The doctor: The five things women often ask the fertility doctor about

Doctor Anna Grynnerup, who is part of Læger Formidler (a Danish parenting and women’s health website), has long worked at the Gynaecological-Obstetrics Department at both Hvidovre and Rigshospitalet, where, among other things, she has researched, AMH measurements to measure egg reserve in women.

Maybe you've heard all the platitudes? "Eat yourself pregnant!" and "Just relax!" and "Be careful with your birth control pills, they can make you infertile!" Yes, lifestyle can affect the hormone system and our fertility, but perhaps to a lesser extent than most people think. There are so many myths and misconceptions when it comes to lifestyle and fertility, and these are exactly the ones I'd like to help you navigate.

1. I play quite a lot of sports, how does it affect my pregnancy chances?

Prolonged periods with no menstruation (and thereby lack of ovulation) may be due to the fact that you expose your body to excessive physical stress e.g. anorexia, extreme sports or heavy weight loss. It can also be due to great psychological strain. As it is ultimately the brain that controls our menstrual cycle, the brain can send signals that it is not a good time to get pregnant. It is in fact a survival mechanism inherited from primitive homo sapiens to ensure that women do not become pregnant in case of extreme hunger. The body always prioritises its own survival. It is very different how much it takes to stop menstruation. Some don't feel that their exercise or diet is extreme and may have difficulty changing lifestyles, so it may be a good idea to get professional help and talk to your doctor about it. The good news is that ovulation and menstruation return when the body gets calm and nourished enough. Even if you do not want to get pregnant, it’s a good idea to address the problem, as the lack of hormones can have other effects on the body in the long term.

2. Can birth control pills make me infertile?

If you stop taking the pill, you may experience a short period of time (of up to about three to six months) with no or irregular menstruation and thereby a lack of ovulation. This not uncommon. It’s because your own hormone production has been low and needs to start again. And I would like to stress that the hormone system is not permanently damaged by taking the pill - even for many years. However, if six months after you stop taking the pill, your periods still don’t come back regularly, there may be another underlying condition that may have lain dormant during the years you took the pill. Therefore, if you haven’t had your period six months after you stopped taking the pill, it’s a good idea to talk to your doctor.

3. I never menstruate - what does that mean?

Absent periods or irregular periods (over 35 days between the first day of bleeding to the next day of bleeding) may be signs of polycystic ovary syndrome (PCOS). It is a disease, but it still has something to do with lifestyle, because the treatment will ultimately imply lifestyle changes. PCOS causes many ovarian blisters and disturbances in the sex hormones. Often you may have too much male sex hormone. Symptoms you may experience in addition to missing or irregular periods may include increased body hair or facial hair, acne and involuntary infertility. However, it should also be said that you can easily have the disease without having all the symptoms. So, why do you get PCOS? There is no clear answer, but there is much to suggest that the disease is partly hereditary and is linked to type 2 diabetes. So, it's something you're born with. However, lifestyle can influence how and whether the disease develops. Healthy eating and exercise are the way forward. And by healthy eating, I mean the usual guidelines from the Danish Health and Medicines Authority, which are that you eat vegetables, raw and varied. All indications are that you achieve weight loss in the same way, whether you have PCOS or not. Many also believe that women with PCOS find it extra difficult to lose weight compared to other women who struggle with obesity. The reason could be that their metabolism is different. There is nothing to suggest this from a research point of view. However, this does not mean that it is not incredibly difficult to lose weight. Here, professional help (e.g. a dietitian and/or personal trainer) can be the way forward, as permanent weight loss is a difficult task. However, especially when treating involuntary infertility, even a minor weight loss can mean you can become pregnant without fertility treatment. So, you don't have to lose weight to what may be described as "normal" weight. Although, weight loss is a really important part of the treatment. It should also be said that slim women with PCOS also benefit from healthy eating and exercise. If you are concerned that you could have PCOS, you can have it checked at your doctor's. If diet and exercise do not help, you can also get medical treatment.

4. I live an ordinary young life with coffee, social smoking and some alcohol occasionally. Should I stop completely?

Well... Smoking, alcohol and caffeine. It goes without saying that a large intake of these is not good for fertility. We know that smoking reduces fertility and increases the risk of miscarriage. Whether coffee is harmful is debatable. Recent studies show that coffee intake does not increase the time it takes to conceive, but that it can affect the risk of miscarriage. For this reason, the Danish Health and Medicines Authority recommends a maximum of three cups of coffee per day during pregnancy.

5. I am severely obese, can I still get pregnant?

Very severe obesity affects the likelihood of achieving a pregnancy, increases the risk of miscarriage and increases the risk of complications associated with pregnancy and childbirth. Therefore, fertility treatment cannot be offered in Denmark under public auspices if you have BMI above 35. Unfortunately, weight loss is really difficult, even if the desire is great, and it is therefore recommended to get professional help instead of blaming yourself for not succeeding.

Conclusion

When all of the above is said and written, it is important to point out that you cannot "eat yourself pregnant". There is no "wonder cure" or supplements that can increase your fertility. And no, sugar doesn't hurt your fertility. If you have regular menstruation (between 21 and 35 days between your period) and are otherwise normal weighty, there is nothing to suggest that you can "boost" your fertility. Remember a good deal of common sense and critical thinking if you hear about special diets or other lifestyle changes that should promote fertility. It can lead to unnecessary self-blame, walking around thinking that you are to blame for your infertility due to your lifestyle.

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