By Professor Greg Whyte, a director at the Harley Street Clinic, CHHP

Bump It Up

Bump It Up

Foreword

When I was clubbing and dancing four nights a week for six hours each night, I didn't need to train or follow an exercise plan. I was fit, active and had bags of energy. But after I had my first baby, Holly, I hadn't got rid of my baby weight before I got preggers with my second baby! Anyhoo . . .

With my second pregnancy, I just ballooned. I was absolutely enormous, and there was a severe danger that even my Crocs wouldn't fit me! But I decided to do something positive about this and started exercising while I was pregnant with Tilly. I am so glad I did, and I can honestly say I never looked back. I took a very sensible approach, telling myself, 'Nice and easy does it . . . but DO it!!!'

Greg and I have often talked about the sketchy and sometimes contradictory advice that is out there for pregnant women, which can be very confusing. So I am absolutely delighted that here, at last, is the definitive guide to what, how much, and when you should exercise, as well as how to prepare yourself mentally for this important time in your life. And no one is better than Greg at that! He is such a fantastic motivator.

With Bump It Up, in addition to guiding you through the exercise plans for each trimester, Greg and his team provide invaluable advice on nutrition and offer some truly yummy recipes, menu ideas and information on how critical a healthy lifestyle can be if you want to enhance your pregnancy journey from conception through to life as a new mummy.

I would literally walk over hot coals for this man because he got me through the toughest experience of my life, my Sport Relief challenge. I know that when you have your great pregnancy and delivery, you'll want to walk over hot coals for him too!

Davina McCall

Introduction

I am delighted to welcome you to Bump It Up, a safe and effective exercise, nutrition and lifestyle programme. While we traditionally think of pregnancy as the nine-month period from conception to birth, it is clear that it is in fact a much longer journey, starting from the path to successful conception and carrying on through the three trimesters of pregnancy and, finally, to the post-partum period and beyond.

Designed to accompany you on your entire pregnancy journey, Bump It Up begins with your personal Fertility Lifestyle Programme, a plan devised to optimize your chances of conception. Once you've successfully conceived, the next chapters in the book focus on the

importance of exercise and nutrition during pregnancy and provide fully illustrated, easyâ€'toâ€'follow exercise plans for each of the three trimesters. Finally, I've provided detailed guidance on exercise and lifestyle during the post-partum period and beyond - all you

need to know about how to look after yourself during this important phase of your life. In short, this chapter is all about you!

To complement the exercise programmes, included here is an overview on the important role nutrition plays in our lives - particularly during pregnancy - together with advice on how to achieve a healthy, balanced lifestyle, and essential guidance on what to eat and what to avoid from pre-conception right the way through to the post-partum period. As an added bonus, there is a range of delicious, healthy recipes that have been designed to include an array of nutrients that are particularly beneficial during pregnancy. I hope you will enjoy these simple, stress-free recipes and make them part of your pregnancy journey.

I wish you luck and hope you find Bump It Up to be the perfect exercise, nutrition and lifestyle companion for a happy and healthy pregnancy.

1

1 Your Personal Fertility

Lifestyle Programme

Infertility affects a large number of couples (up to 15 per cent of those trying to conceive) and can be an extremely traumatic and stressful experience. Irrespective of age, weight, fi tness or any other lifestyle factor, there are sadly some couples who are unable to conceive. The only approach we can take is to do our best to increase the chances of conception. The following chapter details those elements of our lifestyles that can be controlled by our behaviour and examines how best to make positive changes to optimize fertility.

Lifestyles and fertility

It is only recently that we have begun to understand the pivotal role that lifestyle factors play in fertility, particularly in the development of infertility. Lifestyle factors are those habits and behaviours that we control through our own actions and we all understand the impact of many of these on our overall health and well- being - such as the negative effects of smoking, inactivity and excessive alcohol consumption.

But now we are also beginning to understand how these poor lifestyle choices may impact upon fertility.

Recent evidence has shown that a large number of lifestyle factors, such as smoking, poor nutrition, alcohol, caffeine, high body weight (fat mass), lack of exercise, psychological stress, illicit drugs and environmental and occupational toxins, can have substantial effects on fertility. What is very important to remember is that these are all modifiable aspects, which you have the power to control. You can take active steps to enhance your and your partner's fertility and improve your chances of conception.

Of course, improving one's fertility is not an exact science and only a small number of scientific studies have examined the role of lifestyle factors in improving the chances of becoming pregnant.

What is clear, however, is that closely examining your own habits and designing a 'fertility lifestyle programme' tailored to your own personal needs is important in optimizing your fertility. There is no 'one-size-fits-all' solution when it comes to lifestyle factors and there is often a graded scale of the benefits to be accrued from making changes. For example, simply reducing your intake of alcohol and caffeine, rather than cutting them out completely, can improve your fertility, while for smoking the advice is clear - stop it

completely. In addition, changes can be made in different directions. For example, you should increase the amount of exercise you do and reduce your stress levels - and exercise can often contribute to stress reduction.

There are, of course, limits to the benefits that can be gained from lifestyle changes and it is rarely a simple matter of 'if a little is good, then more is better'. Take exercise for example: research suggests that regular workouts improve reproductive function in women

who exercise at a moderate intensity for 30 minutes or more daily, reducing the risk of infertility associated with ovulation disorders.

In contrast, excessive amounts of high-intensity exercise may actually lower fertility, particularly if the menstrual cycle is negatively affected. So getting the balance right and designing your own 'fertility lifestyle programme' is crucial to improving your chances of

getting pregnant.

YOUR PERSONAL FERTILITY LIFESTYLE PROGRAMME 3

It's a weighty matter!

We know that body weight plays an important role in fertility and, in particular, avoiding excess weight appears to be central to optimizing your chances of conception. Maintaining a healthy weight is where diet and exercise come in. The target weight for most women

appears to be a normal BMI (18.5-24.9).

However, it is not all about your BMI, which only takes into account height and weight. Body

composition, which is the combination of muscle mass and fat mass, is particularly important. Research suggests that ovulation is impaired if fat mass drops below 15 per cent or if it exceeds 35 per cent of total body mass. Exercise plays a key role in increasing muscle mass and reducing fat mass, so a good combination of diet and exercise can put

you in the right fertility zone.

Factors affecting female fertility

Overweight

Age

Environment

Underweight

Stress

Genetics

Smoking

Inactivity Extreme

exercise

Nutrition

Alcohol

Medical conditions

Caffeine Illicit drugs

Of course, it's not just about being overweight. Men who are underweight (with a BMI of less than 18.5) have lower sperm counts than those who have a normal BMI. For women, being underweight and having very low body fat is linked to disruption of the menstrual

cycle and ovarian dysfunction. This situation is made worse when your BMI falls below 17. Eating disorders such as anorexia nervosa and bulimia are linked to irregular menses (oligomenorrhoea) or loss of menses (amenorrhoea) and infertility, and during pregnancy

are associated with negative impacts on maternal and foetal well-being.

If you have, or suspect you have, an eating disorder, it is important that you seek advice and support from your healthcare team.

How much exercise is enough?

There is a sweet spot for fertility when it comes to exercise - and it is definitely not a 'more is better' approach! Excessive exercise can create a negative energy balance, particularly when calorie consumption is restricted, and this can have a harmful impact on your reproductive system. It is not uncommon for elite female athletes, particularly endurance athletes, to experience irregular periods or loss of menstruation. The message here is that a little is good but a lot may be problematic. As with most things in life, a balanced, sensible

approach to exercise is the way forward. Indeed, evidence suggests that 4 hours of moderate-intensity exercise each week may be the tipping point beyond which increased exercise duration and/or intensity may negatively impact on fertility. If you exercise excessively (and you really should not), you should ensure that you are optimizing your nutrition (calorie intake) to reduce any potentially detrimental effects.

Men who are moderately active (around 3 hours per week) at a moderate intensity have a higher sperm count, sperm speed and better sperm morphology (shape) than either highly active men or elite athletes. What type of exercise men do may also be important;

research shows that those who cycle for long periods each week have

a lower sperm count.

Importantly, as mentioned, it appears that the interaction between exercise and nutrition is the key to optimizing fertility. Using a combination of exercise and calorie restriction to create a negative energy balance, where your energy expenditure is greater than your energy consumption (food), and to reduce weight and fat mass appears to have positive outcomes for obese women (and men) when it comes to fertility. At the other end of the scale, for women who are underweight or who suffer from an eating disorder, it is important to address the low-calorie state of their diet and add moderate levels of exercise to optimize fertility. For normal-weight women and men, ensuring an energy balance with moderate amounts of exercise combined with a calorie-matched healthy, balanced diet has the most positive effect on fertility.

You are what you eat!

We all know that diet plays a central role in our general health and well-being.

But what you may not know is that modifying the macronutrients (carbohydrates, proteins and fats) and micronutrients (vitamins and minerals) in your diet could have a positive effect on your fertility. For women, the consumption of trans-fats and excessive animal protein has been shown to reduce fertility. In contrast, complex carbohydrates, such as vegetable-based proteins and vegetables rich in iron (such as spinach, broccoli, kale and mushrooms), are linked to improved fertility. Reactive Oxygen Species (ROS) are byâ€'products of energy production in all cells in the body, which, in excess, can lead to oxidative stress, resulting in cell damage and dysfunction. Your body's natural defences include antioxidants that scavenge (consume) ROS. In addition to these natural defences, you can increase your antioxidant level through your diet (by including foods such as blueberries, avocados, kidney beans and dark leafy greens), or by taking supplements such as multivitamins. Evidence suggests that women who consume foods rich in antioxidants and who supplement with multivitamins have improved fertility.

And it's not all about you! Your partner can positively impact his fertility by making a variety of changes. In men, an overabundance of ROS can reduce sperm motility (movement) and alter its DNA.

Research demonstrates that men consuming antioxidants, including vitamins B, C and E, have improved sperm motility, conception and birth rates. In addition, consuming a diet rich in complex carbohydrates, and fruit and vegetables high in fibre, folate (green leafy

vegetables) and lycopene (tomatoes) has been shown to improve semen quality. As with women, a diet high in trans-fats and protein appears to be detrimental to fertility.

Caffeine kicks!

The link between caffeine and fertility is not fully understood. A small number of studies have suggested that high caffeine consumption (more than 500mg per day - about 4 or 5 cups; although upper limits as low as 100mg are considered by some to be problematic)

may affect ovulation and the time it takes to conceive. In addition, there is evidence that caffeine can negatively impact the foetus during pregnancy. Although further studies are needed in this area, given the evidence so far you should consider cutting down on your

caffeine intake, particularly of coffee, tea and fizzy drinks. If you are at all concerned, stop your caffeine intake altogether.

Just a little tipple!

There is definitely a link between alcohol consumption and infertility.

However, it is not clear how much is too much. It does appear that there is a 'dose-

Dependent response'; in other words, the more you drink, the more likely you are to have fertility problems. The reason for this altered fertility appears to be the detrimental effect

alcohol has on your hormones, in particular lowering levels of oestrogen and follicle stimulating hormone (FSH), which leads to the suppression of ovulation. In men, alcohol consumption is linked to shrinking of the testicles and a decreased sperm count and motility.

While many believe that alcohol is a magic love potion, it does in fact reduce libido! In general, the best advice is to reduce your alcohol consumption to a moderate level (no more than 14 units for men and 7 units for women in a week, and no more than 4 units for men, 3 units for women in a single session). Better still, aim for even lower than this or stop altogether to improve your chances of conception.

Remember, less is definitely more when it comes to alcohol!

Fertility up in smoke!

It's not rocket science! Smoking is bad for your health and bad for your fertility. There is no safe limit where smoking is concerned; every drag you take floods your lungs with over 4,000 dangerous chemicals and has a negative impact on your health and fertility.

Don't kid yourself that it won't affect you because you are only an 'occasional smoker'; research has shown that even light smokers have reduced fertility. Smoking reduces ovarian function and ovarian reserve (the capacity of the ovary to provide eggs that can be fertilized). Smoking can also cause menstrual dysfunction and changes in hormones such as progesterone and follicle stimulating hormone. And it doesn't just affect you; evidence shows that men who smoke have increased sperm DNA damage, decreased sperm counts and motility, lower semen volume and fertilizing capacity. There really is only one course of action - STOP SMOKING.

Stressed out!

Stress is not always a bad thing, but when you are highly stressed over prolonged periods your stress hormones (adrenaline and cortisol) are chronically elevated, which can negatively affect ovulation.

For most of us, stress comes in three forms: physical, psychological and sociological. These three types rarely operate in isolation. For example, stress at work (sociological stress) can result in psychological stress (anxiety disorders, depression, etc.), which in turn leads to physical changes, such as elevated levels of stress hormones.

For men, excessive stress, which is often associated with anxiety and depression, negatively affects gonadal function, and reduces testosterone and other key hormones, such as luteinizing hormone.

These changes have been shown to reduce sperm count and sperm motility, and cause problems with sperm production and shape. The double whammy here is that infertility in itself is stressful.

Our hopes and dreams of parenthood, not to mention the pressure from our friends, family and society at large to have children, can be overwhelming when you are struggling to conceive. On top of all this, the strain of medical appointments, tests, associated costs, and failures to conceive can make infertility one of the most stressful experiences in life.

Add general life pressures to this toxic mix and you have the perfect storm for long-term infertility. That's why it is so important that you make every effort to reduce your levels of physical, psychological and sociological stress when you are trying to conceive.

There are a whole variety of strategies that you should explore if you feel this is an issue in your life. Examples include meditation, mindfulness and cognitive behavioural therapy.

Importantly, exercise is a fabulous stress buster. In addition to the physical benefits, the release of endorphins (the 'happy hormones') during exercise not only improves mood but also reduces anxiety and stress. Exercising with family and friends, including attending classes, provides a wonderful environment for support and fun that can ease life's worries and promote relaxation, which may in turn improve fertility.

Your fertility lifestyle programme

As we have seen, and to recap, there are a number of lifestyle factors that can affect your fertility and, while making the changes suggested in this chapter will not guarantee conception, there is no doubt that you have the power to improve your chances if you make the right lifestyle choices.

When it comes to your size, your target should be a normal BMI (18.5-24.9). As discussed, being overweight disturbs hormone production and ovulation, thus reducing fertility. But so too does being underweight, which is linked to menstrual dysfunction and impaired

Taking regular exercise and eating a healthy diet are the most effective methods for controlling your body weight and they can also enhance your fertility. Regular, moderate-

duration (3 to 4 hours per week), moderate-intensity exercise, combined with a healthy, balanced diet targeting specific macro and micronutrients has been shown to improve fertility for both men and women.

Stopping smoking and cutting down on your alcohol and caffeine intake should be an essential part of your fertility lifestyle programme.

Reducing stress, whatever its cause, should be a priority during this very important time. Think about your fertility lifestyle programme as a team event; make sure you surround yourself with family and friends who fully support your goal. And don't forget to stay in regular contact with your healthcare team to make sure you are on track to optimize your fertility.

[CHART]

Your fertility lifestyle programme checklist

Weight

You:

BMI of 18.5 to 24.9 / Fat mass of 15 - 35%

Your partner:

BMI of 18.5 to 24.9 / Fat mass of 15 - 20%

Exercise

You:

3 to 4 hours of moderate-intensity exercise

Your Partner:

3 to 4 hours of moderate-intensity exercise

Diet

You:

Focus on complex carbohydrates, vegetable-based proteins, vegetables rich in iron, and fruit and vegetables high in antioxidants. Consider a daily multivitamin supplement. Avoid

trans-fats and excessive amounts of animal protein.

Your Partner:

Focus on complex carbohydrates, and fruit and vegetables high in fibre, folate (i.e. green leafy vegetables) and lycopene (i.e. tomatoes).Avoid trans-fats and excessive amounts of animal protein.

Caffeine

You:

Less than 500mg per day (4 to 5 cups) - the lower the better.

Your Partner:

Support your partner in reducing caffeine consumption.

Alcohol

You: No more than 7 units per week, and no more than 3 units in a single session. Less is more!

Your Partner:

No more than 14 units per week, and no more than 4 units in a single

session. Less is more!

Smoking

You: STOP! Avoid smoky environments

Your Partner: STOP!

Avoid smoky environments.

Pesticides

You: Wash fruit and vegetables thoroughly. Consider a move to organic.

Your Partner: Wash fruit and vegetables thoroughly. Consider a move to organic.

Stress

You: Evaluate your stress levels carefully and make the necessary adjustments to home

and work life to reduce pressure. Use the available interventions, including exercise, to

manage your stress.

Your Partner: Evaluate your stress levels carefully and make the necessary adjustments to home and work life to reduce pressure. Use the available interventions, including exercise, to manage your stress.

Clothing

Your Partner: Avoid prolonged wearing of tight underwear and trousers that increase testicular temperature. Consider changing to 100 per cent cotton underwear.

Illicit drugs

You: STOP!

Your Partner: STOP!

Fertility lifestyle programme team

You and Your Partner: Surround yourself with friends and family who support your goals.

FAQs

Does age matter when it comes to fertility?

Unfortunately, yes. As we age, the fertility levels in both men and women decrease. Research suggests that for women under the age of 30, the chance of conceiving may be over 70 per cent. However, over 36 years of age, it may drop to closer to 40 per cent. One of the main reasons for this is the declining quantity and quality of a woman's eggs as she ages.

For men, the age-related fall in testosterone leads to a decreasing volume and motility of semen, together with increasing DNA damage to sperm. But all is not lost! By making positive changes to all the lifestyle factors covered in this chapter, you can improve your fertility and increase your chances of conception.

My partner loves wearing tight pants but can they be too tight?

Increasing the temperature of the scrotum can have a negative impact on a man's fertility by reducing the production of sperm (spermatogenesis) and negatively affecting a host of factors from the motility to the shape of sperm. Wearing tight pants and trousers, particularly in hot conditions, increases the temperature of the scrotum. As only around a 4ºC increase is required to negatively affect fertility, it's easy to see how prolonged wearing of snug underwear can impact on your chances of conception. The answer is simple: let it all hang out! Avoid wearing tight clothing on a continual basis, wear loose underwear -

preferably 100 per cent cotton, which is a 'breathable fabric' - and trousers as much as possible, and go commando at night!

Can smoking marijuana cause infertility?

Marijuana contains cannabinoids, which have been shown to reduce fertility. Cannabinoids attach to receptors in the uterus in women and the vas deferens (part of the reproductive system) in men, which results in altered function.

In women, cannabinoids have been linked to changes in hormone regulation that negatively impact on fertility. In men, cannabinoids have been linked to reduced testosterone production, sperm count and sperm motility. As marijuana is also illegal, the best advice is not to use it in any form and avoid environments where it is used if you want to improve your chances of conception. It goes without saying that the same advice holds true for other illicit drugs, including cocaine.

Can pesticides used in food production affect fertility?

There is some evidence to show that pesticides can impair fertility in a number of ways. In women, it appears that pesticides may affect your hormones and lead to irregular menses. In men, there is some evidence to suggest that pesticides decrease semen quality, alter

semen DNA, cause erectile dysfunction and decrease libido. The most obvious place we come into contact with pesticides is in our food, so make sure you wash your food thoroughly before eating, and consider changing to organic produce in order to reduce your exposure to harmful chemicals.

Pregnancy trivia

You're not alone

Approximately 10 to 15 per cent of couples are affected by infertility.

Meds

As well as illicit drug use, some prescribed medications can have a negative effect on fertility in both men and women. Speak to your GP about possible side effects of medications that you are taking and how you might enhance your fertility. An important note: never stop taking prescribed medication without talking to your GP first.

Hold that call!

A number of recent studies have demonstrated the negative effects on fertility of the electromagnetic radiation emitted by mobile phones! One study suggested that men who carry their phone on their belts or in their pockets are more likely to have decreased sperm motility. While the jury is out on this subject, it might be worth popping your phone in your jacket pocket!

What's up, Doc?

Looking after your health and speaking to your doctor if you are worried about your or your partner's fertility has been shown to improve your chances of conception. For example, keeping to your appointments for cervical screening tests or seeking treatment for sexual dysfunctions and infections have been shown to improve fertility. As always, it is usually men who are reluctant to seek help and support; so, as well as looking after yourself, give him a nudge!

Work it out!

Even working long hours (more than 32 hours per week) has been shown to reduce fertility due to its association with increased stress levels. Finding the right work-life balance could

be more important than you think. So take a close look at how hard and how long you work, to ensure you are not putting your fertility goals at risk.


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