So you have decided that you would like to have a baby! Congratulations! You feel mentally prepared to take this next big step, and you have space and time to accommodate a little one into your life. Now is the time to start on a pre-conception plan to optimize your chances of conceiving, and having a successful pregnancy.
When Should We Start?
Although women are born will all their eggs, it takes 90-100 days for an egg to mature, and during this time there is an opportunity to influence egg quality. For men, it takes 116 days for sperm to generate. Seems like a coincidence? Maybe not. But either way, the ideal time to start preconception planning is about 100 days, or 3-4 months, before pregnancy.
Think of pregnancy as lasting 1 year, with the first 3-4 months dedicated to getting you and your partner in optimal health to improve fertility and have a healthy pregnancy. Read on to find out my top 7 recommendations for preconception care.
There is so much talk around what you should and should not eat while pregnant. We know it is important to abstain from alcohol and smoking, and many pregnant women opt to avoid eating sushi or soft cheeses as a way to minimize risks of food poisoning. But what can you eat before pregnancy to improve fertility and increase your chances for having a healthy pregnancy?
Studies have shown that the mediterranean diet improves fertility rates - even when compared to a healthy whole foods diet. The mediterranean diet focuses on high intakes of vegetable oils, vegetables, fish, and legumes and low intakes of snacks. Follow these 10 commandments of the mediterranean diet if you want to learn more and prepare for a healthy pregnancy.
In addition to including specific foods, maintaining a healthy body weight also improves fertility, decreases chances of complications during pregnancy and improves the health of your child. Having a BMI over 35 (obese category) doubles time to conception, and being underweight (BMI less than 19) increases time to conception 4 fold. Pregnancy is not a time to lose weight, so a healthy BMI should be obtained before pregnancy.
Exercise is important for maintaining a healthy BMI, but also improves circulation to your reproductive organs, which enhances your fertility.
2. Lifestyle Changes
There are critical changes you can make in your lifestyle to improve your fertility, and increase your chances of having a healthy full term pregnancy. These changes don't happen overnight so it's important to start making changes early. These changes apply to both men and women.
Quit Smoking Cigarette smoking increases your risk of infertility by 60%
Limit Alcohol (<2drinks/day) More than 2 drinks per day increases your risk of infertility by 60%
Limit Caffeine (<250mg/d) Higher intakes of caffeine decrease fertility by 45%
I truly believe in lifestyle and dietary reccomendations, but do recommend supplements as just that - a supplement to a healthy lifestyle, or when deficiencies exist as a result of lifestyle, medications, health conditions or times of greater physiological need – such as in pregnancy.
It is important for women contemplating pregnancy to begin taking a prenatal vitamin before conceiving. Prenatal vitamins contain higher amounts of most vitamins and minerals to prepare for the demands of growing a baby, and less of certain vitamins, such as high dose Vitamin A, which can cause birth defects in the developing fetus.
- Supplementing with Vitamin B9 (folate) is critical during pregnancy, to prevent against neural tube defects. New research is highlighting the importance of supplementing with activated folate (5-methyltetrahydrofolate) instead of chemically synthesized folic acid.
Supplementation with folic acid requires conversion to a form of folate that is usable by the body. A similar story exists with B12 - synthetic forms of B12 (called cyanocobamalin), require conversion to methylcobalamin (the body’s usable form of B12). Up to 65% of people have a defect in the enzyme responsible for this conversion, called MTHFR. In addition, high supplementation of folic acid has some negative health implications. For these reasons, I recommend supplementing with activated folate and activated B12 (methylcobalamin) to ensure adequate absorption. Look for a prenatal supplement that contains 5-MTHF (5-methyltetrahydrofolate) and methylcobalamin (B12), or talk to your Naturopath about the best brands for prenatal vitamins.
- Zinc is important for sperm production and sperm quality. Low levels of zinc have been established as an important risk factor for male idiopathic infertility. Make sure you take your zinc supplement with food, because it can cause nausea. Your Naturopathic Doctor can perform a test to determine if you have a zinc deficiency. If you are supplementing for longer than 3 months, take a Zinc/Copper supplement as long term zinc supplementation can deplete copper levels.
For most women zinc is found in adequate amounts in prenatal vitamins, and adequate zinc levels are important for maintaining a full term pregnancy.
- Supplementation with Vitamin D can help to increase fertility rates, decrease pregnancy complications including rates of caesarian section, infection and gestational diabetes. Vitamin D supplementation can also help to optimize health of the newborn. Attaining adequate Vitamin D levels takes time, so begin supplementing at least 100 days before conception.
- Demand for essential fatty acids (EFA) increases during pregnancy, so ensuring that your body has adequate stores of EFA before pregnancy will ensure your baby receives adequate amounts of brain healthy EFA. Children of mothers supplemented with EFA before and during pregnancy, had better hand-eye coordination, focused attention and problem solving skills. Fish oil supplementation is a good source of EFA during the preconception period and safe during pregnancy. If you are already pregnant, stop taking fish oil at week 37 to prevent delayed labour due to the anti-inflammatory effects of fish oil.
- Coenzyme Q10 is a powerful antioxidant, and responsible for a critical step in energy generation of the cell. CoQ10 has been found to improve egg quality in women, specifically in older women. In men, CoQ10 also benefits semen count, morphology and motility.
4. Start to Understand your Cycle
During this preconception time, it is important for women to start to understand their cycle. Many women will be coming off birth control pills, or other hormonal methods of contraception, and it takes time for the body to return to natural cycles.
Fertilization occurs during a woman's "fertile window" - 5 days before ovulation, and up to the day of ovulation. This reflects the lifespan of sperm (5 days) and the lifespan of the ovum (24 hours). The timing of ovulation will vary for women based on their cycle, so it is beneficial to start recording several months before trying to conceive - I recommend using an app like Period Tracker. Generally, ovulation occurs between 12-16 days from the last menstrual period, but if you are unsure when you ovulate, here are some ways of knowing:
- Cervical Mucus - mucus is released from the cervix to support, nourish and transport sperm to allow for fertilization. In the days leading up to ovulation, this mucus will be cloudy and white, but when you ovulate, the mucus becomes clear and stretchy - often compared to the consistency of egg whites. Ovulation is likely to occur on the last day you notice this type of discharge and is considered your "peak" ovulatory day.
- Body Temperature - recording your temperature every morning before you wake up will tell you if you have ovulated because the rise in progesterone increases your body temperature 0.4-1 degrees. I find that although this is true in theory, so many factors affect temperature such as time of waking, sleeping partner, consumption of alcohol the night before etc. that it is difficult to obtain an accurate reading.
5. Environmental Toxins
Bisphenol-A, a component of plastics has known effects on our endocrine system. A study conducted at Brigham and Womens Hospital demonstrated that eggs exposed to BPA were less likely to mature, more likely to degenerate and had an increased rate of spontaneous activation (when an egg acts as if it has been fertilized, even though it is not).
Highest sources of daily BPA exposure include plastic water bottles, food packaging, canned food liners and receipts. Try to use glass as much as possible, avoid packaged foods and avoid handling receipts.
Polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), dioxins, phthlates and acrylamide, have been shown to cause oxidative stress and DNA damage to the sperm. In addition to being found in plastics, these toxins also accumulate in the food chain – which stresses the importance of choosing organic foods as much as possible. Some household cleaning products are also high in these chemicals, so opt for natural cleaning products as much as possible.
6. Stress Management
Deciding to have a baby is a big decision. As with any major life change, it can be accompanied by high stress levels. Stress management is important for overall wellbeing, and for the health of your relationship. Physiologically, high levels of stress can inhibit ovulation, which will impede your ability to conceive a baby. Enjoy this time in your life - write in a journal, meditate, do yoga, get acupuncture or make time for any other activity which makes you feel relaxed and helps you to live in the moment
7. Preconception Care and Screening
Make an appointment with your MD or ND to discuss pre-conception blood tests and physical exams. Certain conditions can be dangerous in pregnancy, or make it difficult to conceive. These conditions can often be easily treated, but best to address this early.