1. Truths & Myths about Diet In Fertility and Gender Selection
Dr. Eeson Sinthamoney
Consultant Obstetrician and Gynaecologist
Hospital Kuala Lumpur

2. Nutrients and fertility Gender selection
Outline
Weight and fertility
Nutrients and fertility
Gender selection

3. Weight and fertility
In women: raised BMI associated with difficulty in conceiving
Overweight and obese women undergoing fertility treatment had significantly lower pregnancy rates and higher miscarriage rates
Underweight women had less embryos available

4. Weight and fertility In men, relationship less clear
Many studies indicate high or low BMI associated with significantly reduced sperm quality
However some evidence also suggests otherwise
Body weight loss may be reasonable in male infertility

5. Nutrients and fertility - truth or myth?
Many studies demonstrate the positive effects of OTC supplementation on female fertility, semen parameters and pregnancy outcomes
Conversely, also many studies that demonstrate lack of improvement
Gold standard of evidence?

6. Nutrients and fertility
Why is good evidence difficult to find?
Infertility often multifactorial
Baseline dietary intake
Single agent versus multiple supplements
Dosages?

7. Nutrients and fertility in women
Several small studies suggest that some nutrients may be essential in female reproduction
Current interest focused on vitamin D and anti-oxidants

8. Nutrients and oxidative stress
Cell respirationl
Production
Alcohol / tobacco smoke / environmental pollutants
Reactive oxygen species
Scavenging, disposing or suppresing
Anti-oxidant co-factors
Example: selenium, zinc and copper
Anti-oxidants
(example Vitamin C and E)

9. Which are anti-oxidants?
Main nutrients: vitamin C, vitamin E, selenium, and the carotenoids (vitamin A precursor)
A multitude of other nutrients, including minerals such as copper, manganese, zinc, flavonoids (such as grape seed extract and phenols found in green tea)
Co-enzyme Q10, also possess antioxidant properties

10. Impact of oxidative stress on female fertility
Evidence exists supporting the role of oxidative stress in male fertility
However, in women, while there is suggestion of the same, relationship not well addressed

11. Anti-oxidants and female fertility
Nutrients
Implications in implantation
Effect on embryo quality
Effect on oocyte quality and maturation
Increase in menstrual regularity
Higher rates of conception
Smoking and alcohol
Active and passive smokers have reduced fertility
Reduced implantation rates in IVF reduced pregnancy rates
 2 alcoholic drinks a day impairs fertility
Caffeine
High levels (>500mg/day = >5 cups/day) delays conception

12. Nutrients and fertility in women- Vitamin D
Involved in female reproduction and improves fertility treatment outcome
Some studies show that women with higher serum and FF vitamin D levels have higher pregnancy rates after IVF
Replete vitamin D stores predict reproductive success following in vitro fertilization. Ozkan S et al. Fertil Steril Sep;94(4):
Vitamin D and fertility-a systematic review. Lerchbaum E, Obermayer-Pietsch BR. Eur J Endocrinol Jan 24.

13. Oxidative stress and infertility in women - summary
Some strong but indirect evidence that oxidative stress affects fertility
Best available evidence suggests a varied diet with regular use of multivitamins, limited caffeine and alcohol and a healthy body weight promotes fertility

14. Nutrients and fertility in men
Up to 50% of fertility problems involve a male factor
More information available concerning nutrients and sperm characteristics

15. Carnitines
Assist sperm metabolism as an energy source for spermatozoa and effect motility and sperm maturation
Also an anti-oxidant
Multiple RCT studies demonstrate improvements in concentration, motility, morphology also the converse also shown
Primarily meat products
Dosage?  Up to 3g/day safe

16. Co-enzyme Q-10
Studies in infertile men demonstrate positive co-relation between higher seminal fluid CoQ10 concentrations and sperm motility and fertilization potential in couples undergoing IVF  pregnancy rates?
Source: oily fish (sardines), organ meat, whole grain, vegetables
Dosage: mg/day up to 12mg/kg/day

17. Folic acid Important role in DNA synthesis and proper cell function
Critical role in spermatogenesis
Mixed reports on effect of folate on male fertility
Sources: dark green leafy veg, beans, eggs, meats
Unsure if additional folate above RDA will improve fertility

18. Glutathione One of the most abundant anti-oxidant produced in the body
Important role in maintaining exogenous anti-oxidants (Vitamin C, E) in its active form
Shown to improve sperm motility, improved sperm concentration and decreased sperm DNA fragmentation
Source: fresh meat, fruits & veg
Up to 3g/day tolerated
Poor oral availability  IM administration

19. Vitamin A B-carotene is pre-cursor or vitamin A
Anti-oxidant properties
Specific benefits on sperm production and function difficult to clearly demonstrate
Up to <10000iu/day tolerated
However, readily stored and may reach toxic levels

20. Vitamin C Associated with various improvements in semen quality
Supplementation up to 1000mg/day improves count, motility, viability and morphology
Protects sperm DNA against oxidative damage
May work synergistically with other vitamins and anti-oxidants
RDA: 90mg/day; dosage: 500mg/day

21. Vitamin E Potent anti-oxidant
Substantial support for improvement in many sperm parameters
Sources: veg oil, meat, poultry
Recommended dose: iu/day
Upper daily intake: 1600iu/day
May be increased risk of complications (CVS) if >400iu/day and bleeding risk >800iu/day

22. Selenium
Role in maintaining normal testicular development, spermatogenesis and sperm function
Studies support use of selenium to improve sperm motility, concentration and morphology especially I combination with vitamin E
Optimal dosing: mcg/day
Sources: meat, seafood, eggs; veg is poor source

23. Zinc
Vital role in testicular steroidogenesis, testicular development, sperm O2 consumption and other functions
Chronic mild zinc deficiency assoc with oligospermia, decreased serum T2
Zn therapy associated with improvement in sperm motility, reduced sperm DNA fragmentation and other improvements
Upper limit: 40mg/day

24. Gender selection Not new! mother-in-law’s advice Nutrients?
Sperm sorting mechanisms – varied options, evolving over time
post sort purity average 87.9%
4. PGD
Flow cytometric sorting of human sperm: MicroSort clinical trial update. Karabinus DS. Theriogenology Jan 1;71(1):74-79

25. Conclusion Lack of good quality evidence
However: information available suggests that selective use of certain supplements beneficial but dosage information lacks clarity
Certainly- anti-oxidant use may improve live birth and pregnancy rate outcomes for subfertile couples undergoing ART
However: avoid doses beyond RDA to avoid complications
Blood level assessment?

26. Thank you