x
ivf

A Guide to Preparing for Pregnancy

Organize your life, increase your chance of pregnancy.

CONTENTS

  • What is the ideal childbearing age?

LIFESTYLE PREPARATIONS

  • Ideal Weight and Nutrition
  • Micronutrient Supplements
  • Bad habits
  • Stress

HEALTH-RELATED PREPARATIONS

  • Endocrine Disorders
  • Vaccines
  • Infection Screening Tests
  • Genetic Carrier Screening

RECOMMENDATIONS FOR YOUR EVERYDAY LIFE

In planned pregnancies, especially if it will take place after a treatment that requires a lot of effort and money such as IVF, the most ideal conditions should be met for pregnancy, childbearing, and baby's health.

What is the ideal childbearing age?

Biologically, the ideal childbearing age is between 25-29 years. Physical, emotional, social, and financial well-being should be ensured for an ideal pregnancy.

Over the age of 35 years, both the number and quality of eggs decrease, resulting in reduced fertility.

The probability of miscarriage increases with age!

Rates of Miscarriage  

Age        Rate
20-34      11%
35-39      25%
40-45      51%
> 45        93%

LIFESTYLE PREPARATIONS 

•    Quitting smoking
•    Achieving Ideal Weight
•    Improving Sleep Quality
•    Increasing Physical Activity

Ideal Weight and Nutrition

Overweight

In overweight women, egg and embryo quality decreases, progesterone production decreases, the implantation rate decreases, and the risk of miscarriage increases. In overweight men, sperm quality decreases, erectile problems increase, and libido decreases due to decreased testosterone levels. 

The weight loss of women who apply for IVF treatment does not change the result of the treatment, except for those with polycystic ovary syndrome, hypertension, and diabetes.

Ideal weight loss is 0.5-1 kg per week. Diets that cause sudden weight loss are harmful. Diet is not enough alone. Diet + exercise should be performed together.
Medication or surgery for weight loss can have significant side effects.

BMI (Body Mass Index) (kg/m2)

Underweight    Normal weight    Overweight    Obese  
< 18.5                18.5 - 24.9            25 - 29.9         > 30

Bariatric surgery is applied to those with a BMI > 40 kg / m2 or those with a BMI > 35 and diabetes. It is recommended not to become pregnant for 18 months after bariatric surgery.
53% of obese men and 18% of overweight men experience infertility problems. Aromatase activity in adipose tissue converts testosterone to estrogen. Libido decreases, resulting in erectile problems. With weight loss, testosterone level increases, and sperm quality improves.

Underweight

Excessive underweight causes menstrual and ovulation disorders but does not affect the outcome of IVF treatment. It increases the probability of premature birth and miscarriage.

Underweight does not affect sperm quality.

Even a small reduction in weight allows a healthier start to pregnancy.

Nutrition

30% of the energy we take into our body should come from fat, 45% from carbohydrates, and 25% from protein.             

Polyunsaturated fats should be preferred as a source of fat. Hazelnuts, olive oil, canola oil, fatty fish like salmon, and avocado are rich in polyunsaturated fats.

Fruit and yogurt must be consumed in this process. 

All types of beans, pasta, dried products, fruit, some bread, cornflakes, muesli, and rice are low glycemic index foods. Diets with low glycemic load increase egg and sperm quality.

5% of weight loss significantly improves insulin metabolism.
 

Micronutrient Supplements

Modern sedentary life requires little energy. Therefore, we have to eat limited in order not to gain weight. Today's diets are not sufficient for a successful pregnancy outcome. Micronutrient supplements are needed before and after pregnancy. However, the vitamin and mineral contents of supplements vary greatly, and very few have scientific evidence that they are good for infertility.  Scientifically proven substances include iodine, folic acid, and iron.

Iodine

Iodine is found in the structure of the thyroid hormone, and a very small amount is sufficient. The need for iodine increases during pregnancy. This need can be met from milk, seafood, iodized salt, and iodine-added foods (e.g. bread). 

WHO - UNICEF
recommend taking 100-150 mg / day.

This amount is stated as 250 mg/day in pregnant women. 
Treatment for iodine deficiency should ideally begin 3-6 months before a planned pregnancy.

Urine - Iodine Concentration 

< 100mg / L Insufficient Iodine (General)
< 150mg / L Insufficient Iodine (Pregnant)
> 150mg / L Sufficient Iodine

Iron

Iron is a vital element found in hemoglobin and myoglobin. It is also very important for normal growth, neurodevelopment, and immune function.

Foods of animal origin       Heme iron    

Foods of plant origin          Non-heme iron

10-15% of iron taken is heme iron and is better absorbed.  

Iron is stored in the body. While 2-3% of the iron in the body is contained in hemoglobin in red blood cells, 1/4 is found in the liver as ferritin and hemosiderin. The remaining iron is found in some enzymes and myoglobin in muscle tissue.

According to the World Health Organization, anemia is defined as:

Hemoglobin 

In women          < 120 g / L

In pregnant women          < 110 g / L

Iron deficiency anemia causes a decrease in the workforce, an increase in child mortality, an increase in maternal mortality, a slowdown in child development, and the formation of suspected infectious diseases.

Red meat, seafood, and poultry are excellent sources of heme iron.

Some ingredients (tea, coffee, and bran) prevent the absorption of iron.

 

Dried fruits, sweet corn, broccoli, and spinach are good sources of iron.

The daily need is 18 mg/day for women and 27 mg/day for pregnant women.

Foods rich in iron are recommended during pregnancy. While vitamin C (in fruit juices) increases the absorption of iron, the consumption of tea and coffee reduces it.

Folic acid

Beyin fonksiyonlarında önemli rol oynar. Günlük ihtiyaç 360 – 400 μg’dır. Folik asit gebelik denemeleri başladığı andan itibaren 12. gebelik haftasına kadar kullanılır. Amaç nöral tıp defektinin önlenmesidir.

Folic acid plays an important role in brain functions. The daily need is 360 - 400 μg.  Folic acid is used from the start of pregnancy attempts to the 12th week of pregnancy. The aim is to prevent neural-tube defects.

400 μg is recommended for all women. 4000 mg is recommended for high-risk women (those with neural-tube defects, those using anti-epileptic drugs, those with diabetes, obese women, those with a BMI > 30kg / m2).

Folic acid is found in dark-green leafy vegetables, fruits and fruit juices, hazelnuts, beans, dairy products, poultry, greens, eggs, and seafood.

It is highest in spinach, liver, asparagus, and Brussels sprouts.

Less or more nutrition and insufficiency or excess of micronutrients are critical during fetal growth and development.

Malnutrition of the mother and father during the pre-pregnancy period causes the child to become obese or have cardiovascular and metabolic problems in the future.

 

Bad habits

Smoking

Smoking is harmful to both men and women. The chance of pregnancy is reduced by half.

It reduces sperm quality. Passive smoking has the same effect.

One of the important points of IVF treatment is quitting smoking.

Alcohol

Alcohol is the most commonly consumed harmful substance in women of advanced age and with high educational and socioeconomic levels. Even 1 glass of alcohol per week reduces the chance of reproduction. 1 glass of alcohol every day negatively affects IVF treatment. The superiority of psychological treatment and medication over each other has not been demonstrated in alcoholism. More than 2-3 glasses per week are not recommended.

Caffeine

Caffeine is a popular neurostimulant. It is often found in coffee, tea, chocolate, cocoa, soft drinks, and energy drinks. The amount of caffeine in coffee (70-20 mg/cup) varies depending on the way the coffee is made, the portion size, and the brand. Daily caffeine consumption of women planning pregnancy should be limited to 200-300 mg/day (1-2 cups).

Drug Abuse

There is no safe level in drug use, it should be completely eliminated.

The ideal consumption is zero alcohol, zero cigarettes, and 1 cup of coffee/day.  

In abstinence from smoking, alcohol, or drugs, it should wait for 6 months for the formation of a new egg group.

This period is 3 months for sperm.

Lifestyle change does not affect the outcome of IVF treatment but affects pregnancy.

Stress

The importance of IVF treatment in patients' lives should be taken into consideration, and it should not be forgotten that stress has an important role in treatment success. Throughout IVF treatment, clinicians should screen the risk factors in stressed patients and provide adequate treatment.

Discontinuation of treatment: Individualized information should be provided on the advantages and disadvantages of continuing treatment, adoption, donation, and the special situation of the patient. Patient-centered support should be given.

HEALTH-RELATED PREPARATIONS 

Endocrine Disorders

Thyroid

The TSH value should be 2.5 IU / I or less.

Subclinical hypothyroidism should be prevented.

L-Thyroxin therapy will increase the live birth rate.  

Diabetes mellitus

To diagnose diabetes: 

Fasting blood glucose value ≥ 125 mg / dL
2-hour blood glucose value after 75-g OGTT ≥ 200 mg / dL

Points need to be considered    

  • Using high doses of folic acid.
  • Using metformin.
    • It lowers insulin resistance. 
    • It reduces the risk of overstimulation of the ovaries. 
    • It controls blood glucose. 
    • Its long-term use reduces Vitamin B12 levels, it should therefore be checked regularly.  
  • Prevention of multiple pregnancies.

Vaccines

  • An annual influenza vaccine should be administered.
  • Diphtheria, whooping cough, and tetanus vaccines should be administered, if not before. 
  • Hepatitis B vaccine should be administered especially to healthcare professionals and patients undergoing hemodialysis. 
  • Pneumococcal vaccine should be administered to those without a spleen and those with sickle cell anemia, chronic heart and lung diseases, and diabetes.
  • Rubella vaccine should be administered. Rubella IgG should be tested. Women should not become pregnant for 1 month after vaccination.

Infection Screening Tests

  • HIV, HBsAg, HCVAb should be screened in women.
  • Chlamydia and gonorrhea should be screened by cervical culture or urine test. 
  • Men are recommended to undergo HBsAg, HIV, chlamydia, and gonorrhea screening.

Genetic Carrier Screening

Genetic carrier screening is based on volunteering.

Recommended genetic carrier screening tests are as follows:

Cystic Fibrosis (Autosomal Recessive)

The disease is characterized by obstructive pulmonary disease, pancreatic insufficiency, and elevated sweat chloride levels, its incidence is 1:3500 patients, 1:25-30 people are carriers, and it is a fatal disease. 

Spinal Muscular Atrophy (Autosomal Recessive)

The disease is characterized by the degeneration of spinal alpha motor neurons, proximal muscle weakness, and paralysis, its incidence is 1:10000 births, 1:40-60 people are carriers, and it is a fatal disease.

Hemoglobinopathies

They are single-gene diseases. They are especially common in the Mediterranean race.

Expanded genetic carrier screening includes more than 100 genetic diseases. The more complicated the tests are, the more difficult it is to explain and interpret the results. Knowing the possibility of a sick child in advance provides a chance to perform a double-factor preimplantation genetic
diagnosis (PGD). First, one partner is screened, and the genes that are positive in him/her are checked in the other partner (two-step genetic screening). When a genetic carrier is found in screening, genetic counseling is recommended.

If there is a genetic carrier,

  • PGD
  • Adoption
  • Early prenatal diagnostic options can be recommended.

RECOMMENDATIONS FOR YOUR EVERYDAY LIFE

Smoking

  • Smoking reduces the number of eggs, sperm quality, and fertilization while increasing chromosomal abnormalities and the risk of miscarriage.
  • Smoking also has an effect on the uterus. It reduces the chance of pregnancy.
  • The smoking habit of men also reduces the chance of pregnancy.
  • Being in a smoking environment is equally effective.

Nutrition

  • Red meat and saturated fat consumption should be reduced; seafood, fruit, and vegetable consumption should be increased.
  • Alcohol use in both men and women decreases the pregnancy rate. 3 glasses/week
  • Men should consume 3 cups of decaffeinated coffee a day, and women should consume 1 cup of decaffeinated coffee. Espresso is low in caffeine and rich in antioxidants.     
  • Sugary drinks and sugar-based nutrition reduce the chance of pregnancy.
  • A low vitamin D value increases the risk of miscarriage, reduces egg quality, and live birth rate.
  • Omega-3 intake is very important for both men and women.
  • Excessive folic acid intake increases the rate of miscarriage.

Stress

  • The stress level in infertility is the same as cancer.
  • IVF treatment should not be preferred after experiencing severe stress.
  • Depression and anxiety reduce the chance of pregnancy.
  • The blood supply of the reproductive system is reduced with stress.
  • Chronic mild stress triggers inflammation.
  • Stress can cause pregnancy loss.
  • Anxiety reduces sperm quality.
  • Stress is the most important factor in discontinuing treatment.
  • The goal is to reduce stress from the first phone call to sending individuals to pregnancy follow-up.
  • Meditation may be recommended.
  • Acupuncture does not affect the outcome of IVF treatment.

Sleep-Exercise

  • Irregular sleep can be the cause of miscarriage. It also negatively affects the pregnancy rate.
  • Walking and swimming increase the chance of pregnancy. 
  • The more they exercise, the higher the probability of miscarriage. Women should be active during pregnancy, but heavy exercise should be avoided.
  • Oxidative stress increases in obesity. Exercise lowers this level.
  • Sperm DNA fragmentation increases in men over the age of 40 years and young women's eggs can improve this.

  • make an appointment
  • ask a question

"You can sign up to download your free ""I Wish to Have A Baby"" e-book written by Dr. Hakan Özörnek MD."

X