-Nutrition and fertility- undernutrition is ass with infertility

-body fat and fertility- fat cells produce estrogen, testosterone, and leptin (decreases appetite and increases energy expenditure, and
stimulates gonadotropin secretion
-weight loss- in normal weight women, weight loss that exceeds 10-15% usual weight decreases estrogen, LH, and FSH (consequences is
amenorrhea, anovulatory cycles, and short or absent luteal phase (hypothalamic amenorrhea)
-fertility may be improved through the use of GnRH, FSH, and other hormones (2X as many infants born to underweight women
receiving hormones are small for gestational age)
Nutrient Status and fertility- intake of antioxidants such as Vitamin E, C, beta carotene, selenium, and antioxidant rich pigments in veggies and
fruits play imporatn role in fertility
-antioxidant status- related to increased sperm number and motility in infertile men
-zinc status and men- plays important role in the reduction of oxidative stress, in sperm maturation, and in testosterone synthesis. Zinc
supps have been found to improve sperm quality
-plant foods and fertility- women who consume plant based low fat diets are more likely to have irregular menstrual cycles than
omnivores. Effects of high soy food diets diets on fertility may be related to the influence of isoflavones on levels or the activity of
estradiol, or possibly on other hormones such as progesterone and LH
-folate status- related to improved sperm counts, sperm motility, and decreased abnormal forms of sperm
-iron status- related to infertility due to lack of ovulation is related to iron intake (incrased risk of early delivery and development of iron
deficieny in child)
-iodine- deficiency increases risk that children will experience impaired mtnal and physical development)
-Vitamin A- excessive vitamin A intake (retinol, retinoic acid) incrases risk of the fetus will develop facial and heart abnormalities
-isotretinoin teratogen syndrome
-caffeine- increased pregnancy caffeine intake associated with increased risk of spontaneous abortion (500 mg/day)
-alcohol- may influence fertility by decreasing estrogen and testosterone levels and by disrupting menstrual cycles and testicular
function (not associated with spontaneous abortion)
-increased risk of fetal alcohol syndrome and fetal alcohol effects, which include impaired mental and physical development
-heavy metal exposure- exposure to high levels of lead is related to decreased sperm production and abnormal sperm motility and shape
-exposure to excess levels of cadmium, molybdenum, manganese, boron, cobalt, copper, nickel, silver, or tin may also effect
male fertility.
-exercise- delay and interruptions in normal menstrual cylcles appears to result from hormonal and metabolic changes primarily related
to caloric deficits rather than intense exercise
-reduced levels of estrogen may accompany low levels of body fat and amenorrhea
-Nutrition during the periconceptional period- gene function in the embryo and fetus can be modified during early pregnancy by DNA methylation.
Modifications in DNA functional status can affect growth, development, and disease risk later in life by metabolic programming
-Folate Status- neural tube defects as well as oralfacial, urinary tract, and heart defects. NTDs develop within 21 days after conception.
-folate is an essential nutrient required for DNA replication and a as a component of enzymatic reactions involved in AA
synthesis and vitamin metabolism
-encourage women to consume folic acid, highly absorbable synthetic form of this is B vitamin.
-some studies have shown that increased supplementation may have a risk for increased prostate cancer
-iron deficiency is most common deficiency worldwide- can generally be improved by taking modest doses of iron supplements (18
mg/day) and by regular consumption of vitamin C rich fruits and vegetables along with plant sources of iron, iron fortified cereals and lean meats.
-women with iron deficiency, anemia, may need to take iron supps before conception
-RDI for periconceptional women-
-recommended that women who may become pregnant consume 400mcg of folic acid from fortified foods or supps in addition to dietary
folate from a variety of foods, take no more than 10,000 IU of vitamin A from supps daily, and limit or omit alcohol containing beverages.
Influence of contraceptives- when used together, estradiol and progestin suppress the action of LH and FSH and thereby ovulation. Progestin
blocks LH and ovulation, and by causing the cervical mucus to become thick and sticky it includes a barrier to sperm
-nutritional side effects of hormonal contraception- women using progestin only contraceptives gain on average around 10 pounds within 5 years
of use. (increased fat storage rather than to fluid or lean tissue) (progestin only have also been found to decrease bone mineral accretion in
adolescents)
-combo contraceptives appear to decrease HDL cholesterol, increase LDL cholesterol and TG concentrations, increase blood glucose and
insulin levels, and increase inflammation somewhat
-fertility usually resumes within 3-6 months after contraceptive use stops
-for men, testosterone administration to males suppresses the secretion of LH and FSH, depriving the testes of the signals required for
spermatogenesis
-premenstrual syndrome- begin with luteal phase and end with menses
-symptoms related to enhanced responsiveness to normal changes in ovarian hormone levels that produce ovulation, and to alterations
in the availability of serotonin
-calcium- supps of 1200 mg/day for three cycles have been found to reduce PMS symptoms (may be related to normalization of blood calcium
levels)
-Vitamin B6- involved in the synthesis of serotonin (50-100 mg/day reduce severity of depressive symptoms in some women
-Chasteberry- receiving one 20-mg tablet of chasteberry daily for three cycles reported less irritability, mood alteration, anger, headache, breast
fullness
-weight status and fertility-
-obesity, especially if marked by excess central Body fat is related to insulin resistance and metabolic syndrome
-associated with increased production of androgens (testosterone) by the ovaries
-ovulatory disorders produced by androgen excess are related to anovulation, irregular menstrual cycles, and a delayed time to
conception
-insulin resistance in men is ass with abnormal androgen levels and reduced sperm quality
-sperm has a high content of PUFAs that can be damaged as a result of oxidative stress and chronic inflammation.
-oxidative stress and chronic inflammation are ass with type 2 diabetes, cardiovascular disease, polycystic ovary syndrome, metabolic
syndrome,
-elevated levels of blood glucose, insulin, and FFA may increase production of ROS and nitrogen species that trigger oxidative
stress and inflammation
-adequate intake of the antioxidant nutrients such as vitamin E, C, and beta carotene, as well as the bodys own antioxidant
enzymes, a healthy diet, and aerobic exercise can help prevent oxidative stress
-weight status and fertility in men
-BMI >35 have reduced sperm count, higher volume of sperm with abnormal structure, and sperm with impaired motility
-fat tissue contains aromatase that converts testosterone to estradiol, and this happens in fat people. Increased levels of estradiol inhibit
secretion of luteinizing hormone and follicle stimulating hormone by the pituitary. Alterations in these can lower testosterone synthesis.
-LH stimulates ovulation, the development of the corpus luteum, and the production of testosterone
-FSH stimulates ovarian follicle growth and maturation, estrogen secretion, and endometrial changes characteristic of the first portion of
the menstrual cycle. Stimulates sperm production
 -underweight men (<20 BMI) do not appear to be ass with reduced fertility due to altered sperm production
-weight status and fertility in women
-also results in a higher rate of miscarriage and pregnancy complications (more at risk are central body fat accumulation)
-elevated blood insulin levels reduce sex hormone binding globulin (protein that binds with the sex hormone testosterone and estrogen.
These hormones are inactive when bound to SHBG, but are available for use when needed.- low levels are related to increased availability in the
body) and that prompts the ovaries to increase production of testosterone (excess disrupts egg development)
-BMI <20 kg/m2) may develop anovulation and amenorrhea due to reduced hypothalamic production of gonadotropin releasing
hormone. GnRH stimulates release of FSH and LH from anterior pituitary. Both are needed for egg maturation and release
-weight loss benefits- bariatric surgery are at lower risk during pregnancy than obese women who dont lose weight, but are at higher risk for
deficiencies during pregnancy in thiamin, vitamins B6, B12, and D, and of minerals calcium, iron, copper, and zinc
-poor status of iron, vitamin D, folate, and other nutrients during periconceptional period may impair maternal health and fetal development.
Conception is not recommended after 1st year of bariatric
-Negative energy balance and fertility
-anorexia nervosa and bulimia nervosa are both related to development of hypothalamic amenorrhea in some, but not all women with
these disorders.
-women are more likely to miscarry, experience preterm delivery, and deliver LBW newborns (less than 5.5 pounds)
-very low levels of body fat are related to deficiency of estrogen production in fat cells.
-suppressed activity of GnRH leads to decrease in estrogen production by ovaries. Inadequate estrogen leads to loss of bone mineral
accretion and density, and increase in osteoporosis
-Female athlete triad- simultaneous presence of an eating disorder, menstrual dysfunction, and osteoporosis in otherwise healthy athletes
-energy intake is about 30% less than energy requirement
-this level of energy deficit leads to a loss of LH and FSH, a lack of estrogen production, and other hormonal changes seen in
hypothalamic amenorrhea.
-Vitamin D and calcium supplements may be needed
-Diabetes prior to pregnancy- increased risk of maternal and fetal complications.
-high blood glucose during the first two months of pregnancy is teratogenic (ass with 2-3 fold increase in the incidence of congenital
abnormalities, including malformations of the pelvis, CNS, and heart)
-exposure to high blood glucose during the first 2 months also increases risk of miscarriage
-nutritional management of diabetes prior to pregnancy
-reduce sugar intake and use reasonable amounts of artificial sweeteners. Foods low in glycemic index and high in fiber are encouraged
(high GI foods lead to hyperglycemia
-ample intake of dietary fiber (14 grams per 1000 calories)- increase fruits and veggies also
-reduced calorie diet and physical activity
-gestational diabetes- occurrence during pregnancy increases the risk that type 2 diabetes will occur later in life. (weight loss, increase
dietary fiber by 10 grams/day, exercise prior to preg)
-Polycystic ovary syndrome (PCOS)- leading cause of female infertility- which is primarily related to absence of ovulation)- ovaries of women with
PCOS is thick, hard, and may look yellowish
-many women are obese with increased levels of intra abdominal fat
-excess body hair (hirsutism), acne, high blood levels of insulin, TG, and androgens, and low levels of HDL cholesterol
-less commonly, PCOS is caused by androgen secreting tumors in the ovaries or adrenal glands, other disorders, and some medications,
-high blood levels of insulin stimulates the ovaries to produce androgens, and excess androgens disrupts development of follicles, and
can also lead to excess hair growth,
-women with PCOS are at increased risk of spontaneous abortions, gesttional and type 2 diabetes, hypertension, and CVD
-Nutritional management of PCOS
-primary goal is to increase insulin sensitivity (preferred first line treatment is dietary mods, weight loss, and exercise
-weight loss and exercise improve insulin sensitivity, benefit blood lipids and insulin levels, and lower fasting glucose and testosterone
levels in women with PCOS
-emphasize lean sources of protein, whole grains, fruits and veggies high in antioxidants, ample fiber intake, regular meals, nonfat dairy
products, vitamin D adequacy, and low GI carbs
Phenylketonuria (PKU)- most frequently inherited disorder of amino acid metabolism and is important, preventable cause of intellectual disability
-presence of pheylalanine in the urine of people with this condition. Inherited problem that causes elevation in blood due to very low
levels or lack of the enzyme phenylalanine hydroxylase.
-lack of this enzyme diminishes the conversion of the essential amino acid, and causes phenylalanine to accumulate in blood (impair
nerve fx and interfere with amino acid transport)
-if present during early pregnancy, high levels accumulate in the embryo and fetus and impair normal CNS development. (increase risk
of heart defects)
-the risk increases if this is combined with low protein diets early in pregnancy
-infants born to women with PKU during pregnancy are at elevated risk of seizures, hyperactivity, and abnormal behavioral patterns later
in life
-infants born with PKU be started on low phenylalanine formula as soon as birth as possible.
-some people will consume a low protein diet because rich sources of protein make them lightheaded and easily confused.
-Maternal PKU- PKU diets are for life. Women who go off the PKU diet after childhood and become pregnant are at risk for a condition called
maternal PKU
-PKU can be easily managed by a low phenylalanine diet (maintain blood concentrations 120-360 mol/L) (2-6 mg/dL)
-high phenylalanine protein foods such as meat, fish, eggs, and wheat are excluded from the diet (consumption is met usually by high
protein, low phenylalanine formulas)
-formulated products are generally fortified with tyrosine, vitamins, and minerals
-veggies, fruits, fats, sugars, and high carb foods, and phenylalanine free breads, flours, and pasta are included in the diet. Milk is
allowed if needed to maintain minimal blood levels
-Supplemental DHA (200 mg.day) should be consumed because PKU diets lack dietary sources of this important omega 3 FA) (usually
takes about 4-6 months to lower levels)

Specific foods or nutrients- men

-low zinc intake- reduced sperm volume and testosterone- required for production
-high selenium intake- lower sperm motility
-low magnesium status- reduced motility
-low vitamin D- low sperm count

NTDs- failure of neural tube to close during embryogenesis (at the topanencephaly, at the bottomspina bifida- paralysis and abnormal
function of bladder, intestines, and legs)
-tube closes day 21-28 of gestation, forms spinal cord and brain
Theory of nutritional infertility
-foodglycogen and FFAoxidizable metabolic fuels
1. essential processes: cell maintenance, circulation neural activity
2. reducible processes: thermoregulation, locomotion, growth
3. expendable processes: reproduction, fat storage
-limited oxidizable fuels (energy) can inhibit GnRH and LH secretion and female copulatory behaviors
-low fuel detected by cells in hindbrain
neuropeptide Y and catecholamines
inhibit GnRH no ovum or sperm