Dr. Ali Ainsworth: It seems to be a real growing focus in terms of microplastics and BPAs. You can find a lot of studies about this. I frame it to patients like, there are probably simple things we can do, for example, not heating foods and plastics. You probably don’t need to throw out your whole dish supply, your whole pantry. We don’t have to be so extreme, and the data is still evolving, but I think it is one of the more simple things that people can do to feel like they’re putting their best foot forward.
Tara Schmidt: Okay, so maybe we can store in plastic, like Tupperware in the fridge, but if we’re going to heat something up, let’s heat it in glass. Any thoughts on cleaning products, like ingredients that we should be looking at or chemicals that we need to avoid?
Dr. Ali Ainsworth: I know there’s a whole, whole field that’s interested in that area of study. I don’t personally tell people to avoid things once you’re pregnant, like not cleaning the litter box, right?
Tara Schmidt: Best excuse ever.
Dr. Ali Ainsworth: Yeah, and then what is in cleaning products—it’s not specific to fertility. I think it’s [about] health in general and where people want to put their time and energy.
Tara Schmidt: But if you don’t want to clean and you want to blame it on us, you can.
Dr. Ali Ainsworth: Sure, yeah.
Tara Schmidt: “I heard I’m not supposed to clean the kitchen.”
Dr. Ali Ainsworth: Yeah, I often tell my patients, you can do whatever you want, but if you need to tell your partner that I said you couldn’t, feel free. Whatever.
Tara Schmidt: Also, if you’re the one who’s going through potential subfertility, infertility, and eventually pregnancy, they can clean the kitchen. So just suck it up.
Dr. Ali Ainsworth: In our dream world.
Tara Schmidt: Yeah, exactly. Just like you don’t need to necessarily add foods to your diet to increase fertility, you also don’t necessarily have to cut certain items like alcohol outside of ovulation, but it might be a good idea to limit caffeine. Now when it comes to supplements, there’s plenty out there like vitamin D, folic acid, progesterone, iron, CoQ10, B8, MB-12. Just talk to your provider about what’s best for you before you start.
When it comes to environmental factors like microplastics, you may want to reheat your food in class, but there’s no need to live in fear. Although if you’re falling behind on your chores, tell your partner or family, we said it’s okay. You’re just avoiding toxins. Now let’s get into how prospective parents can manage both their weight and the uncertainty of the future.
One of the most common reasons that patients get referred to dieticians is because they’re going through sub or infertility and it’s recommended that they have some weight loss. What’s the connection there?
Dr. Ali Ainsworth: There are different categories of overweight. In general, the more overweight someone is, the harder it will be to get pregnant, likely related to regularity of cycles. Even in IVF, where we don’t depend on the menstrual cycle. There’s a decreased chance of pregnancy or impacts on safety during pregnancy, like increased need for C-section [and other] complications related.
There is certainly a relationship and also a relationship in both directions. Overweight it’s probably the most common thing that is talked about. Underweight has similar implications, both on regular cycles, safety of pregnancy, risk of preterm birth. There is a relationship—a normal BMI. I probably shouldn’t acknowledge this Tara, to you, but class one obesity actually does pretty well when you look at the outcomes of fertility treatments which I think is also maybe added support here to say, we don’t have to be absolutely perfect. Trying to be within the middle of the bell curve.
Tara Schmidt: Well, and I always remind patients, if I’m helping you, not necessarily to lose weight, though that might be the outcome, I would rather have a counseling session with you about improving your diet, which will help you lifelong, which will help maybe the partner that you’re living with, which will help baby. I’m not really having a weight loss consultation with these patients. I’m having a healthy eating consultation with these patients [for] the end result of more fruits and vegetables, portion control, less ultra processed food, less empty calories.
It’s likely going to have a weight impact, but I’m not here to say “Hey, here’s your goal weights.” We’re just talking about healthy eating, which I hope carries into pregnancy, which I hope carries into how that kiddo is eating. I don’t necessarily focus on the scale or the number of calories. We frame it as “Let’s eat healthier because that’s going to be great all the time, pregnant or not.”
Dr. Ali Ainsworth: That’s good from an overall approach to fertility.
Tara Schmidt: Yes.
Dr. Ali Ainsworth: Many patients know this. Clinics throughout the U.S. have different BMI cut offs at which we offer fertility treatment, which is a whole other kind of ethical and complicated issue, but for some patients, that framework gets thrown by the wayside because they need a BMI under 35 to be seen at the clinic that’s close to them.
I just acknowledge the added pressure that patients with infertility have around weight and specific numbers. It’s kind of unfair, ultimately. Because in an ideal world, [we’d] focus on the health aspects and not a number.
Tara Schmidt: We have an episode on weight inclusivity and the hard thing is that if these people are doing anything, they’ll do anything to lose the weight or to become a candidate for their treatment. We have to switch them to a framework of, “Hey, I actually need you eating really well balanced.” Instead of doing these crazy fad diets and cutting out entire food groups.
I say, “Please can we bring some of those foods back in.” But how stressful and how scary to be going back and forth between this restrictive mindset and growing a human. [They’re thinking] “I don’t want to gain too much weight because I was successful.” It’s a lot.
Dr. Ali Ainsworth: Yeah, on top of everything else that we navigate in a day, it’s a lot. In terms of diet and exercise, I tell my patients, there is no perfect answer here. Whatever you’re going to do that is sustainable and isn’t going to be jarring. We come in and out of this, but let’s really make this a part of our life [is what I would suggest that they do.]
Tara Schmidt: How do you have that conversation? How do you bring up their weight or their diet? Do you simply say this is a risk factor and it may be impacting your ability to become pregnant?
Dr. Ali Ainsworth: I talk to every patient about it, regardless of their weight because society is in all of our heads. First to normalize a broader range of normal than many of us feel, and then I do say that at either extremes—and I tailor it to what I’m talking to—a negative association with both time to pregnancy, fertility treatment success, risks in pregnancy, and then there are times that I have to be pretty direct.
We do also have a BMI cut off. Sometimes acknowledging, this is not what you want to do right now, but if you could, if you were amenable to this, pausing attempts at fertility, to really focus on weight loss for a few months, to not only make this possible for us to do this together, but more successful, that’s really where our best time is spent. But it’s hard. It’s a hard conversation for me to have and certainly to hear.
Tara Schmidt: Especially because they didn’t come here on their first day of trying to conceive. This has already been a long road in the first place. To further pause is just that much more heartbreaking. But what we’re doing is we’re trying to help people be successful in the long run.
Let’s talk about some of the options in that pause. So GLP-1 are pretty hot right now. I’ve also had patients even go through bariatric surgery and be pretty immediately successful with pregnancy after, even though there’s a timeframe that we ask them to prevent pregnancy. So let’s talk about that.
Dr. Ali Ainsworth: Yeah, so, as you said, very common. We are not prescribing them in our clinic, but we are very often referring to primary care to endocrine to others to prescribe the data about GLP-1s in pregnancy. To be honest, it is just limited because it’s a new medication. Current recommendations are not to try for pregnancy while on GLP-1s, stop for two months before attempting pregnancy.
Tara Schmidt: Bariatric surgery.
Dr. Ali Ainsworth: Another really good option, both short and long term. A much harder ask of people [because it requires] avoidance of pregnancy for one year after that surgery to make sure the weight stabilizes.
Tara Schmidt: Yeah, that first year in bariatric surgery, you are losing weight so, so rapidly. Depending on the type of surgery that you’ve had, you may have truly a malabsorptive procedure purposefully, which is the mechanism of action. We need to stabilize, like you said, weight and nutrient stores, make sure that they’re eating well, make sure that they’re maintaining a healthy weight to become pregnant. It’s a long that’s a long ask.
What options are available to patients beyond focusing on their weight?
Dr. Ali Ainsworth: Sperm counts. Are the fallopian tubes open, are they ovulating regularly, which often you can tell by history alone, and if they’re not, what additional testing might we do to better understand the underlying cause? Then depending on what we find, our options are always continued timed intercourse. There’s nothing that says you can’t do that, we just have to acknowledge the lower likelihood of success, or are we talking about oral medications, intrauterine insemination, IVF, donor egg, donor sperm? There’s so many permutations of where we go, but it always just begins with a visit and initial testing to understand where in the process we might intervene.
Tara Schmidt: There’s so much stuff out there about fertility, not all based on scientific evidence. Where can listeners find reliable information?
Dr. Ali Ainsworth: It is very overwhelming. One place specific to fertility is resolve.org. This is a national patient advocacy group that has just a wide breadth of information for patients with infertility, subfertility, needing fertility treatments for other reasons. Itt is a very good place to dig deep if you feel like digging a hole in the internet.
The American Society of Reproductive Medicine is our national organization for fertility providers. They have a lot of patient focused education. I think those are two places I would start.
Tara Schmidt: What do we still have to learn about fertility and diet? What don’t we know yet?
Dr. Ali Ainsworth: A lot of things. The practice of infertility, in the grand scheme of things, is relatively new, and about a third of our patients have what’s called unexplained infertility, meaning regular cycles, open bloating tubes—if there’s a male partner, normal sperm. That’s a lot of people that we have no explanation for why this isn’t working.
Humans at baseline, I tell my patients are not good at this. Chances of pregnancy per month are 20 percent under perfect conditions. But there’s just a lot. I’m sure that there are things from a diet perspective that may modulate some of these [factors], even on a cellular level. When you think about implantation and the way the lining of the uterus, that environment, communicates with the embryo.
There’s so much that we don’t understand. A lot is the honest and very broad answer.
Tara Schmidt: More to come, we hope. And of course, as we’ve mentioned, infertility is a sensitive topic and sometimes factors are simply outside of the patient’s control, like you said. Do you have advice for how patients can navigate this diagnosis and maybe even conversations? The second you get married, people are like, are you going to have a baby?
The second you don’t have a drink on a Wednesday at 10 a.m., people are going to get pregnant. Stop asking people if they’re pregnant, by the way. Anywho, that’s a personal PSA,
Dr. Ali Ainsworth: Yeah.
Tara Schmidt: But how do we navigate the diagnosis personally, and then also have the conversation?
Dr. Ali Ainsworth: It’s really nuanced to the person and to the people around them. Resolve, as I mentioned, has support groups, and again, they’re a really trusted source of support for patients. If you are a Mayo patient, we have a support group people have benefited from that a lot.
It’s different per person, per couple, and throughout their time and treatment. [Infertility] still has a stigma associated with it, and for that reason, it’s sensitive and hard to talk about, and it’s really isolating in that way. It’s the secret, huge thing that’s happening in your life that you don’t talk about.
Often, I find that patients start like that, like, this is just between us, we’re not going to talk about it. For many people, as time passes and they’re still in fertility treatments, they begin to share a bit. There’s a big role that community plays, whether it’s someone going through infertility or not—just involving other people and acknowledging the struggle and the hurt and sharing that load with others. It can be really helpful, but it’s hard because of some of the comments that you’d mentioned. Our patients hear [those] all the time. Just acknowledging that holidays are hard, Mother’s Day is really hard, when you’ve been doing IVF for two years.
Tara Schmidt: Going to a baby shower is hard.
Dr. Ali Ainsworth: Or not going to a baby shower. Which might be a decision that at some point in time you make to say, “I love you and I love me and I can’t be there today.” Both things could be true.
Tara Schmidt: Well, and the fact that you mentioned the frequency of infertility or how many people are going through infertility, if you’re willing to share and if you’re willing to find someone to talk to, you’ll likely find someone that’s gone through it too, right? It doesn’t have to be this big secret.
If you’re willing to seek support from other people or groups, you’re probably going to find someone who says, “Hey, actually I went through that too. Or my sister went through that. My mom went through that.” And it’s nice to have someone to hold hands with.
Dr. Ali Ainsworth: Yeah. I do think people find that. I’ll acknowledge that the vulnerability will be in there. Real fear comes with admitting it because you don’t know how someone will respond. But I think more often than not, it’s a shared experience and [there’s] a lot of support in being able to share it.
Tara Schmidt: I agree. Dr. Ainsworth, you are such a blessing to your patients. This is a hard field to be in. You’re talking to people every day about something that’s really challenging, so I just think they’re so lucky to have you on their team. Thank you for spending time with me today.
Dr. Ali Ainsworth: Thank you. I love what I do and loved sharing a little of it with you today.
Tara Schmidt: Having to worry about your weight on top of worrying about your fertility is an unfair burden. Unfortunately, weight does play a role in fertility. Being on the extremes of underweight and overweight can cause subfertility and complications during pregnancy. It’s also important to know that some treatment centers may have a BMI threshold and may request that you focus on your weight through various pathways before trying to conceive again.
Navigating infertility can be an isolating experience, but you are not alone. There are options like medications, IVF, donor egg and sperm. There are resources online like Resolve or the American Society of Reproductive Medicine. There are also many, many other people out there who know exactly how you feel.
That’s all for this episode, but if you have a follow up question, leave us a voicemail at (507) 538-6272 and we’ll answer it in a future episode.
On the next episode of “On Nutrition,” “Health Technology.”
Next time on “On Nutrition“:
Ro Huntriss: They pulled all of these ideas with zero scientific backing together and said 10,000 steps. And you know what? It’s stuck.
Tara Schmidt: For more on nutrition episodes and resources, check us out online at mayoclinic.org/onnutrition. And if you found the show helpful, please subscribe and make sure to rate and review us on your podcast app. It really helps others find our show. Thanks for listening, and until next time, eat well and be well.
If you have more questions about infertility, “Health Matters” has a two-part series on the science of fertility and options—and check out the Mayo Clinic Guide to Fertility.
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Tara Schmidt, M. Ed., RDN
Tara Schmidt, M. Ed., RDN, LD is a registered dietitian and instructor of nutrition at Mayo Clinic in Rochester, MN. She is the lead dietitian for the Mayo Clinic Diet, host of the podcast On Nutrition, Medical Editor of the Nutrition & Fitness channel, and co-authored The Mayo Clinic Diet: Weight Loss Medications Edition. Tara is passionate about reducing weight bias and educating people about realistic, evidence-based weight management. Tara enjoys staying busy with her husband, two children, and golden retriever (who just so happens to like vegetables).View Bio
Alessandra (Ali) J. Ainsworth, M.D.
Dr. Ainsworth is an assistant professor in the Division of Reproductive Endocrinology and Infertility at Mayo Clinic in Rochester, Minnesota.
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