COLUMN: Treating the Foundations of Infertility
How do I know if I have a problem with fertility?
For women who are less than 35 years of age, infertility is the inability to conceive after 12 months of trying without using any contraceptives. If you are over 35, the definition changes to the inability to conceive after 6 months of trying without contraceptives. If you have never conceived before, this is called primary infertility. If you have conceived in the past, then it is called secondary infertility.
Infertility in couples is quite common, with the following being the most common causes1:
· 50% female infertility (often due to inflammation from a previous infection, tubal or pelvic disease, or ovulatory dysfunction)
· 19% male infertility
· 17.6% combined
· 10.5 % unknown
What are the foundations for addressing infertility?
Track your cycle.
If you are menstruating regularly, the first step is tracking your cycle to see if and when you are ovulating. If you have a 28 day menstrual cycle, ovulation typically occurs on day 14 (day 1 is the first day of your period). The time around ovulation is accompanied by a change in cervical mucous and drop in body temperature.
Ensure you are getting 7-8 hours of a restful sleep each night. Avoiding electronics one hour prior to sleeping, engaging in relaxing activities before bed and using black out blinds or eye covers are all easy ways to enhance your sleep.
Getting adequate exercise—not too much or too little. Women who are underweight ovulate less, decreasing their chance of conceiving. Ideally 30 to 45 minutes per day maximum, especially if you are engaging in vigorous activities.
Stress reduction is key for optimal hormone production. Engage in yoga or other relaxing activities and psychological counseling, if necessary, as measures to decrease stress. Counseling can also address any fears or emotional blocks to conception, which is a common and often overlooked cause of infertility.
If you are having difficulty conceiving, both male and female partners should avoid smoking, alcohol, decaf and regular coffee, as they have all been associated with decreased fertility1.
Eat a whole foods diet as much as possible to increase your vitamin and mineral intake. It is also important not to limit healthy fats because they are precursors to hormone production in our bodies. If there was not enough reason to eat a Mediterranean diet already, there have been studies specifically proving women who ate a Mediterranean diet had a higher chance of conceiving than those who did not2,3,4.
An optimal diet includes plenty of fruits and veggies, complex carbohydrates, legumes, nuts and seeds, organic and free range meats (especially fish and poultry) dairy (preferably goat and sheep), and healthy oils (such as avocado, olive oil, and fish that are low in mercury). Red meat is consumed only a few times per month. This diet is your best bet for optimal health for fertility and also for both mom and baby during the pregnancy and after the birth (however, red meat consumption may change depending on your ferritin levels).
Avoid the following:
· Alcohol and recreational drugs
· High mercury containing foods (eg. tuna, shark, swordfish)
If you are overweight or underweight, you chances of infertility are increased. An optimal BMI for fertility is between 18.5 and 24.9. Women who have more muscle mass may have a higher BMI, yet still be at an optimal weight for fertility. BMI is a screening tool for weight because of its ease of use. If you are unsure about your BMI, the best way to determine your optimal weight is talking to your health care provider.
Supplement for basic nutrient requirements.
The three main supplements I recommend prior to pregnancy are listed below. Please purchase professional quality supplements to ensure you are getting the highest quality and actual dose you are paying for. When planning for pregnancy, this is extremely important.
1. High quality pre natal multi vitamin
2. DHA/EPA (at least 300 mg DHA per day)
3. Probiotics to ensure optimal immune function (talk to your health care provider before starting these once pregnant)
If I have done all of this and still cannot get pregnant, what are the next steps?
If you have followed the above steps and are still unable to conceive, further testing is required. You will need testing for certain hormones (LSH, FH, estradiol, progesterone, testosterone, among others), certain nutrients (vitamin D, ferritin, B12), testing to rule out other causes of infertility (this can include thyroid testing, and a pelvic ultrasound).
Do not give up hope! Many women become pregnant with the help of herbs, antioxidants, vitamins and minerals, and acupuncture before having to consider ovulatory drugs or intrauterine insemination.
1. Hudson, Tori, Women’s Encyclopedia of Natural Medicine. New York, NY: McGraw-Hill; 2008.
2. Estefania Toledo, M.D., M.P.H., Ph.D., Cristina Lopez-del Burgo, M.D., Ph.D., et al. Novemeber 2011. Dietary patterns and difficulty conceiving: a nested case-control study. Fertility and Sterility: Volume 96: Issue 5: 1149-1153.
3. Sofi, F., Abbate, R., et al. 2010. Accuring evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. American Journal of Clinical Nutrition: 92: 1189-1196
4. Vujkovic, M., dr Vries, J.H., et al. 2010. The Preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/ intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertility and Sterility: 94: 2096-2101