Such a difficult topic, of course, because the very clear-cut, medically/legally safe answer is entirely straightforward: never drink, smoke or use illicit drugs.
As physicians, it’s our duty to inform all patients that this is accepted dogma and that there is no minimal dose that is known to be safe and, therefore, no one should use any such substances.
But, speaking to patients who, regardless of the advice above, are going to continue with the lifestyle that they have chosen, we have the following to share.
(And on a personal level, we understand how some people come to those choices. After all, fertility is not something that lasts a couple of weeks, or even a month. It can last six months, twelve months, and longer, and it can be a dramatic and isolating lifestyle change for people to make at a particularly vulnerable time in their lives.)
So, if it comes to harm reduction – if you are looking to minimize stress, knowing that you should really be doing it through going to bed on time, eating better, and exercising in an appropriate fashion – you might also want to have a glass of wine with your friends from time to time.
Please understand we are not talking about excessive drinking or other abuses of alcohol. We all know that alcohol can be used for self-medication purposes. But, it can also be a gentle part of a social lifestyle. Red wine contains resveratrol, part of the antioxidant family that may or may not be beneficial for eggs. So if you are going to have alcohol, perhaps a glass of red wine with friends, as is socially appropriate to your life, would be the best choice.
And what about smoking? It’s true that smoking residues are found in seminal fluid and in the follicular fluid, i.e. the fluid that aids eggs and sperm. What would be an appropriate therapeutic dose? We aren’t sure, but it seems self-evident that if you can minimize smoking as much as possible, you can feel confident that you’ve done all you could at this short time in life to maximize the chances of pregnancy. Once you’re pregnant and delivered, as long as you aren’t smoking around your child, then it’s your decision to make.
We cannot be as calm about marijuana use. It’s very clear that it reduces sperm counts and quality for men, often dramatically. Yes, of course, you all know people who will smoke pot daily and father a pregnancy, but for many men who have average sperm counts, the use of marijuana decreases it substantially.
So, what about eggs? We can’t tell if egg quality changes with the use of marijuana or not. The effects are so profound for sperm that, by extrapolation, we are more worried about pot than cigarettes or alcohol.
And, of course, we cannot advocate for cocaine, MDMA, or other stimulants. We recommend a lifestyle change—perhaps aided by support groups, substance abuse treatment, or therapy, if you’re having a hard time discontinuing use of these substances—if you wish to get pregnant.