Alcohol and Fertility: How Much Is Too Much?

Article reviewed by Lusine Aghajanova, M.D. Ph.D., Fertility specialist, Obstetrician and Gynecologist (OB-GYN), Stanford School of Medicine.

While the non-reproductive consequences and effects of alcohol usage during pregnancy are both well documented, the effects of alcohol on reproductive physiology have not been well delineated due to limited research. However, recent research has demonstrated that alcohol intake does indeed have an effect on both women’s fertility and the quality of male sperm.

If we look at general health conditions, excessive alcohol intake can lead to multiple chronic diseases including hypertension, heart disease, liver disease, gastrointestinal bleeds, cancer (breast, mouth, throat, esophagus, liver, colon), and dementia.  Excessive alcohol intake can also result in cognitive deficits such as anxiety and depression and social and economic losses such as damage to relationships and loss of employment.

So if you envision pregnancy in your near future then (limited) alcohol intake is a factor you should definitely take into consideration.

There is no minimal amount of alcohol that is allowed and is not associated with any adverse effects on pregnancy and fetus. Ideally, in both women and men, the dose-response relationship between alcohol intake and fertility should be performed. But for obvious ethical reasons, such study is very unlikely to ever be conducted. 

Can drinking alcohol affect your conception chances?

Absolutely. Ovarian reserve, a measure of a woman’s reproductive potential determined by her remaining oocytes, can be measured in a variety of ways, including serum follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels as well as antral follicle count. We previously discussed the limitations of this type of test. Recent studies show that heavy alcohol consumption may prematurely diminish a woman’s ovarian reserve.

There is also evidence that women who experienced addiction to alcohol are more likely to enter menopause at an earlier age. 

Several observational studies showed that moderate and heavy alcohol consumption by women (arbitrarily defined as 3-13 and ≥14 drinks per week) is associated with longer time to pregnancy and higher likelihood of needing to be evaluated for infertility. 

It is worth mentioning again that alcohol consumption can impact the developing fetus. 

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Are there any other effects on female reproductive health?

The short answer here is yes. Alcohol, even in moderate amounts, can impact your sexual health, by altering your libido or by increasing the risk of bacterial vaginosis - that can potentially make your vagina more inhospitale for sperm.

Secondly, alcohol can disrupt hormones. Studies have shown that alcohol intake is associated with an increase in levels of estrogen, FSH and LH. Appropriate estrogen concentrations are vital for preparing the lining of the uterus (endometrium) to accept the  embryo when it tries to attach,  such that an abnormally high level could lower the chance of implantation. Suboptimal FSH and LH levels affect the growth and release of eggs, and higher LH levels in the first half of the menstrual cycle have been associated with higher miscarriage rates in one study (although mechanism is unclear).

Studies also show a possible decrease in progesterone levels as a result of alcohol intake. Progesterone secretion starts after the ovaries release an egg - this helps metabolically prepare the uterine lining for the implantation of a fertilized egg (embryo). Without enough progesterone, it can be difficult to get and stay pregnant. Therefore, any interruption in the ovulation process can result in abnormal progesterone secretion. 

Can alcohol impact IVF success rate?

Data are mixed on the effect of alcohol consumption on success rates of women undergoing IVF. The exact etiology for the detrimental effects on IVF outcomes is hard to pinpoint, as the process is complex with many moving parts. However, as mentioned above, acute alcohol consumption can affect levels of reproductive hormones such as estradiol, testosterone, FSH and LH . Furthermore, the significant effect that high alcohol consumption can have on the function of the liver and kidney may affect the hormone levels, as estrogens are metabolized by the liver, and FSH is cleared by the kidneys and the liver. Hence, compromised liver function due to high alcohol consumption may result not only in reduced metabolism of the body’s own hormones, but also to the hormonal medications  used in IVF, and therefore the ovarian response to stimulation. Subsequently these hormonal shifts negatively affect growing follicles ( folliculogenesis) and cause impaired endometrial receptivity. 

Does alcohol affect males as well?

If you are in a relationship with a partner with sperm, what you should know is that alcohol consumption heavily affects the male reproductive system - from proper function of testicles, such as testosterone production and sperm production (spermatogenesis) to impotence. We recommend having an early conversation with your partner and implementing lifestyle changes around alcohol consumption at least 3-6 months before trying to conceive (this is the time the body needs for producing new batches of sperms or eggs). Reaching out to a primary care provider is always a good idea as having a conversation with a professional can help bring data and a new perspective to breaking habits.

What can you do?

The simple answer is to reduce your alcohol intake to zero by the time you’re ready to start trying to conceive. Pro Tip: This will make it easier - in early pregnancy - to justify socially why you’re still not drinking ;).

It might be helpful to take a look at "alcohol-free" beverage alternatives, actually a growing industry!

What are alcohol free beverages?

To clarify, the FDA does not consider the terms "non-alcoholic" and "alcohol-free" to be synonymous. The term "alcohol-free" may be used only when the product contains no detectable alcohol.

Beverages such as soft drinks, fruit juices, and certain other flavored beverages which are traditionally perceived by consumers to be "non-alcoholic" could actually contain traces of alcohol (less than 0.5 percent alcohol by volume) derived from the use of flavoring extracts or from natural fermentation (like kombucha). FDA also considers beverages containing such trace amounts of alcohol to be "non-alcoholic" but not alcohol free!  In short:

• Non-Alcoholic: less than 0.5 percent (or .5%)

• Alcohol free: no (or zero) alcohol 

Ok cool, so what can I buy/drink?

As the Latin used to say ‘de gustibus non disputandum est’:  everyone's personal preference cannot be right or wrong, so they should never be argued. 

But let’s be honest: many non-alcoholic wines taste essentially like grape juice. and if you enjoy wine, then you’ll be disappointed with the available alternatives. On the beer side, the taste is not drastically impacted by the absence of alcohol. There are companies making both "alcohol-free" and "non-alcoholic" beers. The second category still contains 0.05 percent of alcohol but to give you a better idea of how they compare; you’d have to drink 100 of them to get the alcohol content that’s in one regular beer! 

• Heineken 0.0 (less than 0.03 percent)

• Budweiser Prohibition Brew (0 percent)

• Bitburger Drive (0.05 percent)

• Beck’s Blue (0.05 percent)

• Athletic Brewing Free Wave Hazy IPA

• Partake Dark

• Clausthaler Christmas or Grapefruit beer

• More brands here. 

There are also some very fancy and expensive alcohol-free ‘cocktails'  that have recently come onto the market but our recommendation is to discuss their ingredients with your primary care physician. Many alcohol-free ‘cocktails'  may contain benzoate acid. Classified as category C, FDA suggests that you should use drugs containing this ingredient during pregnancy only if the benefit outweighs the risk. Furthermore, according to the FDA, if you're concerned about benzene exposure, avoid buying soft drinks that list both sodium benzoate and ascorbic acid or its chemical cousin, erythorbic acid.

Conclusion

Reducing alcohol intake before trying to conceive can be really hard. Alcohol often plays a big role in our social lives and many of us look at the “pre-parenthood” days of our lives as a time without restriction and responsibility. But the truth is, learning to regulate and reduce alcohol intake - especially during what may be a time of extra social pressure and freedom - is a skill that will serve you time and again through many phases of life. And remember: among the factors that can impact your fertility, alcohol consumption is of those in your control.