Your TTC Strategy 2: Develop Healthy Preconception Habits

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Pregnancy
Pregnancy

So you’re planning to get pregnant this year. In terms of diet, many experts suggest you act pregnant when you want to become pregnant. It’s not just about eating right, although that’s a big factor. Take a moment to evaluate your life in terms of nutrition, exercise, stress, and exposure to toxins.

Health is not merely the absence of disease or infirmity. Health is achieved by becoming aware of and making choices that balance your social, occupational, spiritual, physical, intellectual, and emotional components. Nowhere is this more important than when preparing to become a parent. Let’s look at the evidence available to guide you in the right direction.

Diet

In anticipation of pregnancy, it’s good to get in the habit of eating three healthy meals per day with snacks in between. But should you eat low-fat, high carb, vegetarian, Mediterranean … or what? It is so confusing! Fortunately, a lot of information is becoming available on dietary habits that significantly improve fertility.

According to a Harvard study of diet and fertility (also called The Nurses’ Study), the more of the following changes you make, the more likely you are to improve your ovulatory function and fertility:

  • Eat more complex (“slow”) carbs (whole grains, fruits, nuts, legumes, vegetables) and limit highly processed ones (anything in a box or can) and foods with a high glycemic index (the so-called white foods or “fast carbs” such as sugar, high fructose corn syrup, refined flour, potatoes, white rice, pasta, etc). In the Harvard study, women who ate the most fast carbs were 92 percent more likely to have infertility than women who ate the most slow carbs.
  • Avoid caffeine. Even one cup of coffee a day dramatically increases the chances of miscarriage.
  • Eat organic. This is a simple way to avoid chemicals.
  • Get sufficient essential fatty acids. Omega-3s, found in salmon, flaxseed, soybeans, and walnuts, play an important role in the development of Baby’s brain.
  • Avoid all trans fats (fried foods, cakes, pastries, and chips), which can interfere with normal ovarian function, and eat more healthy unsaturated fats. Research results published in the American Journal of Clinical Nutrition showed the chance of becoming pregnant dropped by 73 percent for every extra 4 grams of trans fats—the equivalent of half a portion of takeaway fried chicken—eaten each day. That’s the amount in two tablespoons of stick margarine, one medium order of fast-food French fries, or one doughnut.
  • Eat whole milk products once a day and avoid low-fat products. A recent US study found that women who consumed a lot of low-fat dairy products, such as skimmed milk, were almost twice as likely to suffer fertility problems as those who did not.
  • Get more protein from plant foods like beans and less from red meat. Women who ate the most animal protein were more likely to experience infertility whereas the reverse was true for women with the highest intake of plant protein (soy, legumes, nuts). Replacing 25 grams of animal protein with 25 grams of plant protein was related to a 50 percent reduction in infertility. (Read more about vegetarian diets here.)

Nutrition

There is a strong and frequently repeated argument that we should be able to get all the nutrients we need from “a well-balanced” diet. With current agricultural practices, however, it may not be possible. Food rich in nutrients needs to be grown in soil rich in nutrients, but much of our soil has been over-farmed to the point that it no longer contains the nutrients we need. In addition, pesticides and other chemicals reduce the nutrient content of the food, and as food is processed it is stripped of its key nutrients even more.

So when you are aiming to boost fertility, it really does make sense to increase your intake of nutrients by taking a multivitamin with minerals.

(Read more about pre-pregnancy nutrition and eating here: The Ultimate Trying-to-Get-Pregnant Diet.)

Weight

Our body needs to be the right weight in order to produce the appropriate balance of hormones to regulate ovulation, menstruation, or sperm production. In fact, more than 12 percent of all infertility patients suffer from weight-related infertility. Gaining or losing weight can often help correct these problems.

Information from the Nurse’s Health Study indicate that women with the lowest and highest body mass indexes (BMI) were more likely to struggle with infertility than women in the middle. Infertility was least common among women with BMIs of 20 to 24, with an ideal around 21. If you need to lose or gain weight, start your eating and exercise program six to 12 months before you try to conceive.

Weight issues can also affect male fertility. Men who are overweight appear to be at risk for low sperm count and motility problems, because extra layers of body fat can produce excess estrogen that disrupts normal hormonal balance. In addition, the excess fat surrounds the testicles, raising their temperature above 96 degrees. Even this slight increase in temperature can cause sperm to die or can lower sperm production. Men who are underweight are also at risk for fertility issues, as they tend to have lower sperm counts and poor motility and morphology, perhaps related to poor nutrition. Men who over-exercise could also increase the temperature of their testicles, killing their sperm. (Read more about how male diet and weight issues affect fertility here.)

Stress Management

With more and more women building high-powered careers, childbearing tends to be forgotten until a milestone, like a birthday, reminds us that it’s time to get on with family building. If your life has been built around high stress and a fast pace, your body may not be prepared to function optimally for conceiving.

Stress can come from just about anything that you feel is threatening or harmful. A single event, such as a death in the family, can produce stress. So can the little things that worry you all day long. Some people are stressed all the time. With either acute or chronic stress, hormones such as cortisol and epinephrine are released to help your body adapt. Yet these same chemicals can disrupt the normal balance needed for conception.

Research indicates that stress may have an impact on many aspects of fertility including ovulation, fertilization, and implantation. Emotional factors may also negatively affect fertility in the male by lowering testosterone and sperm production. Maternal stress, even early in the pregnancy, can affect the developing fetus. Animal and human studies indicate that chronic stress while in the mother’s uterus may predispose a person to depression in later life.

In general, stress is related to both external and internal factors.

  • External factors include your job, your relationships with others, your home, and all the situations, challenges, difficulties, and expectations you’re confronted with on a daily basis.
  • Internal factors determine your body’s ability to respond to, and deal with, the external stressors. Internal factors can influence your ability to handle stress, and include your nutritional status, overall health and fitness levels, emotional well-being, and the amount of sleep and rest you get.

Many medical articles clearly demonstrate that reducing stress levels seems to help fertility. In research published in the journal Human Reproduction, doctors compared pregnancy rates in couples who reported being stressed and those who did not. Pregnancy was much more likely to occur during months when couples reported feeling “good”—happy and relaxed. It was less likely to occur during the months they reported feeling tense or anxious.

This is clearly one area we cannot ignore. All prospective parents need to look into their own lives and try to find tiny spaces where they can give body and mind a respite from the stresses of everyday living. Different avenues suit different people. It is very important to choose something you are comfortable with–something that won’t make you even more stressed! Some tried-and-true methods of decreasing stress include:

  • Take vacations without the Blackberry
  • Avoid over-scheduling activities and responsibilities
  • Learn to say “no”
  • Create structure and routine in your work and home life
  • Develop a hobby that you enjoy
  • Counseling
  • Exercise
  • Acupuncture
  • Meditation
  • Biofeedback
  • Journaling
  • Massage

Stress is a normal part of life that can either help us learn and grow or can cause us significant problems, one of which is difficulty conceiving. While there are effective approaches for stress, the management of stress depends mostly on the willingness of a person to make the changes necessary for a healthy lifestyle. (Read more here in our Stress-Less Guide.)

Exercise

Results from the Nurses’ Health Study show that exercise, particularly vigorous exercise, actually improves fertility. Inactivity deprives muscles of the constant push and pull they need to stay healthy. It also interferes with their ability to respond to insulin and to efficiently absorb blood sugar. When too much blood sugar and insulin accumulate in the bloodstream, it endangers ovulation, conception, and pregnancy.

Exercising for at least 30 minutes on most days of the week is a great place to start. It doesn’t really matter how you exercise, as long as you find something that moves you and gets your heart beating faster. Ideally exercise should rotate among four types of activity: aerobic exercise, strength training, stretching, and the activities of daily living.

There are two aspects of exercise that do present well-documented challenges to parenthood: heat and too much exercise. Raising your core body temperature above approximately 102 degrees Fahrenheit has been linked to birth defects, miscarriage, and low sperm counts. Use your judgment and take it easy on hot, humid days when the body has a tougher time staying cool, and avoid hot tubs and saunas.

Long distance runners, swimmers, dancers, and other competitive female athletes may have varying degrees of menstrual dysfunction: Some do not menstruate, some have irregular cycles, and others may have regular cycles but have hormonal imbalances that impair fertility.

There appear to be three primary causes of exercise-induced effects on fertility:

  1. A critical level of body fat: It has been estimated that approximately 22 percent body fat is necessary to maintain normal menstrual function.
  2. Energy expenditure: Fertility problems can result even when resources are abundant, but food intake fails to compensate for increased energy demands. Restrictive eating behaviors practiced by women in sports or physical activities that emphasize leanness are of special concern.
  3. Stress: Exercise represents a physical stress that challenges the delicate mechanisms that regulate fertility.

The good news is that the ill effects are reversible once body fat is increased, calorie intake is increased, and exercise intensity is decreased.

Management of Chronic Medical Conditions

To function optimally, both male and female reproductive systems rely on an exquisite balance of precisely timed hormonal messages and the peak performance of the reproductive organs. Unfortunately, a chronic health condition in either partner can sometimes cause an imbalance in these intricate reproductive works. Aggressively treating conception-threatening conditions before you’re ready for a baby is your best insurance against infertility.

Some medical conditions can directly affect fertility:

  • endometriosis
  • sexually transmitted infections (STIs)
  • weight
  • polycystic ovarian syndrome (PCOS)

Other medical conditions are treated with medications that make it difficult to conceive or may harm the fetus: high blood pressure, inflammatory bowel disease, rheumatoid arthritis, pain management, epilepsy.

Many medical conditions have alternative treatment options for those wishing to conceive. If you have diabetes or thyroid disease, it is imperative for these conditions to be optimally treated before trying to conceive. (Learn more about managing common conditions that may affect pregnancy.)

Genitourinary Tract Infections

Radical changes in sexual behavior over the last few decades have resulted in a dramatic rise in the prevalence of sexually transmitted infections, sometimes referred to as genitourinary tract infections. Many of these STIs produce symptoms that allow prompt diagnosis and treatment, while others cause silent infection that may adversely affect fertility and the health of the fetus and newborn.

The only way to determine the presence of these infections is to test for them. Among 109 couples attending a Foresight clinic, 69 percent had at least one infection. Given these results, it is recommended that both men and women undergo routine screening tests during annual exams and as part of preconception preparation. These tests should include:

  • Complete blood count for both partners
  • Urinalysis for both partners
  • Testing for Chlamydia, Ureaplasma, Mycoplasma, gonorrhea, and syphilis
  • Vaginal culture for bacteria and yeast
  • Blood tests for cytomegalovirus, toxoplasmosis, and rubella

Smoking, Alcohol, Caffeine, and Street Drugs

None of it is good for you, and all of it—smoking, alcohol, caffeine, and street drugs—is especially dangerous for a developing fetus.

Smoking: According to The American Society of Reproductive Medicine:

Virtually all scientific studies support the conclusion that smoking has an adverse impact on fertility. The prevalence of infertility is higher, and the time it takes to conceive is longer, in smokers compared to nonsmokers. In addition, the impact of secondhand smoke exposure is comparable to the effects of smoking. Smoking appears to accelerate the loss of eggs and may advance the time of menopause by several years. Pregnant smokers are more likely to have low birth weight babies, premature birth, and babies with congenital defects. The incidence of sudden infant death syndrome (SIDS) also increases in households where someone smokes.

Men who smoke cigarettes have a lower sperm count and motility and increased abnormalities in sperm shape and function.

Alcohol: Some studies have shown that even drinking as little as two drinks of alcohol a week can adversely affect fertility. Heavy drinking can lead to the loss of periods altogether, and drinking more than 14 units per week before the developing embryo is embedded in the uterus increases the chance of miscarriage. Not to mention that around 40 percent of male sub fertility is actually caused by excessive alcohol intake, which lowers sperm count and motility. So if you are trying to get pregnant you are strongly advised to cut out alcohol altogether.

Caffeine: Drinking as little as the equivalent of one cup of coffee a day has been associated with an increased risk of a delay of conception and drinking three or more cups of tea or coffee a day is associated with a significantly increased risk of miscarriage. So it is best to avoid caffeine if you are trying to get pregnant.

Chemical and Heavy Metal Exposure

A growing body of scientific evidence clearly shows that prospective parents should pay more attention to environmental chemicalsand their impacts on reproductive health. Laboratory studies prove that many synthetic chemicals cause fertility-related damage in animals, often at very low doses.

Some 85,000 synthetic chemicals have been registered for use in the United States. Every year one thousand to two thousand more are added to the list. They’ve become inescapable, pervading air, water, food, homes—and our bodies. Actual measurements, called “body burden surveys,” of contaminants in people show that average Americans have hundreds of manufactured chemicals in their tissues (including amniotic fluid and umbilical cord blood) at levels high enough to be of concern.

Once you become pregnant, the developing fetus becomes exposed to your body burden of chemicals. Fetal and early life exposures affect the development of your offspring up to adulthood. Many of these impacts are irreversible, especially those involving abnormalities of the reproductive tract, impaired ability to respond to hormonal stimulation as an adult, and decreased sperm production or function in the male offspring. Animal experiments show clear and consistent patterns of developmental impact.

It is not possible to avoid all exposure to chemicals, but you can decrease your chemical burden by avoiding common chemicals such as:

  • cigarette smoke
  • mercury in fish
  • pesticides on food
  • use of chemicals in the home (herbicides, pesticides, personal care products that contain phthalates, polycarbonate plastic bottles, dry cleaning, cleaning products, chemical air fresheners, fabric softeners, paint, glue, and gasoline)
  • chemicals found in processed foods

Because it may take some time to clear accumulated chemicals from your system, it is important to begin these measures even before considering pregnancy and certainly six to 12 months prior to conceiving.

While there are forces in your life you can’t control entirely, such as the quality of air in your neighborhood, or the need to work to earn a paycheck, there is much you can do in the way of health-promoting lifestyle choices that will help you in your goal to get pregnant.

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