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Improving Fertility and the Chance of Conception 59
This high-dose folic acid preparation is available Diabetic women should take a supplement of
on prescription only. 5 mg of folic acid daily along with a daily 10 µg
vitamin D.
Preconception, women should also avoid or
limit certain foods and drinks as is advised for Improving Fertility and the Chance
pregnant women (see Chapter 3.2, page 71). of Conception
Optimizing Body Weight Poor nutritional status in males and females can
decrease fertility and the chance of conception.
Women with a BMI above 27 should be encouraged Fertility problems affect about 15 per cent of
to lose weight prior to conception. Excess maternal couples and are due to male infertility in about
body weight combined with the weight of the baby 30–50 per cent of those couples.
can lead to problems during the course of the
pregnancy. Overweight pregnant women are at Research has shown several key nutritional
increased risk of complications such as high blood influences that can decrease fertility and the
pressure, gestational diabetes and preterm chance of a woman conceiving:
delivery. They are also more likely to have a
low-birthweight baby. ●● body weight
The National Institute for Health and Clinical ●● weight loss and undernutrition
Excellence (NICE) recommends that women with
a BMI over 30 should be informed of the increased ●● eating disorders
risk to themselves and their babies during
pregnancy and birth and encouraged to lose weight ●● poor iron stores
before becoming pregnant (NICE 2008a). It is
preferable for weight to be reduced well in advance ●● extreme levels of exercise
(at least 3–4 months) of conception to lessen the
likelihood of nutritional inadequacy. For pre- ●● caffeine
pregnancy weight loss NICE recommends
providing a structured, tailored programme of ●● alcohol.
ongoing support that combines advice on healthy
eating and physical activity and addresses Body weight
individual barriers to change (NICE 2008a). When
weight has been lost it is then important to Women with a BMI of 20–25 have been shown to
encourage a diet with adequate energy intake and have a higher rate of conceiving than those with a
variety to ensure intake of all essential nutrients to BMI higher than 25 or lower than 20 (Zaadstra et
prepare for conception. al. 1993).
Women with Diabetes Overweight and obesity
Being overweight does not prevent all women from
Women with diabetes who are planning to conceiving but overweight and obesity can affect
become pregnant should establish good glycaemic ovulation and also the response to fertility
control before conception and aim to maintain treatment.
their HbA1c below 6.1 per cent to reduce the risk
of congenital malformations. Women with Obesity with or without the problem of the
diabetes whose HbA1c is above 10 per cent should polycystic ovarian syndrome (PCOS) is associated
be strongly advised to avoid pregnancy (NICE with a doubling in the rate of ovulatory infertility
2008b). (Rich-Edwards et al. 1994) In both PCOS and
simple obesity weight reduction is associated with
a return of ovulation, menstruation and fertility in
many cases. A prospective study (Clark et al. 1998)
showed that when overweight women who were not
ovulating followed a weight loss and physical
