“Toxins”, as I define them in this Plan, are substances that can impact our chances of having a baby. They come in many forms and can have a significant detrimental effect on our health in general. Some of the things we will talk about in this section will be familiar to many people but for others they will be new. If you are planning an IVF cycle it would be wise to do what you can to eliminate toxins as far as possible from your life. They can have a massive impact. Read on.

Smoking

When putting together this Plan I was surprised to learn that relatively few women appear to know how damaging smoking can be to fertility. I had assumed that these days everyone was aware of its harmful effects. I was surprised then to read a study[1] which showed that only 14% of pregnant participants and 47% of infertile patients believed smoking affected fertility.

Make no mistake, smoking is so damaging to our health and our fertility that many doctors will refuse to treat people unless they quit.

Why is smoking so bad for us? Quite simply it is not something that our bodies have evolved to cope with and when you consider that somewhere in the region of 4,000 chemicals[2] are released into our systems when we smoke it is not rocket science to understand why it is harmful.

What can it affect?

How can it harm us?

A lot of research has been carried out showing the negative effect smoking has on fertility. It affects each stage of the reproductive process. It causes problems where either the male or female partner smokes and the effect is strongest when both partners smoke.

In women smoking has been shown to:

1. increase the chances of premature ovarian failure and early menopause[3] [4] [5]
2. affect the ability of follicles to mature into eggs[6]
3. result in the need for higher drug doses and longer treatment times to achieve follicle stimulation[7] [8]
4. doubles the chances of miscarriage[9]
5. makes the womb less receptive to embryos and lessens likelihood of implantation[10]

In men smoking has been shown to:

1. reduce the ability of sperm to fertilise eggs[11] [12]
2. damage the structure of sperm[13]
3. impair sperm motility[14]
4. damage sperm’s DNA[15]
5. cause mutations in chromosomes of sperm[16]

So, in practice what does all this mean when it comes to our chances of succeeding with IVF?

A 1997 meta-analysis[17] (a study where a collection of studies in a particular area are reviewed) showed that smokers on average need twice as many IVF cycles as non-smokers to achieve pregnancy.

A 2005 study[18] involving 225 women undergoing IVF compared the implantation and pregnancy rates of passive (aka sidestream) smokers and active (aka mainstream) smokers with non-smokers. Implantation rates in the passive smoking group were 12.6% and in the active smoking group were 12%. In the non-smoking group they were 25%. Pregnancy rates were 20% in the passive group, 19.4% in the active group and 48.3% in the non-smoking group. Clearly passive smoking poses serious risks too.

An illuminating study[19] of 221 couples undergoing IVF looked at various factors related to smoking including whether the male, female or both smoked together with whether they had smoked for most of their life, a year prior to an IVF cycle, a month prior, a week prior and a day prior.

Where the woman smoked the results were as follows:

1. the chances of not achieving pregnancy was more than double that of non-smokers
2. for each additional year of smoking history the risk of not getting pregnant increased by 9%
3. where they had smoked for over 5 years the risk of not achieving pregnancy was 4 times that of non-smokers

Where the man smoked the results were as follows:

1. smoking in the week of egg collection resulted in a 49% decrease in eggs retrieved, indicating, again, that passive smoking is a significant issue
2. the babies that were born weighed 20% less than babies of non-smoking fathers

Another large study[20] of 8,457 women over a 12 year period who received IVF treatment found that women who smoked the equivalent of 1 cigarette a day for a year had a 28% lower chance of a successful live birth.

And finally a study[21] in 2003 again showed the negative impact male smoking has on IVF. This study looked at 301 couples undergoing either ICSI or IVF; the split was broadly equal. In couples where the male smoked the results for ICSI was a pregnancy rate of 22% compared to 38% for non-smokers. For IVF 18% of couples where the male smoked achieved pregnancy compared to 32% for non-smokers.

What can we do?

It seems clear that smoking has a significant negative impact on our chances of succeeding with IVF. On top of this we have to face up to the fact that if we have smoked for a while then some damage may have already been done. However, it is not all doom and gloom; at least one study[22] has shown that over time male and female ex-smokers can achieve similar levels of fertility to non-smokers. This makes sense as other studies[23] have shown that quitting smoking improves health generally.

We also need to face the fact that quitting smoking is not easy. Studies[24] [25] show that only 6% of attempts to quit are successful and that it may take up to 30 attempts for some people to quit completely. Some do not manage it at all.

There are many options when it comes to giving up smoking but a meta-analysis[26] of studies that examined quitting methods identified the following as being the most helpful:

If you want to quit the first step should be to speak to your doctor and ask for advice. Sponsored programmes may be available and he will be able to put you in touch with those. You should also talk to your IVF doctor as some measures (such as nicotine replacement and other drug treatments) may not be appropriate.

Alcohol

We seem to be bombarded by news stories covering the latest health-related alcohol studies on a daily basis. Some studies suggest that certain types of alcoholic drink are actually good for our health whereas other suggest the opposite. The focus here, of course, is doing what we can to maximise our chances of IVF success so let’s look at the evidence as far as drinking and IVF is concerned.

What can it affect?

How can it harm us?

A study[27] of 2,545 couples who underwent 4,729 IVF cycles examined the amount of alcohol consumed by the participants and found that women consuming 4 or more drinks per week had a 16% lower chance of a live birth compared with those that consumed fewer than 4 drinks per week. Where both partners consumed 4 or more drinks per week the chances of a live birth decreased by 21%.

A study[28] carried out in New York presented at the 2013 American Society for Reproductive Medicine’s Annual Conference looked at the levels of alcohol consumption of 90 couples that had previously undergone, on average, 3 unsuccessful IVF cycles. It found that the women who abstained from alcohol had a 90% chance of achieving pregnancy over the next 3 years. In contrast women who drank on average 3 small glasses of wine per week had only a 30% chance of conceiving over the same period. In addition, women who drank on average just 1-2 small glasses of wine per week only had a 66% chance of achieving pregnancy over 3 years.

Another study[29] carried out at Harvard Medical School presented at the same conference examined the alcohol consumption of 2,574 couples who had undergone more than 5,300 IVF cycles. The researchers found the following:

1. women who drank 2-3 large glasses of white wine a week cut their chances of having a baby by 24%
2. partners of men who drank beer every day had a 30% lower chance of having a baby and a 38% lower chance of an embryo implanting in the womb
3. if both partners drank at least 6 units of any type of alcohol per week the chances of success with IVF fell by 26%

Finally, a study[30] of 221 couples with female infertility found that women drinking more than 1 alcoholic drink a day reduced the number of eggs collected by 13%, increased the risk of not achieving pregnancy 2.86 times and increased the risk of miscarriage 2.2 times. Where the male partner drank more than 1 drink per day the risk of no live birth was 2.26 times higher and 8.32 times higher where drinking continued into the week before sperm collection.

What can we do?

This might not be a popular step but if you want to maximise your chances of success with IVF then it is something that you should seriously consider: it is advisable to avoid drinking alcohol prior to and during IVF. In an ideal world alcohol should be avoided for the 12 months prior to the cycle. In most cases this will not be possible but the longer it can be avoided the better.

Pesticides

Chemical pesticides have been widely used in food production for decades even though they have been linked with a number of health issues including ADHD in children[31], brain and nervous system damage[32] and certain types of cancer[33].

Can they also impact fertility?

What can they affect?

How can they harm us?

Whether chemical pesticides affect our fertility seems to depend a lot on our level of exposure to them. To understand why they may be an issue we need to remember that our reproductive systems depend on a cascade of hormones and that any disruption to this delicate balance, however small, can impact our ability to conceive[34].

A lot of research has been carried out on how pesticides affect our reproductive systems but far fewer studies have been done on how much they impact. It would be overkill to go through everything here but it is important to summarise the research so you can understand the practical impact. It has, for example, been shown that these chemicals affect hormones that are critical to fertility by:

1. interfering with the body’s synthesis (use) of estrogen and certain male hormones[35] [36] [37] [38]
2. impacting the body’s ability to store and release hormones[39]
3. inhibiting the transport, release and clearance of estrogen and testosterone[40] [41] [42] [43] [44]
4. interfering with hormone receptor recognition and binding making it difficult for our bodies to respond correctly to hormone release[45] [46] [47]
5. disrupting thyroid function[48]
6. affecting our central nervous systems[49]

This research is all very interesting (or maybe not!) but what do these things mean in the real world? How do they affect our ability to conceive? Further studies suggest that chemical pesticides impact in the following ways:

1. increase menstrual cycle disturbances and chances of missed periods[50] [51]
2. infertile women are 3 times more likely to have been exposed to pesticides[52] and 9 times more likely to have worked in agriculture[53]
3. workers in flower greenhouses take longer to become pregnant[54]
4. increase the chances of miscarriage and stillbirth in agricultural workers[55] [56] [57] [58]
5. cause birth and developmental defects in babies of agricultural workers[59] [60] [61] [62] [63] [64] [65] [66]

I am conscious that this is pretty scary stuff but unless you work closely with chemical pesticides or live in an area where they are used you may not be affected.

Having reviewed the research the decision that my wife and I took was that, even though we did not work with pesticides or live in an area where they were used, they clearly had the potential to have a negative impact on our ability to succeed with IVF so we would do what we could to eliminate them from our lives. For us this meant looking at our diets.

There is not a lot of research into the effect of pesticide consumption through food but we did find a few studies that formed the basis of our decision.

Firstly, a study[67] carried out at Harvard looked at the diets of 325 women undergoing fertility treatment, focusing on the amount of pesticides consumed through eating fruit and vegetables. The researchers categorised fruit and vegetables as having either “high” or “low” levels of pesticide residue. They found that the women who consumed more than 2.2 servings per day of fruit and vegetables with high pesticide residues were 18% less likely to become pregnant and 26% less likely to have a live birth compared to women who ate less than one serving per day.

Another study by Harvard[68] examined the effect of pesticide residues on fruit and vegetables in men. The researchers found that the men that consumed the highest amount of pesticides had a sperm count that was 49% lower than men who ate the least amount of pesticides. They also had 32% fewer normally-formed sperm.  It is important to note that the researchers were careful to point out that the results of this study should not stop people eating fruit and vegetables but it does demonstrate the negative effect that pesticides can have.

Similarly, in a study[69] of 122 men aged between 18 and 22 researchers found that those men that ate fruit and vegetables with the lowest levels of pesticides had sperm counts that were 169% higher and sperm concentrations that were 173% higher than the men that consumed fruit and vegetables with the highest levels of pesticides.

Other studies have shown just how many foods are contaminated with pesticide residues. For example, the Environmental Working Group[70], a US non-profit organisation, found that:

1. over 98% of strawberries, peaches, nectarines and apples tested positive for at least one pesticide
2. the average potato had more pesticides by weight than any other produce
3. one grape sample and one sweet pepper sample contained 15 pesticides
4. single samples of strawberries showed 17 different pesticides

Finally, a study[71] that looked at pesticides in genetically engineered corn crops that are supposed to be completely destroyed by the human digestive system (and so not absorbed into our bodies) found the pesticide in:

1. 93% of pregnant women
2. 80% of umbilical cords of their babies
3. 67% of non-pregnant women

Despite the negative stuff in this section a couple of studies provide a beacon of hope. A study of children in Seattle[72] substituted organic fruit and vegetables for non-organic produce for 5 days and found that this switch reduced pesticide levels in their urine to undetectable levels. Another study[73], this time of adults, showed that following an organic diet for 7 days reduced pesticide exposure by 90%. These studies show it is never too late to change things.

What can we do?

Firstly, if you work with chemical pesticides you should consider the studies above and decide whether you are prepared to take the risk of continuing in your job whilst undergoing IVF. It would, of course, be a big decision to leave a job but in the spirit of this Plan it would be remiss not to mention the possibility.

When it comes to living in an area where pesticides are used and eating produce on which pesticides have been used the position is not straightforward. In an ideal world we would move to a pesticide-free area and eat a completely organic diet. However, this is not likely to be possible so it is a question of doing what you can within the constraints of your budget and access to organic produce.

Studies show that certain produce contains more pesticides than others. Helpfully, the Environmental Working Group carries out a study each year into pesticides in produce and publishes a list of the most (including what they call “The Dirty Dozen”) and least (the “Clean 15”) contaminated produce. The list is available on their website at www.ewg.org. Whilst the focus is US produce it provides a useful steer as to which non-organic products we can be relaxed about eating and which we should only buy organic (or avoid altogether).

On top of this there are certain steps you can take to reduce the levels of pesticides in non-organic produce. These measures are reasonably effective against pesticides on the surface of produce but there is little we can do to remove systemic pesticides (those absorbed into the produce).

You will find numerous recommendations on the internet for washes (DIY and commercial) that are supposed to remove pesticides. However, a study[74] in 2000 showed that there was little difference between scrubbing/rubbing under tap water and using the washes. In fact, the authors concluded that it was the mechanical action of rubbing and scrubbing under running water that had greatest effect.

To remove residual pesticides from food, you should wash fruit and vegetables carefully in running water (not a bowl of water) and rub well. Other things you can do include:

1. removing outer leaves from leafy produce
2. removing the peel from produce with higher levels of pesticides or produce that has a textured surface that may trap them
3. eating a variety of fruit and vegetables to reduce your exposure to particular items that may have higher levels of pesticides

Trans fats

Trans fats are bad news and should be avoided by everyone but particularly those of us who are trying to conceive. Trans fats are heavily processed oils that have been linked with a host of health problems including brain deterioration[75], diabetes[76], obesity[77], Alzheimer’s disease[78], depression and heart disease[79] and have been shown to increase the chance of death from any cause by 34%[80]!

Trans fats are cheap and have a long shelf life so are widely used. They are so damaging to health that some countries have effectively banned their use.

The list of health problems associated with trans fats shows how damaging they can be to our bodies. This being the case it is probably reasonable to conclude that they impact fertility, right?

What can they affect?

How can they harm us?

A Harvard 2007 study published in the American Journal of Clinical Nutrition showed that for every 2% of calories consumed from trans fats instead of healthier fats a woman’s risk of infertility doubles[81].

Another study[82] involving 120,000 women carried out over a period of 12 years showed that women with the highest intake of trans fats had a 44% greater chance of developing endometriosis (an issue with the lining of the womb which makes becoming pregnant difficult) than those that ate the lowest levels.

Men’s fertility is also affected by trans fats. In another study at Harvard[83] researchers looked at the diets of 141 men undergoing IVF and found that those who consumed the highest levels of trans fats had a 47% chance of becoming pregnant with their partner after two IVF cycles whereas those that consumed the lowest amounts had an 83% chance.

Another study[84] looked at the sperm concentrations of men attending a fertility clinic and found that those with the highest intake of trans fats had average sperm concentrations of 48 million/ml and those with the lowest intake had average concentrations of 79 million/ml.

What can we do?

These studies suggest that trans fats can damage the fertility of both men and women and if you eat processed foods the chances are you are consuming them. Research generally suggests that there is no safe level of trans fat consumption so it would be wise to avoid them as far as possible.

Unfortunately, because they are cheap trans fats are common in many food products. They are often found in biscuits (sweet and savoury), bread and cake mixes, bread rolls, buns, cakes and doughnuts, croissants, desserts and custards, instant drinks and soups, sausage rolls, crisps and savoury snacks, ice cream, peanut butter, chocolate spreads, coffee whiteners, pies and pasties, pizzas, confectionery, frozen potato products, margarines, spreads, mayonnaise and ready-made/microwave meals.

The following tips will help you to avoid trans fats:

1. eat whole foods and avoid highly processed foods
2. if you eat processed foods then examine the ingredients labels. If they contain any “hydrogenated” oils don’t buy them
3. reduce the amount of fried foods you consume
4. do not reuse cooking oils
5. minimise your consumption of foods listed above

Caffeine

Caffeine is found in many everyday drinks including coffee, tea, cola and energy drinks. It is also found in chocolate. Caffeine may appear to be a fairly innocuous substance but let’s see if it has an effect on our ability to succeed with IVF.

What can it affect?

How can it harm us?

Firstly, a number of studies have shown that caffeine can increase the risk of miscarriage. For example, a study[85] of 1,063 women in the early stages of pregnancy found that women who drank more than the equivalent of 200mg of caffeine (about 2 average-size cups of normal strength coffee) had a miscarriage rate of 25.5% compared to only 12.5% in women who consumed no caffeine.

Another study[86] of 221 couples undergoing fertility treatment found that the risk of not achieving a live birth increased 3 times in women who consumed an average of 50mg of caffeine (about ½ a cup of coffee) per day.

It is not just female consumption of caffeine that is an issue. Male consumption also has a surprisingly strong effect. A study[87] of 501 couples found that female consumption of more than 2 caffeinated drinks a day prior to conception increased miscarriage rates by 74% and the same level of consumption by males resulted in an increased miscarriage risk of 73%.

A number of studies also show that caffeine intake is linked to taking longer to conceive. For example, a 1995 study[88] looked at 2,501 pregnancies and found that women who consumed more than 300mg of caffeine (3 cups of coffee) per day were 2.65 times as likely to suffer from delayed conception than women who consumed no caffeine.

Caffeine intake can also impact a baby’s development in the womb. A study[89] published in the British Medical Journal examined 2,635 pregnant women and found that the more caffeine that was consumed the more growth development was impacted. Those women consuming 100-199mg of caffeine (1-2 cups of coffee) had a 20% greater risk of impacting their child’s development and those consuming 200-299mg (2-3 cups of coffee) had a 50% greater risk.

Finally, a Danish study[90] of almost 4,000 IVF and ICSI patients found that the consumption of 5 or more cups of coffee per day led to a 50% reduction in pregnancy rates along with a 40% reduction in live birth rates. As a result of these findings the lead researcher described coffee’s impact on fertility treatment as “comparable to the detrimental effect of smoking”.

What can we do?

There is enough evidence here to suggest that giving up caffeine is necessary to give yourself the best chance of having a baby. If you decide to do this the following should be avoided: coffee, tea, cola, energy drinks, chocolate, cocoa and hot chocolate.

Another option may be to choose decaffeinated versions. However, there is evidence that decaffeinated products may themselves cause problems, albeit for different reasons. For example, a study[91] in 1997 found that drinking decaffeinated coffee was associated with 2.4 times greater risk of miscarriage. This being the case it may be wise to avoid these products altogether.

BPA

BPA is short for “bisphenol A”. It is an industrial chemical that is used in a range of products including aluminium tins, recycled paper, receipt paper, plastic containers and drinks cans.

Like chemical pesticides, BPA is an “endocrine disrupter”, a chemical that when absorbed into our body either mimics or blocks hormones and interferes with our body’s normal processes. It has been linked with a variety of health issues including breast cancer[92], prostate cancer[93], heart disease[94], obesity[95] and diabetes[96]. It is banned in Canada.

One of the issues with BPA is that it can easily leech out of packaging, etc and into food or directly into the human body.

So how does BPA impact our chances of IVF success?

What can it affect?

How can it harm us?

A study of 239[97] women undergoing IVF in Massachusetts between 2007 and 2012 separated the women into 2 groups, those with high BPA levels in their systems and those with low levels. The researchers then compared the pregnancy rates of the two groups. In the group with high BPA levels 17% of women gave birth but in the group with low levels 54% gave birth. Needless to say, that is a big difference and illustrates how damaging BPA can be.

Another study[98], again in Massachusetts, followed 174 women undergoing IVF and found that women with higher BPA concentrations in their urine had on average 24% fewer eggs and a small study at the University of California[99] found that as blood levels of BPA doubled, the percentage of eggs that fertilised normally declined by 50%.

A further study[100] of 137 women having IVF looked at “implantation failure” (where an embryo does not implant in the womb) and found that the women who had the highest levels of BPA in their system were more than twice as likely to have implantation failure.

Studies have also shown a relationship between high levels of BPA and polycystic ovary syndrome[101], one of the most common forms of infertility, endometrial hyperplasia (abnormal thickening of the womb)[102] and recurrent miscarriage[103].

Why does BPA affect fertility so significantly? Science is still trying to work this out but from the studies to date it seems that BPA:

1. interferes with hormones that are vital to fertility and pregnancy[104]
2. stops eggs from maturing and those that do mature often do so abnormally[105]
3. affects an embryos ability to implant in the womb[106]
4. reduces receptivity of the womb[107]

Men are also affected. In a study funded by the US National Institute of Occupational Safety and Health[108] researchers examined the semen of 514 men. They found that men with higher levels of BPA were 2-4 times more at risk of having poor semen quality including low sperm concentration, low sperm vitality and mobility.

The levels of BPA in the men were inversely proportional to sperm quality, ie the higher the levels of BPA, the lower the quality of the sperm. Compared to men without detectable levels of BPA those with detectable levels had more than 3 times the risk of lowered sperm concentration and lower sperm vitality, more than 4 times the risk of lower sperm count and more than twice the risk of lower sperm motility.

BPA clearly has some powerful negative effects but how likely is it that you are exposed to it on a regular basis? The answer is very likely. A study[109] of 2,517 people in the US took urine samples from each of them and found BPA to be present in 92.6% of participants.

This is probably not surprising given the prevalence of BPA and how easily it can leach into our food. A good illustration of this is a study[110] that examined the effects of eating a single can of soup each day for 5 days. Levels of BPA were measured before and after the 5 day period. At the end of the study the participants’ BPA levels had increased by 1,221%!

The good news is that by changing our habits we can do a lot to eliminate BPA from our lives. BPA has a short “half-life” in the body[111] which means that it does not hang around long. The issue with BPA is that it is so prevalent that by the time our bodies have eliminated one dose we have been exposed to further doses.

A study[112] carried out by Breast Cancer Fund showed how quickly BPA is expelled from our bodies. By simply eliminating canned food and food packaged in plastic participants reduced their BPA levels by 60% in just 3 days.

What can we do?

The evidence suggests that BPA impacts fertility so it would be wise to do what you can to avoid it. Here are some tips:

1. avoid bottled water. Thin plastics used in bottles leach BPA into the water and this issue becomes worse if the bottle is reused
2. use only BPA (and phthalate! – see below)-free plastics, particularly for food storage/preparation. If possible avoid plastics altogether. Whilst there are fewer studies on the effects of other chemicals in plastics there is evidence[113] that they may also be harmful
3. avoid plastic bags and food wrap, unless BPA-free
4. eat/drink fewer canned/tinned foods/drinks
5. do not accept till receipts unless necessary

Phthalates

Phthalates are another group of chemicals that are found in a wide range of products including glues, building materials, personal care products, packaging, toys, shower curtains, floor tiles, food containers and cleaning products. Their use in children’s toys is banned in the European Union and the United States as they have been linked to several health issues, including cancer, diabetes and birth defects, ADHD, asthma and obesity[114].

Phthalates are another endocrine disrupter so they mimic hormones in our bodies and can disrupt the delicate balance required to achieve pregnancy.

What can they affect?

How can they harm us?

The first thing to note is that phthalates are used in so many products and leach out so easily[115] that we are exposed to them at every stage of our life, even prior to our birth[116]. They can enter our bodies via inhalation, orally, through our skin, from our mothers in the womb and even intravenously. In one study[117] 9 types of phthalate were detected in over 95% of pregnant women studied!

For over 50 years it has been known that phthalates disrupt male hormones and this, in turn, seems to result in sperm defects. For example, a 2003 study[118] collected urine samples from 168 men receiving fertility treatment and found that the men with the highest levels of a certain phthalate were more than twice as likely to have low sperm motility and reduced sperm concentration. They were also 70% more likely to have a higher percentage of deformed sperm.

Another study[119] looked at phthalate levels in 501 couples and found that in couples where the male partner had the highest levels of phthalates the time it took to become pregnant increased by 20%.

There have been fewer studies in women but there is a growing body of evidence that suggests that phthalates negatively impact female fertility too, but possibly to a lesser extent than their impact on male fertility. For example, a 2013 study[120] involving 231 women undergoing 325 IVF cycles found that women with the highest concentrations of certain phthalates in their urine produced 11.4% fewer eggs after stimulation than those in the lowest group.

Another study[121] involving 256 women going through IVF found that women with the highest levels of phthalates in their systems were 19% less likely to have a live birth compared to women with the lowest levels.

A 2014 study[122] involving a total of 482 women compared the phthalate levels in women suffering pre-term births with women who gave birth at full term. The researchers found that the women with the highest level of phthalates in their urine had a risk of pre-term birth that was 2-5 times higher than women with the lowest levels. Pre-term birth can be a serious issue; it is a leading cause of death and long term neurological issues in children.

Whilst phthalates are all around us it is possible to reduce our levels of exposure. In the study[123] referred to in the BPA section above researchers also examined phthalate levels and found that they were reduced by 53% by avoiding canned and packaged food.

What can we do?

My wife and I decided to avoid phthalates as far as possible and to achieve this we did the following:

1. avoided artificial perfumes, scents and other fragrances, in whatever form, and chose fragrance-free, phthalate-free or naturally-scented products instead
2. used only phthalate (and BPA!)-free plastics, particularly for food storage/preparation and, where possible, avoided plastics altogether
3. ate as organically as possible as phthalates are used in chemical pesticides
4. ceased using most cosmetics, only using those considered not toxic by the Environmental Working Group’s brilliant Skin Deep database (ewg.org/skindeep)
5. avoided eating at restaurants (one study[124] showed that people that ate at restaurants, especially fast food restaurants, had 35-55% higher phthalate levels)
6. minimised the level of packaged foods
7. consumed only filtered water

Environmental pollution

We live in an increasingly industrialised world where vehicles and industry pump out waste products into our environment. These pollutants are a mixture of different substances, the proportion of which will vary based on your location but to give you an idea a study[125] in the US identified 70,000 different industrial chemicals in the environment with 1,000 new synthetic chemicals being produced each year.

In 2016 the British Royal College of Physicians and the Royal College of Paediatrics and Child Health published a report[126] looking into the effects of environmental pollution and estimated that 40,000 deaths in the United Kingdom each year are linked to pollution. It also linked pollution to asthma, heart disease, cancer and diabetes.

The World Health Organisation had earlier concluded that pollution causes cancer, particularly lung cancer, and estimated that it was responsible for 3.7 million premature deaths worldwide in 2012[127].

This is clearly serious stuff and other studies suggest that it can also affect fertility.

What can it affect?

How can it harm us?

A study[128] of 226,430 women considered whether living close to a major road (within 200 metres) impacted fertility. It found that for women living close to a major road the risk of infertility was 11% greater than women who did not.

A study[129] reported in Environmental Health Perspectives looked at 501 couples trying to get pregnant over a period of 12 months. Researchers measured participants’ blood for 63 different pollutants and found substances that had been banned since the 1970s. They also found pesticides that are supposed to degrade in the environment but are, in fact, absorbed by livestock which is then consumed by humans. At the end of the study the researchers analysed the blood levels of the participants and found that for each unit increase in blood concentration the chances of becoming pregnant decreased by between 17% and 29% depending on the particular pollutant.

Looking specifically at the effect of pollution on IVF, a study[130] of 7,403 women over a period of 7 years looked at the levels of air pollution in the area each woman lived together with the levels of pollution at their fertility clinic at various stages of treatment. The researchers found that for every unit of nitrogen dioxide (a common airborne pollutant) the chances of the woman conceiving were reduced by between 13% and 24%.

A study[131] in Korea had similar findings with women undergoing IVF exposed to high levels of common pollutants having pregnancy rates between 7 and 18% lower depending on the type of pollutant and timing of exposure.

Another study[132] looked at levels of pollutants called PCBs in women in the US undergoing IVF treatment. PCBs have been banned in the US since 1979 but take a long time to break down so they persist in the environment. The levels of PCBs in the blood of 765 women were analysed and the researchers found that the women with the highest levels were 40% more likely to suffer failed embryo implantation that women with the lowest levels of PCBs.

Men are also affected. For example, environmental pollution has been linked with reduced sperm motility[133], a greater proportion of deformed sperm[134] and lower sperm counts[135].

What can we do?

Move to the countryside at least 100 miles from the nearest town! Seriously, the following can help reduce our exposure. They may not be possible all of the time, or even most of the time, but the more you do them the more you will reduce your exposure:

1. keep away from busy roads as much as possible. Use roads with little traffic instead
2. steer clear of factories and industrial plants as far as you can
3. avoid “urban canyons”, areas with tall buildings where pollution collects
4. check daily pollution forecasts and avoid areas forecast to have high pollution
5. avoid areas of traffic congestion
6. when exercising outdoors make a greater effort to apply the above measures as it has been shown[136] that exercising near sources of pollution causes 5 times as much pollution to be inhaled
7. if you live in an urban area or near an industrial plant keep your windows and doors closed, particularly on days forecast to have high pollution

Detox

As we have seen, we are exposed on a daily basis to various chemicals, heavy metals and other substances that have the potential to impact our fertility. Some of these things can be eliminated through simple changes to our lifestyle but others are all-pervasive and therefore difficult to avoid.

By following the action steps set out you will help to minimise your exposure to toxins and hopefully increase your chances of succeeding with IVF. You may well also improve your health generally. However, you have most likely been exposed to certain substances for a long time, perhaps all your life, and whilst they remain in your body they can continue to cause damage.

This is where a detox comes in. A “detox” for these purposes refers to a plan to encourage our body’s natural processes to remove unwanted toxins from our systems.

Detoxes can be a controversial subject. There are many proponents and there are many who think they are a waste of time; as far as typical detox plans go, with good reason. There are many detox plans out there but many of them will only make us more toxic as they fail to understand the complex process of how our body rids itself of toxins. Let’s have a quick look at this now.

The 3 stages of detoxification

The human body has complex systems for handling and eliminating toxins. Our liver, lungs, skin, kidneys and gastrointestinal system (our stomach and intestines) all play an important role. Detoxification is a 3 stage process:

Stage 1

Our liver’s job is to filter toxins out of the blood and this is the first stage of the detox process. The liver in effect grabs toxins from the blood as it passes through. This happens continuously with approximately a third of the body’s blood going through the liver every minute.

The liver then attempts to attach the toxins it has grabbed to an antioxidant (a nutrient or other substance designed to neutralise the toxin). Issues can occur if the body is not capable of processing the toxins. They can, for example, be stored in the body’s fat cells if the liver is overloaded or insufficient antioxidants are available. To help prevent this a good detox plan needs to ensure an adequate supply of nutrients.

Stage 2

Once the liver has added an antioxidant to the toxin it then attempts to convert it into another molecule by adding something called an amino acid or a sulfurous compound which has the effect of changing the toxin from a fat-soluble compound into a water-soluble compound which is easier for the body to process.

Stage 3

These water-soluble toxins are then moved to our kidneys where they are expelled from our body in urine or faeces.

The first stage of the process is reasonably straight forward to achieve. Most of the detox plans on the market (particularly the fruit/vegetable only plans) will do this. However, if the plan does not provide enough antioxidants or amino acids (which are the building blocks of protein and fruit/vegetables only contain small amounts of protein) what often happens is that the liver grabs the toxins, stores them in fat cells and because the detox plan is low calorie, the body releases fat for energy which causes the toxins to be released back into the blood stream. These toxins can cause outbreaks of spots, stomach problems, nausea, fatigue and other symptoms.

This explanation is a very simplistic description of a hugely complex process but hopefully it will set the scene for the detox plan below.

The 7 day detox

An effective detox plan provides support for each stage of the process to ensure that toxins end up in your toilet and not back in your body. It should also ensure that you do not get hungry or overly tired and can function normally.

The following nutrition and supplement programme is designed to be followed for 7 days and provides the support our bodies require. You should not get hungry and you should have energy to carry on life as normal, although your energy levels may be lower. I will not pretend that it is easy however. Limiting food intake to the things in the detox plan is boring but if you focus on the reason for doing the detox in the first place that should provide you with the motivation to get through.

Before starting any detox plan you should first consult your doctor and proceed only with their approval.

The plan

For a period of 7 consecutive days eat an unlimited amount of one raw organic vegetable per day, changing the vegetable each day. Organic is important here. During the detox we are attempting to remove as many toxins from our body as possible so the last thing we want to be doing is adding more toxins in the things we consume.

The following are some of the best vegetables to consume: green and red cabbage, broccoli, cauliflower, green beans, asparagus, Brussels sprouts, peppers, kale, spinach and courgettes.

The reasons for limiting food in this way are, firstly, to ensure you are not consuming anything that is going to add to your existing toxic load and, secondly, to reduce the risk of consuming foods that you may, unwittingly, be intolerant to. This is important as intolerances can trigger inflammatory responses in the body which, as we have seen, can lead to other health issues.

Along with the vegetables, take the following supplements each day:

There are a lot of supplements here! It may be helpful to explain the purpose of each one:

fibre supplement: we have all heard about the benefits of eating fibre. The purpose of fibre as part of the detox is to ensure that our body can efficiently eliminate toxins in the form of faeces and to provide a food source for the healthy bacteria in our guts to allow them to proliferate. It also helps prevent toxins from breaking free from our intestines and re-entering circulation.

Greens supplement: greens supplements are in essence compacted, dried, powdered vegetables providing a blend of vitamins, minerals, phytonutrients, antioxidants, enzymes and fibre. They should not be seen as a replacement for fresh vegetables but they are a useful top-up. By consuming a greens supplement during the detox we help ensure our body has a full range of nutrients available to it to support the elimination of toxins.

UltraClear Plus: you will notice that I have referred to UltraClear Plus by Metagenics. This is one of the few specific brands I have referred to in the entire Plan and the reason for including it here is that it is the only commercially available detox-specific product that I could find that has undergone clinical tests. One study[137] put participants through a 7 day programme using UltraClear and gauged the effects by using a questionnaire to determine the severity of a range of health issues before the detox and then again afterwards. Each issue was scored using a points-based system with higher scores indicating greater health issues. Following treatment with UltraClear there was a 47% reduction in scores.

UltraClear is coldly termed a “medical food” providing a range of proteins, carbohydrates, vitamins, minerals, amino-acids and trace elements. It effectively replaces the need for normal food over a short period.

Calcium d-glucarate: this is a specific form of calcium that has been shown to have anti-cancer effects[138] and to support our body’s detox processes[139] [140]. Calcium d-glucarate enhances stage 2 by improving our body’s ability to turn fat soluble toxins into water soluble toxins that are easier to pass. It also improves the activity of enzymes which results in other substances being inhibited and consequently prevents toxins being reabsorbed back into the body.

Vitamin D: I talk about this amazing vitamin and its ability to increase our chances of success with IVF in more detail later but for the purposes of a detox it has a number of benefits. Every cell in our body requires vitamin D to function and without an adequate supply we will not be able to detox effectively. One of the most important benefits of vitamin D is that it turns on certain anti-inflammatory processes that help support detoxification.

Fish oil: also known as omega 3, EPA and DHA, fish oil has potent anti-inflammatory actions and therefore provides perfect support during a detox. It has also been shown to support a substance called Nrf2 which is involved in the detox process[141].

R-alpha lipoic acid: alpha lipoic acid is a powerful antioxidant that, unlike most other antioxidants, works on both fat soluble and water soluble toxins. It also recycles other antioxidants and so improves their effectiveness. It has been shown to support detoxification of heavy metals such as mercury[142] by binding to them as part of stage 2[143]. One point to note is that the “R” form of alpha lipoic acid has been shown to be the most effective so this is the form you should opt for.

Plant-based protein powder: adequate protein consumption is important to ensure that we maintain lean tissue during the detox and to provide sufficient amino acids to bind with toxins as part of stage 2. A lack of protein is one reason why many commercially available detoxes cause problems. Without protein the body in effect starts cannibalising itself to support critical processes that keep us alive.

The form of protein is also important. The most widely used form of protein powders such as whey and casein are derived from dairy products and some people are intolerant to them, even if they are not aware. Unfortunately, many plant-based protein supplements lack important amino acids which means they are not used as effectively by the body. However, a number of manufacturers blend different forms of protein (such as rice, pea and hemp) to ensure a better amino acid profile and these are the ones to go for.

Probiotics: probiotics are good bacteria that occur naturally in our stomachs and elsewhere. They are fundamental to life and health. Unfortunately, overuse of antibiotics and poor diets can cause the amount of these good bacteria to decrease and the amount of bad bacteria to increase. One of their functions is to ensure proper absorption of nutrients in our guts which is fundamental to the detox process. We can consume all the vegetables and supplements we want but if our body cannot absorb them it is a waste of time.

Probiotics also have specific benefits when following a detox programme. They have the ability to displace harmful bacteria and improve our ability to eliminate toxins in the form of waste.

Magnesium glycinate: magnesium is involved in around 300 essential processes in our bodies, many of which involve the elimination of toxins. It is also required for removing artificial external estrogens and a hormone called cortisol, known as the “stress hormone”, from the body. Additionally, without sufficient magnesium the body cannot utilise vitamin D.

Exercise

When detoxing you should exercise in a way that supports the detox process. You will almost certainly be consuming fewer calories than normal so energy levels may not be as high and your ability to recover from exercise will be impaired. Exercise supports a detox programme in a number of ways:

1. blood circulation is increased[144] allowing the liver to process more toxins
2. lymph circulation[145] increases allowing lymph nodes to increase toxin removal. Lymph is the substance that contains white blood cells which break down microbes, germs and other unwanted substances. Unlike blood which is mainly propelled by the heart, lymph is propelled by movement of muscles
3. by increasing the rate of breathing we increase the rate at which our lungs expel toxins
4. the functioning of key organs involved in the detoxification process is improved with exercise[146] [147]
5. sweating increases the removal of toxins from our body through sweat glands in our skin[148]
6. fat is mobilised to be burnt for energy which in turn releases fat soluble toxins into our systems for elimination
7. exercise regulates hormones so that fewer toxic by-products are produced through poor hormonal performance[149]
8. animal studies also suggest that exercise causes the release of an enzyme that purges the body of harmful substances[150]

So what exercise can you do? In large part it depends on your current activity levels. Before you start any exercise programme you should consult your doctor. Assuming that you have no health issues and your doctor is happy you can exercise at an intensity that gets your heart pumping, you feel slightly out of breath and you have a reasonable sweat by the end. If you currently do very little exercise then brisk walking is a good start. If you are fit you can do something more intense. The key for everyone is to do some form of low-moderate intensity exercise for 30 minutes each day during the detox. If you find exercise boring then mix things up. Exercise does not have to involve spending ages on a treadmill in a gym.

Sweating

As mentioned above, increasing the rate at which we sweat is one of the reasons exercise is helpful during a detox. If you are female you can add in other activities that make you sweat to further benefit from this process. Males should avoid these activities for the reasons set out in Section Seven: Lifestyle. These things should not be seen as replacements for exercise, instead they are a useful addition. Sweating has been shown to have numerous health benefits, including reducing the risk of death from any cause and reducing the risk of death from heart problems by 50%[151].

The skin is the largest organ in our body and plays a key role in the detoxification process. Throughout the ages different cultures have prized the value of sweating to keep us healthy. The Romans and the Turks are famous for their baths, the Scandinavians for their saunas and the Aboriginal Australians and Native American Indians for their sweat lodges. Modern medicine now seems to be catching up. For example, a review[152] of studies published in the Journal of Environmental and Public Health found that numerous toxins are expelled from our bodies through sweat including arsenic, lead, BPA and mercury. Another study concluded that sweating should be the primary treatment for people with high mercury levels[153].

Saunas and Turkish baths are a great way of increasing sweating and if you have easy access to one you should use it during the detox. Subject to any health issues – again, check with your doctor first – aim to take a sauna every other day during the detox. The duration depends on the temperature and your heat tolerance. Obviously be sensible and only spend a short time in there.

If you do not have easy access to either of these, and most of us won’t, another option is to take a hot bath. You may not realise it but when we bathe in hot water we sweat a lot. Aim for a 15-30 minute bath on alternate days during the detox.

Finally, one of the indications that your body is getting rid of toxins can be sore muscles, particularly around the neck and shoulders. Saunas, Turkish baths and normal baths are a good way of easing this soreness.

Hydration

Staying hydrated is extremely important during a detox. We need water for optimal digestion and liver function anyway but following a detox plan such as this increases the need for water to help flush toxins through our systems and to replace water lost in the form of sweat. Expect your requirements to increase quite a bit during the detox so sip water throughout the day. Not only will this keep you hydrated it will also help keep hunger away.

One of the easiest ways to tell if you are drinking enough is to look at your urine when you go to the toilet. If it is dark in colour then you are probably not drinking enough water. It should be a very pale yellow.

Chewing food properly

Chewing food properly is important when detoxing. I have included this topic in the Section Five: Bodyweight so I won’t repeat it here but suggest that you read that section to ensure that you are fully aware of the benefits.

What you can expect

Depending on the amount of toxins that have built up in your body you may experience one or more of the following symptoms. They are caused by the body processing and expelling the toxins. The higher your toxic load the more likely it is that you will experience them. The symptoms will subside after a few days of finishing the detox:

1. sore/stiff neck and shoulders
2. skin outbreaks such as spots, pimples, rashes and oily skin
3. headaches
4. Although the detox should provide sufficient energy to go about your daily life it probably involves fewer calories than you are currently consuming
5. weight loss. For the same reason as fatigue, you may experience weight loss. It is important to remember that the object of the detox is not to lose weight and most of the weight lost will be in the form of carbohydrate and water stored in the muscles as glycogen which will be replaced once your normal diet is resumed
6. emotional disturbances such as irritability, anxiety and stronger emotions generally
7. nausea
8. gastrointestinal disturbances such as bloating, wind, increased stools and diarrhoea. Most of the toxins will be eliminated via the gastrointestinal tract so some degree of disturbance is considered normal

Transitioning back to a normal diet

Once you have finished the detox start reintroducing foods into your diet slowly. Have smaller, more frequent meals whilst your digestive system gets used to things. Choose lighter options rather than heavy, stodgy foods and listen to your body. If after a few of these meals you feel like you can move on to more substantial food then do so but it would be wise to start off with small portions and build up gradually from there.

When we did this detox we did not get hungry (we ate a LOT of veg!) but we were bored of eating such a bland and samey diet. In the middle of the detox I dreamt about plates of steak and chips, full English breakfasts, roast beef with all the trimmings and spent a lot of time trying to decide on my first proper meal after transitioning back on to “real” food. For whatever reason these yearnings passed after a couple of days and by the time my detox was finished I was not craving anything in particular; I just went back to my normal diet (the MDWT).

Support

I did the detox with my wife even though our circumstances were slightly different to the average couple going through IVF. I had “done my bit” a few years previously so doing a detox myself would not have had a direct bearing on our success. As we have seen, there is a fair chance that men’s fertility may be impacted by toxins and so a detox would be beneficial. Even if this is not the case for you there is a lot to be said for doing the detox with your partner to provide support for her. I took the “we’re in it together” approach and I suggest that you do the same. This way you are more likely to complete it.

Timing

Finally, a note on timing. If you are planning an IVF cycle when should you do a detox? Timing is a balancing act between doing it sufficiently close to the cycle to ensure your body is purged of toxins as far as possible but far enough away to ensure it has regained its balance. We completed the detox 6 weeks prior to our cycle but you should consult your doctor to decide what is reasonable for you.