Emily Moreton (Bsc Msc ANutr RN) is both a registered nurse and registered nutritionist. She holds a bachelor’s degree in adult nursing and a Masters degree in clinical nutrition and public health and is a trained nutrition counsellor. Emily works as a fertility nurse and clinical nutritional practitioner at Hertility Health and has a background in sports nutrition in women’s fitness. Emily specialises in women’s health focusing on health-promoting behaviours, empowering clients to improve their health and well-being by leaving the diet mentality behind and improving their relationship with food, movement and their body, whether it be to optimise fertility chances, manage PCOS symptoms or guide you through menopause.
The benefits of exercise for reproductive health
The benefits of exercise for your overall mental and physical health are well known but how about exercise when it comes to your reproductive health?
Firstly, we know that trying for a baby can be a stressful time for some people, especially if it’s taking you a while to get pregnant but physical exercise can release feel-good endorphins, and movement such as yoga can help to reduce the production of hormones, like our stress hormone cortisol. Physical activity can also improve blood flow to the reproductive organs such as the ovaries and uterus.
For people with PCOS, regular activity can improve the levels of key hormones involved, such as increasing levels of SHBG and reducing androgens such as total testosterone, independent of any dietary change. It will also help to maintain glucose control and reduce insulin resistance, which in turn can help with regularity of periods. Strength training is also really beneficial for this reason in people with PCOS and there are lifelong benefits for strength training for all females, including strengthening the bones and minimising the risk of osteoporosis which increases at menopause.
The risks of exercise and energy intake on reproductive and general health
We’ve covered the benefits of exercise for reproductive health but what should we be mindful of with exercise?
Undereating, overtraining, stress and under-recovering can be a deadly combo for our reproductive and general health, putting us at risk of hypogonadotropic hypogonadism or RED-S, conditions which occur as a result of the body being under increased stress, affecting the hypothalamus which is the main control organ of all the hormones within the body. This can occur if your energy intake is not matching your energy output and will affect everything, from your thyroid, your digestive system, your cardiovascular system, and your reproductive system, thus having a knock on effect on your ovulation and period (known as hypothalamic amenorrhea). What’s more, it can cause oestrogen levels to drop which plays a huge protective role in bone health as well as affecting cognition, metabolic rate, your immune system and increasing endometrial cancer risk. If this sounds familiar and you’ve been experiencing amenorrhea (absence of menstruation), then it is worth checking in on your hormones (you can do this at Hertility) and by taking a trip to the doctor, you can also book in to a virtual consultation with Hertiliy’s gynaecologists..
• Avoid too long a period of time without any food, for example as in intermittent fasting. If you struggle to know how much is ‘enough food’, try eating every 3-4 hours, eat around training, eat to match the training volume and make sure you plan and prep. I.e. always have a snack in your bag!
• Avoid training fasted which is a stress on the body. People often do this for fat loss but it doesn't necessarily translate to loss of body fat or enhance performance and could actually worsen performance
• If you are training for less than 1 hour, at a low intensity, and you feel good training fasted, then it’s ok to train fasted.
• If you are training for over 1 hour or at a higher intensity then try adding in a high carbohydrate snack prior to your workout (around 30- 60 minutes). A banana and a milky coffee or a slice of toast and jam or peanut butter will work well.
• Make sure to refuel after your workout with a balanced meal comprised of carbohydrates, healthy fats and protein which are all important for recovery and in the regulation of our hormones.
Distribute protein evenly throughout the day. The recommendations are 1.2 to 2g per kg body weight or around 20 - 25g of protein per meal. Think Greek yoghurt or soya yoghurt and nuts, meat, eggs, fish, tofu, beans and pulses. There is also protein in whole grains!
• Fruit and vegetables are essential for our micronutrient and antioxidant intake which plays a huge role in fertility nutrition.
• Include dairy or non-dairy alternatives to help support immune and bone health
• Ensure you get enough sleep and recovery
Nutrition and fertility
Since it takes around 90 days for eggs to mature and ovulate and around 72-days to develop and increase sperm count and both processes are affected by nutrition, it is therefore really important to start optimising your diet around 3 months before you are planning on trying for a baby. In cases like Polycystic Ovary Syndrome (PCOS) it can also take time to balance hormones and improve symptoms of PCOS as well as regulating menstrual cycle regularity after coming off of hormonal contraception.
Whilst there are no guidelines for a fertility diet, the Mediterranean style diet is considered to be the best fertility diet due to the amount of vitamins, minerals, polyphenols and fibre it contains. The Mediterranean-style diet is rich in oily fish, vegetables, fruits, legumes, nuts, seeds, whole grains, beans and unsaturated fats such as olive oil and avocado. It includes smaller amounts of dairy, eggs and lean meat and limits processed and red meats and highly processed foods. This way of eating will help to ensure that you are eating essential nutrients required for conception and pregnancy as well as consuming the right nutrients required for recovering from exercise such as omega-3 PUFAs, iron, zinc, iodine, calcium, selenium, choline, Co-Q10 and Vitamins B, C, D and E.
In addition to a healthy balanced diet, there are some supplements that should be considered; 400 mcg a day of folic acid or a higher dosage of 5 mg per day for certain types of people who are at risk of having a child with a neural tube defect; 10 mcg a day of vitamin D or a prenatal supplement that contains both. Strict vegans might also consider vitamin B12, iodine and omega-3 PUFAs.
We should also be aiming to avoid the same foods that should be avoided during pregnancy, for example, alcohol, raw and undercooked meat, keeping caffeine under 200 mg a day etc. You can find the whole list on the NHS website.
Good nutrition, managing stress, getting adequate sleep, taking regular exercise and timing sexual intercourse are the foundations for the best chances of conceiving. When it comes to fertility and movement, the best choice is to find something that you enjoy, keep active through regular movement throughout the day and don’t put too much stress on your body by suddenly deciding that you want to train for a marathon or take up a new sport. You can happily carry on training as you were prior to conception as it’s equally important to carry on exercising throughout pregnancy. The NHS suggest that 150 minutes of exercise each week has loads of benefits for pregnant mothers-to-be. You will just need to be mindful of avoiding certain exercises and slowing right down in the third trimester. Whatever your fitness level, it's really important that you listen to your body and do what feels right for you.