Following a study linking infertility to dietary habits, gynaecologist Mark Formosa tells Simonne Pace that work still needs to be done on lifestyle education to guide women wishing to have children.

A study published in the journal Human Reproduction has suggested that women who eat less fruit and more fast food take longer to get pregnant and are less likely to conceive within a year.

The objective of the study was to examine the impact of women’s diet before they conceived a child on their time to pregnancy (TTP) and their (in)fertility.

Compared with women who ate fruit three or more times a day in the month before conception, women who ate fruit less than one to three times a month took half a month longer to become pregnant, the research showed.

Similarly, compared with women who never or rarely ate fast food, those who consumed fast food four or more times a week took nearly a month longer to get pregnant.

The study saw 5,598 women questioned about their diet during their first antenatal visit. The women, from the UK, Ireland, Australia and New Zealand, had not had a baby before.

Professor Claire Roberts, of the University of Adelaide, who led the study, said: “These findings show that eating a good quality diet that includes fruit, and minimising fast food consumption improves fertility and reduces the time it takes to get pregnant.”

First author, Jessica Grieger, a post-doctoral research fellow at the University of Adelaide, said: “We recommend that women who want to become pregnant should align their dietary intakes towards national recommendations for pregnancy. Our data show that frequent consumption of fast foods delays time to pregnancy.”

Approached by the Times of Malta for his comments, gynaecologist Mark Formosa, who described the paper as an interesting attempt to create factual knowledge on how dietary habits can affect the TTP and infertility, said: “As the authors themselves point out, all previous publications related to patients already on treatment. The paper, however, has its shortcomings in design, being a retrospective study from a questionnaire submitted at 15 weeks gestation.”

Among all the couples in the study, 468 (eight per cent) were classified as infertile (defined as taking longer than a year to conceive) and 2,204 (39 per cent) conceived within a month.

When researchers looked at the impact of diet on infertility, they found that in women with the lowest intake of fruit, the risk of infertility increased from eight to 12 per cent, and in those who ate fast food four or more times a week, the risk of infertility increased from eight to 16 per cent.

“My view is that the association between a low intake of fruit and a high intake of fast foods with infertility is related to a broader lifestyle issue. A healthy lifestyle consists of a good diet, adequate exercise, avoidance of alcohol, cigarettes and recreational drugs,” said Mr Formosa.

“Individuals who indulge in fast foods most likely have a diet with little space for fruit or vegetables. This type of diet is also associated with obesity, which is a risk factor for TTP and pregnancy in its own right,” he added.

Asked if infertility had increased in Malta over the years, Mr Formosa says his impression is a “definite yes”, although there is no hard data on the matter.

“The reasons are multiple and reflect the same pattern on the continent and in the UK. I think the most important is a socio-economic one, that is delaying having a family until later on in life, with the associated increase in rates of infertility that this brings with it.

“There are other reasons, such as an increase in male factor infertility, which are possibly due to environmental issues,” Mr Formosa said.

“Alcohol, smoking and the use of recreational drugs all have a negative effect on fertility. Work stress is also becoming a critical factor in Malta, with many young couples working very long hours in professional jobs, leaving them with no time for anything else.”

When infertility is not due to a medical or physical condition but to environmental, lifestyle or dietary factors, Mr Formosa thinks it is a good idea for a woman who is considering getting pregnant to visit her general practitioner and check a few things before resorting to IVF.

“A simple blood test will ensure basic health facts and the opportunity to check for rubella and varicella immunity. The patient can also be guided on improving her general health by touching on lifestyle issues. In broad terms, a woman needs to reduce obesity, introduce some exercise and eliminate bad habits,” he said.

“A year is the internationally accepted definition for a couple to practise unprotected intercourse before resorting to a medical practitioner. The situation regarding IVF will depend on the individual case, as, for example, a woman with tubal factor infertility should be advised to try this straight away. Age is another very important consideration in this regard.”

Does our Mediterranean diet help or hinder a woman trying to get pregnant?

“Our local diet is not really a Mediterranean diet but a combination of the eating habits of all our former rulers. The result may be appetising but not very healthy, making us one of the leaders on the obesity table in Europe.

“Bread is still highly consumed, leading to high BMIs (body mass indexes) coupled with a significant population of women suffering from polycystic ovary syndrome. Work still needs to be done to educate and guide women wishing to conceive on dietary and lifestyle measures.”