What lifestyle modifications should I recommend to patients trying to conceive, and how do they impact fertility?

Lifestyle modifications recommended for patients trying to conceive include:

• Smoking cessation: Women should be advised that smoking, including passive smoking, reduces fertility and harms the developing fetus. Men should be informed that smoking affects semen quality, although its impact on fertility is uncertain. Referral to smoking cessation programs should be offered to support quitting efforts ¹,².
• Alcohol moderation: Women trying to conceive should limit alcohol intake to no more than 1-2 units once or twice per week and avoid intoxication episodes to reduce fetal harm risk. Men should keep alcohol consumption within recommended limits (no more than 14 units per week) as excessive intake can impair semen quality ¹,².
• Weight management: Women with a BMI ≥30 kg/m² are likely to take longer to conceive and have increased risks of infertility and pregnancy complications; weight loss improves ovulation and conception chances. Men with BMI >29 kg/m² likely have reduced fertility. Women with low BMI (<19 kg/m²) and irregular menstruation should be advised to gain weight to improve fertility ¹,²,³.
• Regular sexual intercourse: Vaginal intercourse every 2-3 days optimizes the chance of pregnancy ².
• Stress management and psychological support: Stress can reduce libido and intercourse frequency, contributing to fertility problems. Counselling should be offered before, during, and after fertility investigations and treatment ¹,².
• Folic acid supplementation: Women planning pregnancy should take 0.4 mg folic acid daily before conception and up to 12 weeks gestation to reduce neural tube defect risk ¹,².
• Other advice: No consistent evidence links caffeine intake with fertility problems. Men should be informed that wearing loose-fitting underwear may not necessarily improve fertility despite associations between scrotal temperature and semen quality ¹,².

Impact on fertility: Smoking and excessive alcohol intake negatively affect fertility and pregnancy outcomes. Obesity delays conception and increases pregnancy risks, while weight loss can restore ovulation and improve fertility, especially in women with polycystic ovary syndrome. Regular intercourse timed around ovulation maximizes conception chances. Stress reduction and psychological support improve sexual activity and coping with fertility challenges. Folic acid supplementation reduces fetal neural tube defects but does not directly affect fertility ¹,²,³.