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4. What We Tell Our Patients about Alcohol, Caffeine and Exercise

What We Tell Our Patients about Alcohol, Caffeine and Exercise

Among the most common questions we get as fertility physicians from patients trying to conceive a pregnancy are: how much alcohol is safe to consume and when? Should I stop having any caffeine altogether? How much exercise is safe while trying to get pregnant?

With regards to alcohol, we are fairly liberal in allowing small amounts of alcohol consumption while trying to conceive. According to Dr. Schriock, "My advice is, if they are trying to get pregnant, to cut back on the alcohol consumption, but if you have a party and you want to have a couple glasses of wine, that's fine. Less is probably better, but once we do the (embryo) transfer, they shouldn't drink at all." Dr. Herbert's advice is: "Then with alcohol, after embryo transfer or once you are pregnant, there is always a concern with fetal alcohol syndrome. But a glass of wine or cup of caffeine with a full stomach is not a problem." There was just a recent article suggesting that women who drink more than two or three drinks per week have lower pregnancy rates. Generally I tell people that when they get their period, they can have a glass of wine or beer. But once they have ovulated and are in the luteal phase and they could be pregnant, try and avoid any alcohol at all. Certainly avoid any binge drinking which is very detrimental. Alcohol is also very dehydrating, which is not conducive to conception.

So what about caffeine? Again, the data in regards to caffeine consumption and fertility is very limited. Studies in women who are pregnant have suggested that heavy caffeine consumers (equivalent to 5-6 coffee servings per day) have been found to have higher rates of miscarriage. Dr. Ryan's advice is " one to two cups per day, max, even after (embryo) transfer." Dr. Herbert says: "More than 4-6 cups of coffee a day has a higher risk of miscarriages associated with it, although its direct effect with fertility is unknown. They can drink decaf coffee, which is better, but if they are going to drink caffeinated coffee in the morning, they should have food in their stomach." My advice is that caffeine is a drug that causes vasoconstriction (narrowing of blood vessels). It's not a drug you want to expose your baby to when pregnant. Since it is sometimes difficult to stop drinking coffee cold turkey, why not try to wean oneself off of it while trying to conceive? Decaf is fine.

And exercise? How much is too much? What about moderate exercise? Dr. Schriock says "For exercise, there are two studies that I quote. The first specifically looked at IVF patients, and they divided exercise into two categories: high aerobic, example in this group is running and intense cycling, and low aerobic, the example in the low group is walking and yoga. Then they asked patients how long they had been doing that activity. They drew a line at ten years. If you started running five years ago, then it seemed to lower your chances of getting pregnant. However, if you had been running for ten years of more, then it didn't seem to make any difference. The interpretation of that is that it takes ten years for your body to get used to an activity. But the low intensity group, it didn't seem to make any difference if you had done the exercises once, twice, five years, or ten years. Low exercise, it doesn't matter, but high intensity exercise, should be doing it for ten or more years.

The second study I quote is not for how long they have been doing it, but how much they were doing. If they have more than four hours of aerobic activity per week, it seemed to lower pregnancy rates. Then I discuss what would you like to do? And I finally say that this is probably a balance between exercise and stress. Because if you are using exercise as a stress reducer and you take it away, all of the sudden your body gets stressed out. Then I leave the door open to be individualized."

Dr. Chenette's advice is that "as far as exercise, I tell them not to do any lifting over 40 pounds. On the day of transfer, they can not do any exercising, but then after that, they can resume their normal exercise regime. However, I tell them to refrain from any exercise that involves jumping. I recommend swimming and Pilates as a source of exercise. I also do not suggest any exercise that will result in weight loss because that means that they are not getting enough calories."

Dr Ryan's advice? "For exercise, I say in moderation. No more than four times a week for a max of one hour to 1 ½ hours. Then, in treatment, it needs to be low impact and no hot exercises like Bikram yoga after embryo transfer." And Dr. Herbert says, "In regards to exercise, I suggest that they do not do any training for an excessive event, like a marathon. Exercise should be reasonable. It depends on their weight and the amount of time that they exercise. It is good to continue to exercise, but in moderation."

I think the bottom line on exercise is moderation, generally no more than 4 hours of aerobic exercise per week and no exercise with weight loss as a goal. Yoga, Pilates and non-aerobic strengthening exercise is fine but again, more moderation immediately after an embryo transfer.

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