Pre-conception

Question 1

What is fertility?

Answer 1

Actual production of children (although commonly used to refer to the ability to bear children - see ‘fecundity’)

Question 2

What is infertility?

Answer 2

Failure to conceive after 1 year of unprotected sexual intercourse with the same partner

Question 3

What is subfertility?

Answer 3

Reduced level of fertility characterised by unusually long time to conception (over 12 months) or repeated, early pregnancy losses

Question 4

What is fecundity?

Answer 4

Biological ability to bear children

Question 5

What is infecundity?

Answer 5

Biological inability to bear children after 1 year of unprotected sexual intercourse with the same partner

Question 6

What is miscarriage?

Answer 6

The loss of a foetus in the first 20 weeks of pregnancy. Also known as ‘spontaneous abortion’.

Question 7

What do unfavourable conditions at pre conception lead to?

Answer 7

Adaptation

Suspension of reproductive function (infertility)

Question 8

What percentage of cases of infertility are due to male physiological factors and what does that mean for nutritionists?

Answer 8

Whilst we often associate infertility with women, male physiological factors have been shown to be responsible for ∼25% of cases. We therefore must consider the health, wellbeing and nutritional status of both partners.

Question 9

Se and sperm?

Answer 9

Se appears to have positive effect on sperm by increasing glutathione peroxidase-1 activity an antioxidant enzyme which scavenges hydrogen peroxide and quenches reactive oxygen species. Sperm are particularly susceptible to oxidative stress.

Question 10

Zn and sperm?

Answer 10

Zn acts as a membrane-stabilizing source by inhibiting membrane-bound oxidative enzymes such as NAD(P) oxidase, which increases sperm concentration and motility. Zn is also required for correct sperm DNA condensation/descondensation. Some studies suggest that chromatin stability of the ejaculated human spermatozoon is Zn-regulated and that Zn controls the formation of disulfide bridges. Low content of sperm chromatin zinc has been related with some cases of male infertility

Question 11

Omega 3 and sperm?

Answer 11

Studies suggest that they act by modifying the cell membrane composition through their incorporation into the spermatozoa cell membrane, helping functionality of the cell.

Question 12

CoQ10 and sperm?

Answer 12

can inhibit organic peroxide formation in seminal fluid, reducing sperm OS and increasing the sperm quality

Question 13

Food sources of selenium?

Answer 13

Many whole grains and dairy products, including milk and yogurt, are good sources of selenium. …
Pork, beef, turkey, chicken, fish, shellfish, and eggs contain high amounts of selenium.

Question 14

Food sources of zinc?

Answer 14

Whole grains and milk products are good sources of zinc. Many ready-to-eat breakfast cereals are fortified with zinc.
Oysters, red meat, and poultry are excellent sources of zinc. Baked beans, chickpeas, and nuts (such as cashews and almonds) also contain zinc.

Question 15

Carnitines and sperm?

Answer 15

Carnitines, such as L-acetyl carnitine (LAC) and L-carnitine (LC), act as a transporter of long-chain fatty acids into the mitochondria providing energy for use by spermatozoa.

Question 16

Food sources of carnitines?

Answer 16

Red meat and in smaller amounts in chicken, milk and dairy products, fish, beans, and avocado.

Question 17

Fruit and veg and sperm?

Answer 17

High in antioxidants which can act as sperm ROS regulators reducing sperm DNA damage and increasing sperm motility and vitality. Also high in folate which may have an important role in spermatogenesis. folate-deficient diets could result in an alteration of sperm DNA methylation at genes implicated in development and some metabolic processes.

Question 18

Fibre and sperm?

Answer 18

fibre consumption could reduce plasma estrogen levels. This is important, because high estrogen levels could disrupt endocrine homeostasis, which is essential for normal spermatogenesis

Question 19

Why might breakfast cereals be good for conception?

Answer 19

they are commonly fortified with antioxidants and minerals which are helpful for conception.

Question 20

What should red meat be substituted for to improve sperm quality? What is a pontential down side of this.

Answer 20

Fish which is helpful because it is high in omega 3. However, these beneficial effects can be negatively affected by the high concentration of some environmentally-persistent organic pollutants in the fish, as well as mercury (Hg) and other neuro-toxic elements.

Question 21

Poultry’s effect on sperm?

Answer 21

Positive effect on sperm although has to be interpreted cautiously because of the different use of antibiotics in different places. Researchers are unable to explain why poultry was beneficial.

Question 22

Are dairy products good for sperm?

Answer 22

Full-fat dairy is bad for sperm, but low fat dairy is good. Low-fat and skimmed milk consumption have been associated with increased levels of insulin, probably via increasing levels of insulin-like growth factor 1 (IGF-1), animal studies indicated that subcutaneous insulin administration may increase sperm motility and concentration.

Question 23

What kind of nuts should you have to improve sperm quality?

Answer 23

A mix (probably almonds, hazelnuts, and walnuts) because it reduces DNA fragmentation in sperm.

Question 24

What two diets are helpful for sperm?

Answer 24

prudent diet, which is characterised by a high consumption of fruit, vegetables, fish, legumes, poultry, and whole grains.
Mediterranean diet (MD) is characterized by a high consumption of olive oil, nuts, fruits, vegetables, legumes, and whole cereals, along with a moderate consumption of fish, poultry and wine

Question 25

All the benefits of folate/folic acid for pregnancy? Potential concerns?

Answer 25

Folate, involved in the synthesis of DNA, is crucial in gametogenesis, fertilization, and pregnancy. Therefore, folate (natural form of vitamin B9) or folic acid (synthetic form of vitamin B9) may play an important role in human reproduction. Prevents NTDs and is no longer associated with spontaneous abortion.

Question 26

What does vitamin D do and what could it potentially be helpful in?

Answer 26

vitamin D stimulates ovarian steroid synthesis, promotes follicular maturation, and regulates gene expression involved in successful implantation, and its deficiency may be involved in the development of PCOS. Deficiency related to worse ART outcomes but not worse regular fertilisation

Question 27

What are the recommendations for men before conception? and why?

Answer 27

The male sperm cycle is thought to be 74 days +/- 4.5 days so at least 2 - 3 months prior to intended time of conception consume a balanced and varied diet moderate alcohol intake Correct grossly abnormal body weight (BMI at upper end of normal range) Normal range is 18.5- 24.9

Question 28

What are the recommendations for women before conception?

Answer 28

Consume a balanced and varied diet Correct grossly abnormal weight well in advance of conception (at least 4 months) BMI at upper end of normal range at most Stop smoking Moderate alcohol intake Commence folate supplementation at least 3 months prior to conception

Question 29

What might increase ovulatory function in PCOS women but appears to be unrelated in healthy regularly menstruating women?

Answer 29

Reduction in dietary carbohydrates among PCOS women improved insulin sensitivity and decreased circulating testosterone levels, potentially enhancing ovulatory function.

Question 30

Whole grains and fertility?

Answer 30

Whole grains have phytic acid, vitamins, and selenium, which have antioxidant anti-inflammatory properties and beneficial effects on glucose metabolism, this could boost fertility because insulin resistance and oxidative damage have been implicated in the pathogenesis of subfertility. Lignan in whole grains may exert reproductive benefits. Whole grains eaten before preconception were related to more live births.

Question 31

Omega 3 and trans-fat's relationship with pregnancy?

Answer 31

fatty acids are used as energy during oocyte maturation and early embryo development, and they serve as critical precursors for a variety of substrates playing a vital role in implantation and pregnancy maintenance. Trans fatty acids increase insulin resistance, adversely affecting the ovulation, however research is mixed. Increased long-chain u-3 PUFA intake was associated with increases in luteal progesterone concentration, long-chain u-3 PUFA (fish) was associated with increased ovary estrogen and lower risk of anovulation, taken together, higher u-3 PUFA and lower trans fatty acid intake may enhance female fertility.

Question 32

What meat was bad for ART outcomes?

Answer 32

blastocyst formation following ART was decreased among patients consuming more red meat

Question 33

How much fish should a pregnant/ women who may become pregnant consume? Which fish to be carful about and why?

Answer 33

Two to three servings of a variety of fish per week, with no more than one serving per week of fish such as albacore tuna, and to avoid fish (e.g., bigeye tuna, king mackerel, swordfish) with the highest mercury concentrations.

Question 34

What is menarche and what is the trend that has occurred over the years?

Answer 34

first occurrence of menstruation and over the years it has been occurring younger and younger in women.

Question 35

What is the critical fat hypothesis? Evaluations?

Answer 35

Critical fat hypothesis states that girls need about 24% body fat to be reproductively mature. Lacks the link between fat mass and hypothalamus which triggers hormonal changes. A hypothesis as to why girls are starting their period younger.

Question 36

What is the metabolic signal hypothesis?

Answer 36

Proposed the availability and oxidation of metabolic fuels is linked to reproductive ability, possibly by metabolites being sensed by the brain and the liver. Leptin may play a role but it is unclear. This is another theory as to why women are getting their periods earlier.

Question 37

What can delay puberty in boys?

Answer 37

Under nutrition.

Question 38

What can happen to a women who starts menarche and then becomes under nourished?

Answer 38

Irregular or infrequent menstruation Amenorrhoea in excessive weight loss / anorexia nervosa This can occur in women in particular who do a lot of sport. The reasons this might happen is to prevent pregnancy so they don't give birth to an infant they cannot sufficiently nourish and to protect the mother so she can conserve energy because she is not getting enough. But pregnancey can still occur lowest weight documented was 14.9 kg/m2.

Question 39

What is there increases frequency of for undernourished mothers? What should be done?

Answer 39

``` Spontaneous abortion Congenital abnormalities Perinatal mortality IUGR (Intra-uterine growth retardation) Can have healthy offspring by having a healthy varied diet where she gains weight. Under nourished mothers also have decreased sex drive and performance. ```

Question 40

Is there long term effects of a starved mother or is the problem fixed straight away by proper diet?

Answer 40

Long term as in there are still more deaths of babies after a food shortage than without one.

Question 41

How much weight should an Underweight (< 18.5kg/m2) mother gain during pregnancy?

Answer 41

12.5 – 18kg

Question 42

How much weight should an Healthy (18.5 – 24.9kg/m2) mother gain during pregnancy?

Answer 42

11.5 – 16kg

Question 43

How much weight should an overweight (25 – 29.9kg/m2) mother gain during pregnancy?

Answer 43

7 – 11.5kg

Question 44

How much is normal to gain for an obese (>30kg/m2) mother during pregnancy?

Answer 44

6.8kg minimum

Question 45

What happens to men in terms of reproductive functions when they are undernourished?

Answer 45

1. Loss of libido (early effect of energy reduction and subsequent weight loss) 2. Loss of prostate fluid 3. Decreases in sperm motility 4. Decreases in sperm longevity 5. Cessation of sperm production at weight loss of ∼25% normal body weight Weight gain reverses descending order

Question 46

Cycle of subfertility caused by obesity in men?

Answer 46

Obesity, insulin resistance, metabolic syndrome 🠗 Reduced androgen secretion and transport 🠗 Altered androgen status and impaired hormone action =subfertility 🠗 Reduced lipolysis and lipid mobilisation, increased adipogenesis (leads back to the start)

Question 47

What are the causes of decreased sexual activity and function of obese men?

Answer 47

Psychological handicapping (not feeling attractive because your over weight) Gross obesity may alter sex hormone production (Calloway, 1983) Obesity is associated with erectile dysfunction and oligospermia in males (the adipose may keep the sperm too warm) (Derby et al, 2000) Obesity related diseases (interfering with sexual behaviour) Weight may make it harder to have sex

Question 48

Reduced reproduction for obese women?

Answer 48

Increase in ovulatory disorder infertility in women with BMI >30 kg/m2 (Chavarro et al. 2007) Obese women have increased incidence of miscarriage (Norman & Clark, 1998) NTDs in offspring seen more commonly despite adequate folate supplementation

Question 49

What is folate?

Answer 49

The term ‘folate’ refers to the many compounds derived from folic acid. Folate is part of the vitamin B complex (B9). Humans are unable to synthesise folate, and therefore must rely on exogenous sources to provide it.

Question 50

Sources of folate and something to consider?

Answer 50

Rich dietary sources of folate include liver, green leafy vegetables, such as kale and spinach, and also fortified cereal products. The amount of folate that can be absorbed from foods varies.

Question 51

What can destroy folate?

Answer 51

Overcooking can destroy folate.

Question 52

What does the body do to folate to absorb it and? Is folic acid the same?

Answer 52

Natural sources of folate, from food, require conversion from polyglutamates to monoglutamates in the upper small intestine in order to be absorbed. However, synthetic folic acid supplements contain only monoglutamates and therefore are more stable and provide better bioavailability, although they are metabolised slightly differently when compared with folate.

Question 53

Role of folate in the body?

Answer 53

Folate has two known important biological roles. It acts as a cofactor for enzymes that are essential in the synthesis of DNA and RNA, and is required in the transfer of methyl groups in the amino acid methylation cycle, an important step in the recycling of homocysteine back to methionine.

Question 54

RNI for folate in men and women? Reason for these values?

Answer 54

The RNI for both men and women has been set at 200 μg/d, since the slightly smaller requirement for women due to lower lean body mass may be offset by a greater requirement for reproduction.

Question 55

Which groups are more likely to be folate deficient in the UK?

Answer 55

Women between 11 and 24

Question 56

Factors that increase the risk of low folate status?

Answer 56

smoking, non-use of vitamin-mineral supplements, pregnancy, oral contraceptive use, high parity (had 5 or more babies)

Question 57

What is neurulation?

Answer 57

Neurulation is the process, occurring during early pregnancy, which transforms the flat neural plate into a tube that becomes the brain and spinal cord. The neural tube is formed and closed by the end of the seventh week of pregnancy.

Question 58

What are NTDs and what are some examples?

Answer 58

Neural tube defects arise as a result of the failure to close the neural tube at specific sites. NTDs are one of the most common congenital malformations and include spina bifida, anencephaly, and encephalocele.

Question 59

What is spina bifiba?

Answer 59

Spina bifida is when a baby's spine and spinal cord does not develop properly in the womb, causing a gap in the spine.

Question 60

What is anencephaly?

Answer 60

a severe congenital condition in which a large part of the skull is absent along with the cerebral hemispheres of the brain.

Question 61

What is encephalocele?

Answer 61

Encephalocele is a neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull.

Question 62

UK current rate of NTDs?

Answer 62

They affect around one in 1,000 pregnancies, with 190 babies born alive with an NTD in the UK every year

Question 63

Changes in amount of NTDs in the uk?

Answer 63

Wend down from 1970s to 1990s but went up again but by not as much now.

Question 64

What were the results of folic acid consumption and why it was or wasn't consumed after health campaigns?

Answer 64

Awareness of folic acid levels prior to conception improved post-campaign from 6 to 41%. Knowledge about consumption and correct periconceptional use of folic acid also improved. However, in most studies more than 50% of women did not take folic acid as prescribed. Factors associated with or without taking folic acid post-campaign: incomplete outreach, prior awareness and knowledge, closeness to pregnancy, demographics and other personal characteristics. Sustained campaigns are needs.

Question 65

Recommendations for folate for women who are planning to become pregnant?

Answer 65

take a folic acid supplement containing 400μg (0.4mg) folic acid per day for at least three months prior to conception and continuing until the 12th week of pregnancy.

Question 66

Recommended dose for those at higher risk of having children with NTDs and who are these People?

Answer 66

recommended to take a 5000 μg (5 mg) Woman who have/are: coeliac disease (or other malabsorption state), diabetes mellitus, sickle-cell anaemia, is taking anti-epileptic drugs. Couple: either partner has a neural tube defect, either partner has a family history of neural tube defects, a previous pregnancy affected by a neural tube defect

Question 67

What else should be considered other than folate supplementation?

Answer 67

shouldn't just be dependent upon a supplement to achieve a good folate status. Women planning to conceive are encouraged to choose folate fortified foods, and avoid over-cooking folate rich foods

Question 68

How much folic acid is in 100g of fortified non- wholemeal wheat flour in the uk?

Answer 68

240 μg folic acid/ 100g flour

Question 69

What did the SACN report find about consuming 1mg/d of folic acid?

Answer 69

It did not mask B12 anaemia or accelerate/aggravate cognitive decline in older adults. However this doesn't change the UL of folate which is 1mg/d

Question 70

Folate and cancer?

Answer 70

Unclear if there is a risk with cancer but people aged over 50y and those with a previous history of colorectal adenomas were advised not to consume supplements containing folic acid above the RNI for folate (200 µg/d)

Question 71

What is a genetic cause for NTDs?

Answer 71

MTHFR C677T genotypes

Question 72

What can be done to reduce some potential folic acid risk e.g. in relation to B12, cancer and cognitive decline?

Answer 72

curbs on voluntary fortification and some other measures such as population monitoring of folate status and relevant health outcomes.

Question 73

Which groups are less likely to take folic acid in preparation for pregnancy?

Answer 73

Disadvantaged women under 18, top 10% most deprived women, balck and asian women.

Question 74

As men get older what happens to them in terms of fertility?

Answer 74

testosterone levels begin to decrease and hypogonadism(decreased functional activity of the gonads) results but if testosterone is administered it can suppress spermatogenesis (process of developing male gametes, known as sperm). Semen volume, viability and motility both decrease and DNA damage increases. Can cause an increase in time to pregnancy.

Question 75

What happens in terms of fertility as women get older?

Answer 75

increased aneuploidy (wrong amount of chromosomes)/ decreased euploidy (right amount of chromosomes), this may increase spontaneous abortion and implantation lost. Also overall lower fertility.

Question 76

Obesities effect on male fertility?

Answer 76

more likely to exhibit a decrease in semen quality, concentration and motility. Increase in sperm DNA damage. Erectile dysfunction more comon likely because increased adipose can result in more of the enzyme that converts androgens to estradiol. Decreased inhibin B decreases Sertoli cells (involved in sperm production) and sperm production. Increased levels of leptin which can lead to decrease in leptin receptors in the testes (leptin resistance) could play a negative role in male fertility.

Question 77

Obesities effect on women's fertility?

Answer 77

Higher rates of miscarriage may be due to endometrium (womb lining) receptiveness or higher rates of aneuploidy. Also a decreased implantation (where egg buries itself into womb lining). This could be because of increase in follicular fluid levels of insulin, lactate, triglycerides, and C-reactive protein; there may also be decreases in SHBG. These effects of obesity may be reversible.

Question 78

Impact of being underweight on fertility?

Answer 78

Men: lower sperm concentrations Women: ovarian dysfunction and infertility, preterm births, women with eating disorders may be at a higher risk of infertility.

Question 79

Physical exercise and fertility?

Answer 79

Men: physical exercise aided male fertility, decreased DNA damage and ROS except it seems over 5 hours of cycling. Women: exercise with weight loss for obese women is good for fertility but excessive exercise isn't because a negative energy balance may occur and may result in hypothalamic dysfunction and alterations in gonadotropin-releasing hormone (GnRH) pulsality, leading to menstrual abnormalities, particularly among female athletes. IVF women suffer if they do excessive exercise. Normal amount of exercise appears to be fine.

Question 80

Stresses effect on fertility for men?

Answer 80

Two or more stressful events means that a man is likely to be below WHOs standards for sperm concentration, motility and morphology. Stress and depression are thought to reduce testosterone and luteinizing hormone (LH) pulsing, disrupt gonadal function [64], and ultimately reduce spermatogenesis and sperm parameters. It was reported that actively coping with stress, such as being assertive or confrontational, may negatively impact fertility [69,70], by increasing adrenergic activation, leading to more vasoconstriction in the testes. This vasoconstriction results in lower testosterone levels and decreased spermatogenesis.

Question 81

Stresses effect on women's fertility?

Answer 81

Stress is bad for fertility, receiving some group cognitive intervention or who were part of a support group or working less hours can help. Anxiety is correlated with still births. Alpha amylase (a biomarker of stress), but not cortisol nor adrenalin may decrease fertility mechanisms are unknown, but it is hypothesized that catecholamine receptors could alter the blood flow in the fallopian tubes

Question 82

Dietary requirements for folate in men and women? why are they the same?

Answer 82

The RNI for both men and women has been set at 200 μg/d, since the slightly smaller requirement for women due to lower lean body mass may be offset by a greater requirement for reproduction (Department of Health 1991)