 What a woman eats when she is pregnant can have profound and lasting effects on her

child’s health. The expression “you are what you eat” applies, but in this case, it is this:
“You are what your mother eats.”
 During the prenatal period, the fetus has the enormous task of evolving in only 9 short
months from a single-celled, fertilized egg to a human infant.
 To accomplish this, the fetus must have all of the necessary resources available in the
proper quantities and at the exact times they are needed.
 Despite the daunting nature of the task, mothers have been producing healthy infants for
thousands of years, demonstrating the amazing adaptability of both the mother and
her child. The capacity of the mother’s body to create the necessary conditions for fetal
growth is one of the great miracles of life.
 There are limits, however, and the health of the child may suffer in obvious and not so
obvious ways if certain thresholds for nutrients are not met.
 Although a pregnant body has an amazing ability to compensate for nutrient
deficiencies and excesses, a woman cannot provide essential nutrients for her child if she
herself is deficient in them.
 Many factors influence a mother’s nutritional status during her pregnancy. The mother’s
own health before conception, her health during pregnancy, her lifestyle choices, and
environmental exposures can all change what and how much she eats and limit precious
nutrients available for the growing fetus.
 It is important that knowledgeable healthcare providers are available to support the
mother-to-be with strategies to help her achieve the most balanced diet possible, thus
ensuring the health of both mother and child.
 Infertility Involuntary absence of production of children.
 Infecundity Biological inability to bear children after one year of unprotected
intercourse.
 fertility Actual production of children. The word best applies to specific vital statistic
rates, but it is commonly taken to mean the ability to bear children.
 fecundity Biological ability to bear children.
 miscarriage Generally defined as the loss of a conceptus in the first 20 weeks of
pregnancy. Also called spontaneous abortion.
 fetus The developing organism from 8 weeks after conception to the moment of birth.
 endocrine A system of ductless glands, such as the thyroid, adrenal glands, ovaries, and
testes, that produces secretions that affect body functions.
  subfertility Reduced level of fertility characterized by unusually long time to conception
(over12 months) or repeated pregnancy losses.

Overview

 Fertility is a person’s ability to conceive children. In general, when a woman is unable

to get pregnant even after at least one year of unprotected sex, she is considered to
have infertility and her doctor will begin evaluating the possible causes. Of course,
infertility is not strictly a female problem. According to the Centers for Disease
Control and Prevention, in 35 percent of couples who cannot conceive, the cause can be
attributed to factors on both the female and male side.
 Infertility has several possible causes. In women, problems with ovarian function,
obstructed fallopian tubes, or uterine abnormalities like fibroids are common causes.
In men, infertility can be the result of disrupted testicular or ejaculatory function, or a
hormonal or genetic condition.
 In both men and women, factors that can contribute to infertility include age, smoking,
alcohol and drug use, certain medications, cancer treatments, and certain medical
conditions.
 Women or men who are having trouble conceiving should ask their doctor for a referral
to a reproductive endocrinologist, who can help identify the possible causes,
recommend treatments, and discuss options including artificial insemination and assisted
reproductive technology.

INTRIDUCTION
Oxford English Dictionary defines the word “infertile” or barren as “inability to give birth or
procreate.”
According to the reports of the International Committee for Monitoring Assisted
Reproductive Technology (ICMART) and the World Health Organization (WHO),
“infertility” is a couple’s failure in pregnancy after 12 months of unprotected sexual
intercourse and pregnancy attempts.
Infertility is a global problem affecting people around the world whose cause and importance
may vary according to the geographical location and socio-economic condition. According to the
statistics, annually 60-80 million couples around the world suffer from infertility (2). The
estimated infertility rate in Canada is 11.5% to 15.7%.
One out of seven English couples suffers from fertility problems (3). The number of couples
affected by infertility has increased from 42.0 million people (39.6 million people, 44.8 million
people) in 1990 to 48.5 million people (45.0 million people, 52.6 million people) in 2010 (4).
Ten to 12% of couples around the world are suffering from infertility in half of which, the man
is infertile.
The estimates show that in 35%-40% of cases, the man is infertile and in 35%-40% of cases,
the woman is infertile and in 20%-30% of cases, it is related to the combination of other
factors (5).
Infertility occurs once pregnancies are ended up with abortion (ASR) or the delivery of a child
with multiple hereditary diseases.
Secondary infertility refers to a state in which pregnancy does not occur after one year (in
some epidemiologic studies 2 years) of unprotected sexual intercourse despite at least one
pregnancy in the past. Women with secondary infertility cannot give birth to alive child.
Infertility may result from a wide range of abnormalities one or both of which exist. However,
infertility is not much different in people and it can have a variety of causes.

Primary causes: of infertility, such as genetic factors, hormonal disorders, genetic

disorders, congenital defects or reproductive system diseases;

Secondary factors, including lifestyle related factors, such as obesity, diet, smoking,
alcohol consumption and chemical environments, and secondary factors related to human
infertility such as unsafe methods of childbirth and post-partum period as well as symptoms
of sexually transmitted diseases.
The Nutrition Fertility Link: An Evaluation of the Evidence
Although it has long been thought that there might be a connection between nutrition and
fertility, only recently have researchers specified the conditions under which and the mechanisms
by which nourishment could affect the ability to reproduce.

There is evidence that food is linked to fertility in some situations. Meuvret noted that in France
in the seventeenth and early eighteenth century the ratio of deaths to conceptions (births nine
months later) reached unusual peaks at the same times that the price of wheat was exceptionally
high.

Famine amenorrhea in both world wars has been well documented, and there have been
widespread reports by relief agencies of amenorrhea among Cambodian women; Le Roy Ladurie
has suggested that famines in Europe before the twentieth century may also have been
accompanied by amenorrhea (the cessation of menstruation and presumably of ovulation). The
birth rate fell in a particularly striking fashion in Rotterdam just after the period of severe food
shortage at the end of World War II, and rose equally dramatically nine months after the Allies
liberated the city. . In a rural area of Bangladesh, the crude birth rate varied between 41.8 and
47.8 births per thousand women in the decade prior to the 1974-75 famine; it plummeted to 27.6
shortly afterward.
That the observed birth rate declines during a famine is not, however, conclusive evidence of a
rise in amenorrhea or anovulation. Frequency of intercourse is likely to decline for a variety of
reasons. Male prisoners during World War II reported a loss of libido as did participants in the
classic experiments conducted by Keys et al. to determine the effects of reduced nutritional
intake. Individual perceptions about the future may also result in deliberate postponement of
childbearing or loss of libido. Separation also, of course, reduces fertility.
Ovulation ceases in conditions other than famines. For example, female patients suffering from
anorexia nervosa, a disease characterized by extreme and deliberate malnourishment, typically
are amenorrheic. Exceptional emotional stress alone however, engendered, may also be
accompanied by amenorrhea. Although we know of no situation in which severe malnutrition has
not been accompanied by stress factors known to affect ovulation (since sudden deprivation is
itself stressful), extrapolating from the study of males by Keys (in which the volunteers
experienced decreased semen volume and sperm longevity and an increased proportion of
abnormal sperm), it seems unlikely that females would not also react physiologically to drastic
reduction in food supply.
That amenorrhea exists under extreme conditions of malnourishment has also raised the
possibility that there may be some effects on the reproductive system of chronic or endemic
malnutrition, a situation distinct from either starvation or famine.

Amenorrhea is the absence of menstrual periods. There are two types

of amenorrhea: Primary amenorrhea—This is when a girl does not get
her first period by age 15. Secondary amenorrhea—This is when a
woman who already menstruates does not get her period for 3 months
or more.
Frisch has proposed that this is indeed the case, and has written that among the effects of malnourishment on the
female reproductive system (and, therefore, on the level of fertility in t population) are a shorter childbearing span
due to later menarche and earlier menopause, a longer period of amenorrhea follow the birth of a child, and a greater
frequency of anovulatory cycles.

Nutrition, Frisch maintains, is related to fertility through ovulation. She has proposed that a critical minimum weight
for height is required to maintain regular ovulation and menstruation below a certain height-weight ratio, which
represents a critical proportion of body weight in the form of fat, ovulation ceases.

She points out that this important and critical ratio is well ab the starvation level. Thus, for example, women who
have lost weight while nursing a newborn child may need to regain at le some of this weight before they begin
ovulating again. She has stated that undernourished women are slower to regain minim energy levels, stored in the
form of fat, required for resumption of ovulation and, therefore, have longer periods of postpartum amenorrhea. In
Frisch's view, then, not only severe food deprivation but also any weight loss that reduces the fat reserves beneath a
critical minimum will cause anovulatory cycles, during which conception cannot occur