Lifestyle and dietician advise

The nutritional state of the parents at the time of conception is important to the foetus as it is to the woman during pregnancy.

Women planning a pregnancy should follow a healthy, balanced diet following the principles of the Eatwell Guide.

• Eat at least 5 portions of a variety of fruit and vegetables every day.
• Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates, choosing wholegrain versions where possible.
• Have some dairy or dairy alternatives (such as soya drinks), choosing lower-fat and lower-sugar options.
• Eat some beans, pulses, fish, eggs, meat and other proteins.
• Choose unsaturated oils and spreads and eat in small amounts.
• Drink 6-8 cups/glasses of fluid a day. If consuming foods and drinks high in fat, salt or sugar, have these less often and in small amounts.

The websites we would recommend you looking at are:

• Eat Well
• Food Standards Agency
• NHS.uk

Those most at risk of poor nutrition preconceptually are:

• Underweight - fertile weight varies widely.
• Limited income.
• Not eating a wide variety of foods or regular meals.
• Habitual dieters who restrict intake.
• Heavy periods.
• Eating disorders.
• Vegans.
• Monotonous or bizarre diets, or those who avoid whole food groups.
• Those with illnesses which affect digestion.
• Alcoholics.
• Smokers.

Research shows that the poorly nourished, especially at the beginning and end of pregnancy, tend to have lower birth weight babies.

Those having fertility treatment, especially the underweight, should first make sure they are well nourished; otherwise, we may be encouraging ovulation in women who are not nutritionally prepared for pregnancy.

If overweight, lose slowly (1 to 2 lbs / 0.5-1 kg a week) on a good, well-balanced diet. Avoid erratic or faddy diets and meal replacements.

Male fertility is affected by low zinc, selenium, vitamin C and alcohol, obesity and smoking.

All women planning a pregnancy should take a daily folic acid tablet. Ideally to be taken three months prior to pregnancy and for the first three months of the pregnancy. Folic acid has been shown to reduce the likelihood of a baby being born with spina bifida. The recommended dosage is 400 micrograms. You can buy the tablets from chemists and supermarkets or obtain them on prescription. If you suffer from epilepsy, you need to consult your GP because you need a slightly higher dosage, which can only be obtained on prescription. Ordinary vitamins do not contain enough folic acid. You should also increase the amount of folate rich foods in your diet.

Good sources of folic acid include:

• Beans
• Pulses
• Peas
• Fortified breakfast cereals
• Yeast extract
• Raw green vegetables
• Eggs
• Nuts
• Cooked green vegetables
• Avocado pears
• Bananas
• Melons
• Oranges
• Wholegrain cereals
• Bread

A significant proportion of the UK population have low levels of vitamin D. This has resulted in a rising number of reported cases of rickets in children and osteomalacia in adults. Those most at risk are pregnant and breastfeeding women.

Our body creates most of our vitamin D from modest exposure to UVB sunlight. People living in the UK do not get adequate exposure. It can also be found in foods such as oily fish, eggs and meat. Some manufacturers add it to cereals, soya products and low-fat spreads; however, it is difficult to obtain enough this way.

It is therefore recommended that you take 10 ug/day of vitamin D whilst trying to conceive and throughout pregnancy and breast feeding..

We would recommend Healthy Start vitamins which contains vitamins C and D as well as folic acid. These can be obtained from your GP or your local pharmacist. It is important that any supplements you take are suitable for pregnancy.

If you are diagnosed with anaemia, you should be prescribed the required iron medication. Do not take over the counter supplements with iron without discussing it with a health professional. Too much iron could be harmful and is not advisable in people who are not anaemic.

All women should include iron rich foods in their diet, such as red meat, pulses, bread, green leafy vegetables and fortified cereals. Including fruit and vegetables with an iron rich meal will help your body absorb iron more effectively.

Calcium supplements could be useful for those who avoid dairy (i.e. allergy or vegan). However, any supplements should be discussed with your doctor first.

Vegans may need a vitamin B12 supplement or should use B12-fortified foods such as Marmite, Vecon and some margarines. Soya products such as milk and yoghurt substitutes are also good sources.

Tell your GP, dentist or pharmacist if you are trying to conceive before being issued with any drug. Preferably avoid taking medicines unless specifically prescribed to you by a Doctor.

Alcohol preferably should be avoided preconceptually. There is no nationally accepted standard of what is considered a safe alcohol limit during pregnancy. Alcohol affects male and female infertility and can contribute to miscarriage. Excessive alcohol consumption has also been linked to an early menopause in women.

Smoking may make men and women less fertile. Smoking females are 3 to 4 times more likely than non-smokers to take longer than a year to conceive.

Smoking males have an average of 13-17% lower sperm counts than non-smokers, as well as having an increased number of abnormal sperm in their ejaculate.

New research shows that women who smoke in their pregnancy may be putting their baby at risk of heart disease in his/her later life. It is also known that passive smoking can have a detrimental effect when trying to conceive and can also increase the risk of miscarriage. Smoking is associated with a one third reduction in fertilisation of eggs with in vitro fertilisation. If you cannot give up, cut down as much as possible. If you would like some support in stopping smoking, the staff on the unit can refer you to the smoking cessation nurse for advice and support, or alternatively, you can seek advice from your GP.

The Food Standards Agency advises pregnant women to limit caffeine to less than 200mg; the equivalent of 2 mugs of coffee a day. Caffeine intake above this level is associated with low birth weight and sometimes miscarriage.

Caffeine is found naturally in coffee, tea and chocolate. It may be added to some soft drinks and 'energy drinks'. Some cold and flu remedies may contain caffeine, so ask your pharmacist or doctor for advice. Coffee need not be cut out entirely; just have sensible amounts. Try decaffeinated tea and coffee and soft drinks instead.

The approximate amount of caffeine found in food and drink is:

• 1 mug of instant coffee 100mg
• 1 mug filter coffee 140mg
• 1 mug of tea 75mg
• 1 can of cola 40mg
• 1 can (250ml) of energy drink 80mg
• 1 50g bar of chocolate contains between 10-25mg

There is little information on the safety of green and herbal teas in pregnancy, so it is best to drink them in moderation. The Food Standards Agency recommends drinking no more than 4 cups a day and bearing in mind green tea contains caffeine.

Toxoplasmosis

Toxoplasmosis is caused by a common parasite. The symptoms are similar to flu and can be difficult to diagnose. Toxoplasmosis is found in cat faeces, soil contaminated with cat faeces, raw and under cooked meat, unpasteurised goat’s milk and unwashed vegetables and salads.

If caught in pregnancy, it can cause miscarriage, stillbirth, blindness and brain damage. Once you have had the infection you are immune and cannot pass on the infection to your baby.

Some simple advice to avoid Toxoplasmosis includes:

1. Do not eat raw or undercooked meat (Parma ham, salami etc).
2. Wash hands after handling raw meat.
3. Wash thoroughly all fruit, vegetables and salads to remove dirt.
4. Wash hands after handling cats.
5. Wear rubber gloves when changing cat litter trays, then wash gloves and hands.
6. Wear gardening gloves when handling soil.
7. Cover outdoor sandboxes.
8. Do not eat unpasteurised goat’s milk or their products.

Listeriosis

Listeriosis is caused by a bacterium. This bacterium is widely distributed in this environment. It is found in soils, water, vegetation and some foods. Unlike most bacteria that require a warm environment, their bacterium can multiply itself in very cold conditions, such as refrigerators. The symptoms of the disease are flu like symptoms, making diagnosis difficult. If caught in pregnancy it can result in still birth or miscarriage.

Women planning a pregnancy or who are pregnant should avoid soft ripened cheese like Camembert, Brie and blue vein type cheeses. Hard cheeses like Cheshire and Cheddar are fine along with soft cheeses that are not mould-ripened such as cottage cheese, mozzarella, feta, cream cheese, paneer, ricotta, halloumi.

Listeria is frequently found in:

1. Cooked chilled meals – cook until piping hot.
2. Ready to eat poultry – cook until piping hot.
3. Pâté including vegetable pate
4. Liver sausage.
5. Soft whipped ice cream.

 Avoid all of the above foods.

Chlamydiosis

This infection is found in sheep and lambs. Although it is a very rare disease, it can cause miscarriage. It is important to avoid contact with sheep during lambing,

Salmonella

Some eggs produced under a food safety standard, called the British Lion Code of Practice are considered very low risk for salmonella and have a red lion stamped on the shell of the egg. So these are safe women planning a pregnancy to eat partially cooked or raw. If they are not lion code they should be cooked so that the white and yolk are solid. If in doubt of the source, always assume non-lion code and well cook.

Liver

Don’t eat liver, liver pate, liver sausage or haggis, as these foods contain high quantities of vitamin A which can harm the developing baby.

Game

Avoid all game that may have been shot with lead pellets, such as partridge and pheasant. Venison and other large game are low risk, but always ask the retailer.

Fish

Do not take fish liver oil supplements, or any supplements high in vitamin A.

Fish to avoid:

• Shark
• Swordfish 
• Marlin

Fish to restrict:

• Limit the amount of tuna to no more than 140g cooked per week. This is equivalent to 2 tuna steaks or 4 medium sized cans of tuna (drained weight 140g). Tuna contains more mercury than other fish, and if taken in high levels, can affect the development of the baby's nervous system.
• You should also avoid having more than 2 portions of oily fish a week, such as salmon, trout, mackerel and herring, as they can contain pollutants.
• There is no need to limit the amount of white fish and cooked shellfish. Raw shellfish should be avoided, as they can contain harmful bacteria and viruses that can cause food poisoning.
• Smoked fish, such as smoked mackerel, is considered safe to eat.
• Sushi - is ok to eat as long as it has been frozen first. If in any doubt, avoid eating raw fish sushi and choose cooked varieties.

Additional food considerations

• Peanuts: Peanuts or food containing peanuts are safe to eat unless you are allergic to them or a health professional advises you not to.
• Dairy foods: Stick to pasteurised or UHT/long-life milk. If unpasteurised or raw, boil before taking. Cheeses made with unpasteurised milk should be avoided. All types of yoghurt, including live, bio and low-fat, are fine.
• Liquorice: Sweets or teas in moderation are ok to take, but avoid liquorice root.

To support you from the very start, we offer a dedicated space to talk with a specialist counsellor. All patients are offered two counselling sessions per cycle without charge. Extra sessions are available on request. Please see our Price List for current charges.

• Confidentiality: Counselling offers a private, safe environment away from the clinical team.
• Relationship Support: It can help partners manage the strain that treatment sometimes puts on a relationship.
• Informed Decisions: For specific paths like donor-assisted conception, "implications counselling" is a vital (and often required) step to help you consider the long-term impact on your future family.

Research around the use and benefits of complementary/alternative therapy is not well documented; therefore, we are unable to recommend their use alongside your fertility treatment. It is, however, known that Chinese herbal medicine can have a detrimental effect on treatment.

Dietary

• Start looking at what you are eating and drinking. Try to eat a healthy, varied diet with more fresh fruit and vegetables.
• Keep alcohol intake low, reduce or stop smoking.

Exercise

• Try and take some form of regular exercise.

Stress

• Try and look at areas of stress in your life. Remember, we have a counsellor whose services you may find useful. Learn more about our Counselling Service.
• Read Fertility Network UK's advise on stress and infertility.

Women who are overweight and have a body mass index greater than 30 are likely to take longer to conceive and are more likely to miscarry. It is also known that by reducing their weight, it will improve their chances of conception.

Women with a body mass index below 19 should try to gain weight, as it will improve chances of conception and a healthy pregnancy.