Weighing up your options: the impact of weight and nutrition

I had a front row seat for session three of Progress Educational Trust's 2012 annual conference 'Fertility Treatment: A Life-Changing Event?'.

This session was entitled 'Weighing Up Your Options: The Impact of Weight and Nutrition' and sought to explore the impact of mothers' and fathers' weight and nutrition upon the success of fertility treatment, conception and the health of any resulting child.

The session was chaired by David Whittingham who is Emeritus Professor of Experimental Embryology at St George's University of London, and the first speaker was Nick Macklon who is Professor of Obstetrics and Gynaecology at the University of Southampton. His talk was entitled 'Periconceptional Nutrition and Outcomes'.

He began by explaining how, as an IVF doctor, he feels a responsibility to discuss obesity with his patients; primarily because he has found that early intervention improves the outcome. In a 2007 study, he found a clear correlation between how good a woman's diet was and her fertility. The paper concluded that having a lower body mass index (BMI), a read-out for human body fat, was beneficial for women considering IVF.

Nick then discussed the effect of Omega 3 on embryo quality, saying that clinical data showed there might be a beneficial outcome if women were to take Omega 3, but adding that more data was needed to confirm this conclusively. He also offered a word of caution - that more properly designed studies need to be undertaken before clinicians give supplements to women - mainly because supplements are categorised as food not medicine, so evidence on their effectiveness is very weak.

He then went on to reveal some startling information: that a mother's diet is not only important for producing the optimal environment for her embryo, but that it can also affect the quality of that embryo's future fertility. So, not only do we have to think about the fertility of the patient, but also the fertility of any resulting child.

The next speaker in the session was dietician Fiona Ford. Her talk was entitled 'Universal Panacea or Snake Oil?'.

Fiona focussed on food supplements for women, starting with folic acid. She explained that there is lots of evidence to suggest that taking folic acid is beneficial for women looking to conceive (there has even been a Department of Health campaign for folic acid implementation) but she questioned whether such evidence should lead to food being fortified with folic acid.

This question is still being debated in the UK; however Fiona believes this will soon be resolved in favour of fortification, as very few women are taking folic acid when they should. She believes this is the right decision as any information in specific campaigns on the subject often gets forgotten with each new generation of pregnant women.

Fiona confirmed that official recommendations are for women to take folic acid and vitamin D as a supplement. From this she then explored the confusion surrounding additional fertility supplements, giving vitamin A as an example. In its 'true' form vitamin A is known to be harmful to a fetus; however the plant form, beta carotene, can be beneficial.

Fiona then mentioned an additional confusion for many: what makes a balanced diet? She talked of the 'Eat Well Plate' campaign which outlines the different types of food we 'need' to eat in order to achieve a balanced diet. Only 4 percent of people achieve the five targets mentioned, with 51 percent achieving none, she reported. From this, Fiona questioned whether we have in fact got the basics of nutrition right, concluding that it is not only knowledge that has to be imparted, but that there also needs to be a change in people's behaviour.

The final speaker of the session was Bas Heijmans who is Associate Professor of Molecular Epidemiology at Leiden University's Medical Centre. His talk was entitled 'Your DNA Doesn't Forget (But Will it Forgive?)'.

Bas began by explaining the genetic code and how it leads to new life, but how this genetic code is not enough. Giving the analogy of a dictionary not leading to the creation of a new book, he explained that in life, it is epigenetics that instruct the genes.

He showed us a picture of two mice. One had yellow fur, the other brown. He explained that although they looked different, they had the same genetic makeup. The only difference between the two of them was their diet. Bas explained that although you can clearly see the impact that diet has on mice, it is more difficult to transpose that study on humans as they have a longer life span (and you can't keep them in cages!).

In his work, Bas studied the Dutch 'Hongerwinter' famine and found a link between the famine and fertility. Using the famine as an extreme example, he found that overall there was a 5 percent difference in fertility between those who were exposed to the famine and their unexposed siblings.

Bas then went through the scientific explanation of a modern study looking at folic acid supplements. He said that the study is in the early stages of development: the focus being that epigenetics outlines the way DNA interacts with its environment, but why does this happen and what are the consequences?

There were some very interesting questions from the floor during the discussion. These ranged from whether there have been studies of sperm DNA and epigenetic effects (none in this context, but there should be more), to whether there really is a nutritional concern in pregnant women (there is a generational gap on food nutritional information that needs to be overcome).

One of the most interesting topics from the floor was on fetal programming. It would seem that consistency is the key when it comes to a woman's diet. Changes in a mother's diet could have a detrimental effect on a fetus' development as it tries to adjust to a new situation.

PET is grateful to the conference's gold sponsors, Merck Serono, silver sponsors
London Women's Clinic and bronze sponsors Ferring Pharmaceuticals.