for men and women, some feedback between these systems is likely. Women who suffer from premenstrual symptoms have been shown to get less of the deep slow brain wave stages of sleep than asymptomatic women.⁷³ Here we see the connections between Liver Qi stagnation, Liver Blood deficiency and sleep.

Sleep and metabolism

Sleep scientists at the University of Chicago have found that those who suffer from an accumulated sleep debt may develop serious ongoing health problems. Sleep deprivation causes alterations in metabolic and endocrine function that show all the hallmarks of aging. The odds of becoming obese and developing metabolic syndrome (including diabetes, heart disease, high blood pressure) are nearly doubled in men and women who sleep <6 h, compared with those who sleep between 7 and 8 h/night.^74–77

Being overweight or obese has significant deleterious effects on fertility in men and women (as we saw above). Weight loss is an important part of improving fertility but it is hard to lose weight if sleep is inadequate. In fact, weight loss programs are 50% less effective if they are not accompanied by adequate sleep. Less sleep results in increased hunger but lower resting metabolic rate; a sure recipe for weight gain, not weight loss. Lack of sleep also raises levels of ghrelin. This hormone not only reduces energy expenditure but promotes the retention of fat.⁷⁸

Over and over, overweight, overworked women, or overweight mothers of young families have demonstrated that being chronically tired (failing Spleen Qi) can make you fat, and now the clinical research confirms it!

So important is the role of sleep in weight loss that the Stanford Sleep Medicine Center in California has suggested that sleep needs to be included in weight loss packages that have traditionally focused on just diet and exercise. Skipping sleep does not just consume Kidney energy, it risks damaging the Spleen.

We spend Qi all day, every day, some of us more than others. The only way to replenish this essential resource is to take in fuel, keep breathing, and to rest. We are all familiar with the role of the Spleen in maintaining good metabolism, the efficient movement, absorption and use of nutrients, and removal of waste products. When the Spleen Qi weakens and any of these steps are compromised, then fat deposits occur, boggy congested tissue starts to appear and weight is gained. Alongside eating the right foods in the right quantity, and breathing, sleep is essential to safeguard optimal Spleen function.

Sleep and stress

Anxiety levels increase incrementally, the longer sleep loss continues. Sleep restriction affects biologic mechanisms involved in the stress response. The two major neurobiologic transmitters of the stress response (cortisol regulation and sympathovagal balance) show significant changes after just a few days of sleep restriction.⁷⁹ However, emotional and physiologic stress caused by lack of sleep is reversible once sleep loss is recovered.⁸⁰

Levels of stress hormones are higher and thyroid hormones are also disrupted when sleep is cut short. Mental sharpness and the ability to concentrate effectively and remember, have been shown to be affected by inadequate sleep.

Lack of sleep and the resulting compromised stores of Liver Blood creates the conditions for Heart Blood deficiency and a disturbed Shen and mental agitation, and also Liver Qi stagnation and enhanced stress reactions. Lack of Blood and Qi feeding the brain will also contribute to memory problems.

Sleep and the immune system

The complex and intimate interactions between sleep and the immune system have been the focus of study for several years. The equally complex and intimate interactions of immune factors and fertility are also currently the object of intense research.

We know that certain immune factors (cytokines) regulate sleep and in turn are altered by sleep and sleep deprivation. People with chronic insomnia tend to have higher levels of some cytokines, notably interleukin-6 and tumor necrosis factor.⁸¹ These immune factors can impact on certain parts of the reproductive system, particularly implantation of the embryo and placental development. Some researchers have proposed that a suboptimal cytokine environment can contribute to miscarriage.⁸²

Certain cytokines can lead to clotting of the placental vessels in cases of early or late pregnancy loss, or interference of angiogenesis in cases of occult pregnancy loss. Disturbed sleep also increases inflammatory processes in the body.⁸³ Thus, regulating the immune system, particularly in its autoimmune aspects, is another reason for encouraging sufficient and sound sleep.

Ensuring smooth movement of Blood and Qi and adequate Kidney Yin levels will help prevent the scenarios we often see in autoimmune conditions, i.e., Heat and inflammation from Yin deficiency and Blood stasis from insufficient Blood or poor Qi movement.

Although not so related to reproductive issues directly, other immune issues, i.e., inadequate defenses against infection, are seen more often in sleep-deprived people. Here we see a consequence of reduced Wei Qi from compromised Kidney Yang function.

A good night’s sleep

What, then, does sufficient and sound sleep actually mean?

It means allowing the body to build resources like the Blood, the Qi, the Yin and the Yang, all of which fit into our picture of optimal fertility in the many different ways we have outlined above. This takes a lot of hours of maintaining a deeply quiescent state of the mind and body.

It may be the case that those hours before midnight, which our grandmothers always told us were the most important, are the time that the Kidney Yang in particular is recuperated. Certainly, it is in those first few hours of sleep when we experience slow brain wave sleep, the deepest type of sleep, that growth hormone is secreted, and the first stage of learning and memory is carried out as newly acquired information is sent from the hippocampus to the cortex. The early morning hours of sleep seem to be the time when the mind gets its rejuvenation and when the second stage of learning is carried out as memory is solidified in the cortex during the replays of REM (rapid eye movement) sleep.⁸⁴

With the clarifying and steadying action on the mind which early morning dream sleep (REM) brings, the deep levels of Yin have the chance to recuperate too. In summary, it is the early bedtime and the early morning hours of sleep that are important for regenerating Kidney Yin and Yang.

Attention to sleep is especially important after the age of 30, when both capacity for deep sleep and the production of growth hormone start to decline quite rapidly,⁸⁵ paralleling the decline in Kidney Yin and Yang which begins at this time.

In summary, sleep is clearly important for many reasons: preserving the Spleen Qi and Liver Blood, regulating the Heart Qi, and regenerating Kidney Yin and Yang. For couples trying to get pregnant, long and deep sleep is very important even if it no longer comes quite so easily once they are past their mid-30s. Acupuncture and herbal remedies are quite effective at helping to achieve healthy sleep patterns as we all know. (For representative herbal formulae and acupuncture point prescriptions for various types of sleep disturbance, refer to the Clinical Handbook of Internal Medicine, Vol. 1.)⁸⁶

Caffeine

A large study carried out by the Yale Medical School found that the risk of infertility (which they defined as not being able to conceive after 12 months) was 55% higher for women drinking just 1 cup of coffee per day; 100% higher for women drinking 1.5–3 cups per day; and 176% higher for >3 cups per day,⁸⁷ and this was backed up 5 years later by a study in Europe, which found that high caffeine intake in women slowed rates of conception.⁸⁸ The effect of caffeine on the fertility of men has not been examined to the same extent but one study did find a delay in conception related to caffeine intake though the dose was not significant.⁸⁹ Additionally, there is evidence that coffee drinking in men and women increases miscarriage rates and that caffeine intake during pregnancy has a negative influence on fetal growth.^90,91

Most studies indicate that it is the consumption of ≥300 mg of caffeine daily that can lead to fertility problems. It is estimated that >20% of Australians and Americans drink more than 350 mg/day. So, coffee drinkers having difficulty falling pregnant may well be advised to reduce their intake significantly, switch to low-caffeine varieties of tea, or to find alternatives for their morning and afternoon cuppas.

Alcohol

Many couples are told that they should stop drinking alcohol altogether in preparation for conception. But the evidence for such prohibition is not clear cut. Exploring the literature on the effect of alcohol on fertility, it would appear that alcohol has little effect on fertility in some countries and a dramatic effect in others. For example, the Italians are quite sure that alcohol intake has no negative effect on their ability to fall pregnant.⁹² Similarly, other large studies carried out in a number of countries in Europe have been able to demonstrate no relationship between moderate alcohol intake of men and women and ability to get pregnant,⁹³ although heavier consumption (defined as >8 drinks a week) did have a negative effect.

A study in Denmark⁹⁴ showed that women who drank moderately (2 glasses a week to 2 glasses a day) conceived more quickly than those who didn’t drink at all. However, before advising all prospective parents to raid their cellars, it should be noted that these results do not mean that consuming alcohol is better for fertility than not drinking alcohol at all. Non-drinkers differ from moderate drinkers in many other aspects; for instance, they may have a weaker constitution or other health problems that can influence fertility, directly or indirectly. In addition, alcohol drinkers may have a higher frequency of sexual intercourse.

Women do metabolize alcohol much less efficiently than men and there is certainly evidence to suggest that alcohol can increase incidence of some gynecological and other disorders which might contribute to infertility. Alcohol consumption is associated with altered estrogen and progesterone levels as well as menstrual irregularities and increased incidence of endometriosis, abnormalities in the ovaries, impaired implantation and blastocyst development and the early onset of menopause.⁹⁵

Some studies have found evidence that moderate drinking by women (5–10 drinks per week) is linked to lower fertility and increased miscarriage.⁹⁶ And others have found a definite relationship between even modest alcohol consumption in women (<5 drinks/week) and delay in conception.^97,98

Alcohol consumption by men in many of these studies seemed to have little effect on fertility of the couple. However, very heavy drinking on the part of the male partner significantly negatively impacts the time it takes for a couple to conceive.⁹⁹ Excessive alcohol consumption can induce testicular atrophy, impotence, reduced libido, and cause a deterioration in sperm count.¹⁰⁰

It therefore seems that evidence can be found to support either camp on this issue, but most professionals working in the field of fertility will advise against too much alcohol consumption on the part of either partner for both general health reasons and consideration of health of the gametes. Completely restricting all alcohol intake in couples (with no history of, or reasons for infertility) planning to become pregnant is not justified.

There is however some good evidence to suggest that couples should abstain from alcohol in the lead up to starting an IVF cycle. Consumption of as few as four alcoholic drinks per week (either partner) is associated with a decrease in IVF live birth rate.¹⁰¹ Other researchers have found that alcohol consumption by the woman in the month before IVF meant reduced numbers of eggs collected and by the male partner meant reduced live birth rates.¹⁰² The European Society of Human Reproduction and Embryology has issued guidelines for ART specialists, saying that: ‘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.’¹⁰³

From a TCM point of view, excessive or chronic use of alcohol can increase internal Heat or Damp-Heat. Thus, a patient with a tendency to a Hot or Damp-Heat constitution (especially the larger or ruddy type), who is trying to conceive will be advised to limit alcohol severely. On the other hand, colder or Qi-deficient patients trying to conceive may positively benefit from small amounts of red wine taken with food. The doctor of Chinese medicine should be able to give discerning and educated advice to individual patients about the consumption of alcohol.

Once pregnancy is confirmed, then all or nearly all alcohol consumption by the mother should be avoided for the duration of the pregnancy and breast-feeding. Alcohol has been shown to have effects on the child both before and after birth.

Nicotine

The effect of smoking has been examined by many researchers and the general consensus here is the same. Most studies have shown negative effects of smoking on reproduction, and in couples where either partner smokes, it takes longer for them to conceive.¹⁰⁴

Female smokers also experience the menopause earlier than usual. Additionally, smoking has been strongly associated with tubal factor infertility, and it has been linked to increased rates of miscarriage. The effects of smoking are also felt at the level of the uterine lining, affecting its receptivity to the embryo.¹⁰⁵

Smoking has also been shown to have a deleterious effect on sperm counts. On average, smoker’s sperm counts are nearly 20% lower than non-smokers. And when smokers stop smoking, their sperm counts were seen to rise between 50% and 800%, indicating that toxic chemicals in the tobacco have a very deleterious effect on sperm production but that these effects can be reversed.¹⁰⁶

Marijuana

Women trying to conceive are generally advised to avoid marijuana. This is on the strength of animal studies which showed that THC (the active ingredient in marijuana) is toxic to the developing egg and at certain levels, could delay ovulation markedly.¹⁰⁷

There is also ample evidence demonstrating a damaging effect by THC on sperm production and function. Sperm production and motility have been shown to be drastically reduced in heavy marijuana smokers and new research indicates that the THC might also interfere with the binding of the sperm to an egg and its ability to fertilize it.¹⁰⁸

Junk food

A junk food diet is one which is high in fat and sugar and low in nutrients. Fat and sugar are not actually drugs, however many of us are addicted to them.

A diet high in fat, especially trans-fat, such as that found in many processed and take away foods, is associated with lower sperm counts, whereas higher intake of omega-3 fats (in fish and some vegetable oils) improves sperm quality.³²

Men who eat a lot of processed foods (and meat) have poorer sperm quality (in particular motility) than men who eat more fresh foods and fish.¹⁰⁹ Men who drink 1.2 litres (a quart) or more of cola daily have sperm counts almost 30% lower than men who drink no cola.¹¹⁰ This finding could be related to the caffeine or the sugar content of such a high consumption of cola. The excessive amount of sugar would certainly contribute to insulin resistance and excess weight (which we saw above had a negative impact on fertility).

Assessing the effect of junk food on egg quality is more difficult than it is for sperm, however the diet that appeared to promote fertility in the Nurses study quoted above was based on whole foods and avoided junk foods.^9,10

Eating more whole foods appears to have a good effect on reducing C Reactive protein (CRP) levels which are correlated with fertility in women.¹¹¹

Other drugs

Polychlorinated biphenyls or PCBs

This family of chemicals, which includes DDT, concentrates through the food chain, accumulates in fat tissue, and comprises the bulk of organochlorine residues in human tissues. They can be detected in follicular fluid of infertile women doing IVF.¹³³ Human reproductive toxicity of PCBs has been examined in studies of fishing communities, fish eaters and the general population.^134,135 The level of PCBs (and phthalates) are higher in the semen of infertile men than that of men with normal fertility. The highest concentrations were found in fish eaters.¹³⁶ More Y chromosome bearing sperm are manufactured in men who are exposed to higher levels of PCBs, and sperm motility overall is reduced.^137,138

Polybrominated diphenyl ethers (PBDEs)

We are exposed to PBDEs which can leach out into the environment and accumulate in human fat cells mostly through food and house dust. These chemicals are endocrine disruptors which have a damaging effect on male reproductive hormones and fertility.^139,140 Additionally, PBDE levels are associated with increased odds of subclinical hyperthyroidism in pregnant women (and therefore increased risks of adverse pregnancy outcomes)¹⁴¹ and can compromise fetal health resulting in low birth weight babies.¹⁴²

Phthalates

The general population is exposed to phthalates through consumer products, as well as diet and medical treatments. Phthalates are thought to have damaging effects on fertility, particularly on sperm.¹⁴³

Bisphenol A (BPA)

BPA is another ubiquitous chemical in the industrial world, which has the potential to interfere with biological processes because its structure resembles estrogen. More than 90% of the US population have detectable levels of urinary BPA.

Research has shown that BPA disrupts normal development of oocytes and increases DNA fragmentation in sperm.^144,145

Women with higher serum or urinary levels of BPA not only have poorer quality oocytes, but also reduced fertilization rates and higher implantation failure rates in IVF cycles.^146,147

It is not only in fertility stakes that this common environmental pollutant causes damage. BPA also appears to affect in utero development, particularly of baby girls. Those girls who are exposed in utero show impaired behavioral and emotional regulation when they are toddlers.¹⁴⁸

Perfluorinated compounds (PFCs)

Grease-resistant products are often coated with this compound, including stick-resistant cookware, dental floss, and carpets. Exposure to PFCs risks lower conception rates, i.e., it takes longer to become pregnant.¹⁴⁹

4-vinylcyclohexene diepoxide (VCD)

VCD is a metabolite of a product released during the manufacture of rubber tires, flame retardants, insecticides, plasticizers, and antioxidants. It is well known as an ovarian toxicant and has been shown to quickly destroy oocytes in animal studies.¹⁵⁰

Trichloroethylene (TCE)

TCE is used as a solvent and degreaser. Mechanics and others who work with engines are frequently exposed to this chemical and the seminal fluid of mechanics contains discernible levels of TCE.¹⁵¹ Others are exposed to TCE through contaminated drinking water; seepage of this compound into groundwater has raised health concerns in many locations.

Exposure of mice to TCE affects the ability of sperm to fertilize eggs, even at levels that have no discernible effect on the testes or the count or motility of the sperm. Similarly, maturing oocytes are susceptible to even very short in vivo exposures to TCE which reduces their ability to be fertilized and form embryos.¹⁵²

Alkylphenol ethoxylates (APEs)

APEs are commonly used in cleaning products like laundry powder and cleaning products used in the kitchen. The breakdown products of these detergents are found throughout the natural environment now, especially in the waterways, where they are wreaking havoc with the reproductive systems of some aquatic organisms such as turtles, fish, and frogs. APEs are also found in house dust and food^153,154 and have been shown to have damaging effects on the reproductive system in laboratory studies.¹⁵⁵

Some countries have taken steps to ban these chemicals.

Glycol ethers

Glycol ethers are a large group of organic solvents used in industry and the home as glass cleaners, carpet cleaners, floor cleaners and oven cleaners. They are absorbed as volatile fumes from the air by the skin as well as inhalation. Animal studies have reported testicular damage, reduced fertility, early embryonic death, birth defects, and delayed development from inhalation and oral exposure to the glycol ethers.¹⁵⁶ Occupational exposure to glycol ethers has also been shown to result in reproductive and developmental impacts in humans. Studies of exposed male workers show that glycol ethers can reduce sperm counts and pregnant women exposed to glycol ethers in their work environments are significantly more likely to have children with birth defects such as neural tube defects and cleft lip.^157,158

Heavy metals

Exposure to heavy metals has also been implicated in reproductive disorders and fetal mal-development. Mercury – which is present in fish at the top of the feeding chain (e.g. tuna or shark), in some industrial chemicals used in printing processes and in leaking dental amalgams – is antagonistic to zinc, a mineral thought to be very important in many body functions, including gamete manufacture. Some populations with high blood mercury levels are less fertile than those with lower levels.¹⁵⁹

Lead, which is found in all city dust, contaminated soil and water, and in painted finishes in older houses (pre-1960), can affect sperm manufacture and can cause miscarriages. High blood levels of lead in men are associated with delayed conception.¹⁶⁰ Lead also interferes with the metabolism of iron, an important mineral in reproductive health.

Cadmium is another heavy metal which, when present at high blood levels in women, has been associated with pregnancy loss and delayed conception.¹⁶⁰ It is used in the manufacturing process of plastics, ceramics, metals, rubber, pesticides, some refined foods, and cigarettes. Air-borne particles of Cadmium (e.g., from cigarette smoke) can travel over long distances and may be accumulated in animals, fish, and plants. Like mercury, it is antagonistic to zinc.

Electromagnetic fields

• Don’t smoke (anything).

• Sleep 7 or 8 h a night.

• Exercise regularly but not too much. Make it fun.

• Eat organic foods where possible and enjoy a good wholesome tasty diet.

• Take a preconception vitamin formula.

• Drink plenty of fluids – but not of the alcoholic or caffeinated variety.

• Have plenty of sex but not at the cost of adequate sleep.

• Avoid fumes where ever possible.

• Don’t worry too much or get stressed about trying to follow all of the above advice.

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