Preconception care aims to:
- enhance your fertility and increase the likelihood of conceiving (it only seems like everyone else falls pregnant at the drop of a hat when you aren’t), and to
- help ensure mum and the growing baby are as healthy as possible and to avoid preventable conditions
Preconception care is the ultimate preventative health care for the parents-to-be, the baby-to-be and possibly for several generations to follow. Whilst there has been an increase in the focus on nutrition in pregnancy and the first 2 years of the infant’s life, we know that the health of offspring is determined well before sex and conception. Epigenetic studies show the benefits and damage incurred during preconception can extend at least another 2 generations! Epigenetics is the study of inherited changes to the appearance (phenotype) or expression of genes caused by mechanism other than changes to the underlying DNA sequence. That is, non-genetic factors caused the person’s genes to behave (express themselves) differently. These changes may be short-term or may stay for the life of the person and then for multiple generations after. Changes can occur because of nutritional status as well as exposure to toxins such as cigarette smoke and organochemicals.
Preconception care is important for both parents, not just the future mum. We know that sperm counts are dropping and the ratio of abnormal sperm is increasing, and that smoking, heat, alcohol, diabetes, being overweight, as well as nutritional status, all affect the reproductive health and fertility of men. These issues may reduce how easy it is to conceive, increase the chances of miscarriage and affect the long-term health of the offspring.
Goals of preconception care
To have optimal health prior to attempting conception with the aims of:
- the couple being in their best health
- conceiving easily
- enjoying a healthy and trouble-free pregnancy
- and having a robust, healthy baby!
To enhance fertility rates
To optimise the health of the child, for example, to reduce the incidence of:
- learning difficulties
- behavioural disorders
- allergies
- long-term chronic health conditions, such as cardiovascular disease, cancer and diabetes
To optimise maternal health by reducing the risk for maternal nutritional deficiencies, complications and ill health, including post-natal depression and anxiety
To support healthy post-partum & lactation
Who benefits from preconception care?
If you read the goals of preconception care above, you see the answer is “everyone and their offspring”! To be more specific, preconception care is beneficial to:
- healthy individuals planning to start a family
- individuals and couples who have reproductive health issues such as PCOS (Polycystic ovary syndrome), issues with sperm health etc.
- individuals and couples who have sub-fertility or infertility
- individuals and couples who have experienced pregnancy loss (miscarriages and stillbirth) or who have a child with congenital conditions
- women who have experienced pregnancy complications, such as pre-eclampsia or diabetes, or who have had a premature birth, low birth weight baby or other complication.
- women who have experienced anxiety and/or depression in previous pregnancies or post-natally
- older men and women
- individuals and couples who have health concerns; this may be undiagnosed and general, such as significant fatigue or digestive issues, or diagnosed conditions such as Hashimoto’s disease, type 2 diabetes, etc.
- individuals who are planning to undergo ART (Assisted reproductive technology), for themselves or for someone else (as an egg or sperm donor or as a surrogate)
Who gets pregnant and is involved with preconception care?
Anyone involved in the whole baby-making process. Sometimes my language can be a bit clunky when referring to who has preconception care and that is because it is not always, or only, a married heterosexual couple. Conception can occur in a variety of ways:
- heterosexual couple, have sex
- heterosexual couple, assisted insemination or in vitro fertilisation, using the male partner’s sperm or donor sperm
- heterosexual couple, donor eggs fertilised with partner’s sperm or donor sperm
- single or homosexual woman with consensual or anonymous sperm donor
- a surrogate
What happens in preconception care?
Having a baby, or maybe a few of them, is a big thing! Like other big events in our lives, it doesn’t just happen on one day (ie, the day of birth), but there is a whole lot of prep leading up to the event. Just think, the last time you went on a big trip, did you just rock up at the airport with your tickets and hope for the best (which can be fun but risky)? Or did you do some research about where to go, when to go, what currency they use, what vaccinations might be needed, booked a hotel or two, arranged annual leave from work, put the dog in a kennel etc? What about if you have had a wedding, or organised a big party; there is weeks, months, and sometimes years that go into making sure everything goes according to plan, as perfectly as possible. And so it should be when planning to make a baby, and that is what preconception care is all about. Preconception care is for your first and every pregnancy, regardless of your age, health or previous pregnancy history. Preconception care is also valuable if you are trying to conceive via ART/ IVF.
Preconception care has common themes for everyone, but it is individually tailored to meet your needs. A key part of preconception care is education and support. Aspects of preconception care may include:
- thorough health assessment and referral as required
- review of ovulation and menstrual cycle, learning the key signs and dates
- dietary and nutritional advice and support
- supporting your body’s detoxification processes
- nutritional supplements and herbal medicine as required for reproductive and fertility
- identifying potential problems and reducing the risk of miscarriage and preventable conditions (e.g. spina bifida and neural tube defects)
- addressing any general health conditions, eg thyroid, gut problems
- reducing exposure to environmental risks
- lifestyle and exercise review and advice
- strategies to manage stress
In addition to being in great health and increasing your chances of an easy conception and healthy pregnancy and baby, individuals undergoing supported naturopathic preconception care report:
- feeling supported, being heard
- feeling better informed and empowered to make changes and take control of their health
- generally feeling healthier, having more energy, sleeping better
- having less troublesome periods
How long should preconception care be?
About 4 months, minimum. Let’s look at why.
A woman is born with all of her follicles (containing oocytes, or immature ovum/eggs) and it takes around 100 days for the follicles to mature to the point where ovulation can occur. So if you ovulate today, that egg has been developing for the past couple of cycles, and has been affected by your health in that time. As the follicle develops it may be affected by environmental toxins, illness, nutritional deficiencies, alcohol, smoking, drugs and other factors.
A man isn’t born with all of his sperm, but instead spermatogenesis starts with puberty. Depending on how it is calculated, it takes between 74 and 120 days for sperm to develop, mature, be stored and ultimately to be ejaculated. Sperm are the smallest cells in the body (by volume) and are very vulnerable to damage. As with the woman and her developing follicles, a man’s health and sperm health is influenced by environmental toxins, illness, nutritional deficiencies, alcohol, smoking, drugs and other factors in the 3-4 months before conception. Handy that the time-frame is pretty much the same for the man and the woman.
The four month time-frame is typically for people without significant health issues. Individuals may require longer in the preconception care phase if any of the following apply:
- long-term use of oral contraceptive pill
- recent use of a copper IUD
- use of the Depo Provera injection
- chronic illnesses, eg leaky gut, thyroid conditions, diabetes
- need to make significant changes (e.g may have a very low-nutrient diet, heavy alcohol use, smoking, are very over- or under-weight)
- post-natal (the woman needs adequate time for her body to fully recover and replenish after pregnancy and breastfeeding; there is an increased risk of pre-term birth and other complications if conception occurs less than 6 months since previous birth)
- if there is a history of infertility, subfertility, miscarriage or stillbirth
- reproductive conditions such as PCOS or endometriosis
Have all the factors required for a healthy foetus and mother
+
Have none of the factors harmful for the foetus and mother.
Fertility support
Fertility can be surprisingly easy (as in “surprise, you’re pregnant”!) and heartbreakingly difficult. Whilst we sometimes know what the problem is, and may be able to fix or get around the problem, unfortunately for many the issue is “unexplained infertility”. Not knowing is frustrating and disempowering and it can place stress on a relationship. People experiencing fertility issues need support, advice and compassion, not judgement, blame or shame, and to not have their desire for children be exploited.
Fertility issues are common. Infertility is defined as the inability to conceive after 12 months of trying. In Australia, it is estimated that 1 in 6 couples experience infertility at some point. It may be primary infertility, where there has never been a pregnancy, or secondary infertility, where there has been a previous pregnancy/pregnancies. I tend to use the term sub-fertility as well; this is where fertility is compromised and conception isn’t happening unaided, but may happen with naturopathic or medical support.
Below is some general information about infertility, however it is essential to recognise that every person and couple is different and they have their own particular history and circumstances. This information helps inform the most appropriate treatment for you, as opposed to having a general fertility program for everyone. Some of the key issues to consider are:
- how long you have already been trying to conceive
- how old you are (for example, someone who is 25 years old might readily try for 12 months without treatment, where someone who is 40 years old will need to act sooner than that)
- what treatments you have already tried (trying for this pregnancy and previously)
- general health issues for the man and the woman
- specific fertility factors, how treatable they are and how long they have been present
- your specific needs about timing, how you want to approach your fertility and what other support you are seeking
Having fertility struggles can be incredibly difficult. In addition to considering all the things that impact on your fertility, it is also important to look at the ways your fertility impacts on you. You may be frustrated by not knowing why you are having problems, you may have had difficult treatments and surgery, and you may have financial strain and challenges managing work and multiple appointments. All of this can contribute to feelings of:
- anxiety
- stress and ‘infertility burnout’
- depression
- fatigue
- disempowered
Acknowledging the challenges infertility can present is important in managing them. Looking after yourself and having a health care provider who can support you in these aspects, as well as the more clinical aspects of treatment, is important. Relaxation techniques, nutrition and herbal medicine can help support you as can counselling or peer support.
Some numbers about fertility
Is infertility a woman problem or a man problem? Yes, and both. More often than not there is more than one issue at play, for instance, the woman may have irregular ovulation and the man’s sperm DNA may be damaged. The distribution of problems is roughly as follows:
- 40% female factors (e.g. endometriosis)
- 40% male factors (e.g. abnormal sperm)
- 10% couple factors (egg is ok, sperm is ok, but together it isn’t working)
- and the particularly frustrating 10% which is unknown
The National Fertility Study was conducted in 2006, and while a little old, it still provides valuable information. The study was led by Dr Anne Clarke on behalf of the Fertility Society of Australia, and surveyed 2400 couple, revealing some incredibly interesting facts and views, including the following:
- 1 in 6 couples do not conceive within 12 months (infertile).
- Only 2% of those surveyed thought that male factors were a reason to have IVF – yet male factors are the single largest reason for Australian couples to have IVF, with 24% of treatment cycles being for male factors alone.
- Not one person in the study thought a man’s age was a factor in requiring to do IVF yet 34% of IVF cycles involve men over the age of 40 years.
- 51% of childless women aged 30-49 years thought they could still conceive whenever they wanted to, even though 95% also believing their fertility declined with age.
- Only 4% women believed their partner’s fertility could affect their chance of conceiving. I think this one is the one I most struggle with; the baby is 50% male DNA after all!
It takes two to tango, even if the dance involves donors, naturopaths, psychologists and ART, and both the man and the woman are integral to reproduction and therefore both deserve support and assistance.
If one in six couples don’t conceive within 12 months, how long does it take everyone else? Our figures are a little imperfect, as calculating fertility is unimaginably complex. The commonly quoted expected conception rates are in fact derived from a study on French couples from the 17th century. It is fair to say that things are probably better and worse since then. Fertility rates differ across age groups, countries, seasons and with a range of other factors. That said, here are the often-quoted figures, just as a rough guide.
Conception rate
After 1 month: 20%
After 3 months: 30%
After 6 months: 50%
After 12 months: 85% (1 in 6 is about 83%)
After 24 months: 90 to 95%
To add a bit of complexity we can start adding in health issues. Again, it is imprecise, but importantly it shows that one plus one does not equal two. Instead, the reduction in fertility is increased by a greater degree for each issue present. The following table gives an idea of the impact of what might be considered minor problems or factors. The bad side of this is that these minor factors can have a big impact on fertility, however the good side is that they can often be fixed. And whilst you can’t be a “little-bit” pregnant, you can be a “little-bit” infertile, and the factors reducing your fertility may be able to be resolved.
| Number of problems/factors | Average monthly conception rate (%) | % Pregnant in 2 years | % Pregnant in 3 years | Average time needed to pregnancy |
| 0 | 20 | 94 | 97 | 3 months |
| 1 | 5 | 64 | 76 | 2 years |
| 2 | 1 | 21 | 29 | 7 years |
| 3 | 0.2 | 5 | 7 | 40 years |
Ref: Professor Rob Jansen
Whilst the table is confronting, remember it might be that the female has insulin resistance and high blood sugar and the man has IBS with frequent diarrhoea and may not be absorbing his nutrients adequately, issues that can absolutely be improved. It is not all major stuff, like no sperm or not ovulating, but when two, or three relatively minor issues combine they can have a big effect and so it makes sense to address them.
So let’s look at some of those factors or problems that can negatively affect fertility, with the following affecting both sexes:
- age
- sex; how often and when in the woman’s cycle
- genetic integrity (the quality of your genes and the stability of the DNA in the egg and sperm)
- immune function and problems, e.g. sperm antibodies, auto-immune conditions
- specific reproductive issues, e.g. endometriosis, impotence
- sexually transmitted infections
- toxicity, environmental chemicals
- oxidative damage
- weight, both under- and overweight
- diet and nutritional status, extreme diets and eating disorders
- stress and adrenal fatigue
- sleep quality
- smoking
- alcohol, both prescribed and social drugs (including non-steroidal anti-inflammatory drugs, such as Nurofen)
- exercise, physical activity – not enough as well as over-training
- non-reproductive health problems, e.g. malabsorption conditions, under- and over-active thyroid
- radiation exposure
- radiotherapy and chemotherapy (fertility preservation can occur)
Female factors include:
- reproductive hormone patterns and balance
- PCOS, irregular or absent ovulation and menstruation
- poor egg quality
- diminished number of eggs left (poor ovarian reserve)
- cervix surgery
- fibroids
- endometriosis
- endometrial thickness and health
Male factors include:
- poor condition of sperm
- reproductive hormone levels, e.g. testosterone is lowered in obesity
- low sperm count or no sperm
- sperm problems, e.g. excessively high number of abnormal sperm (morphology issues) or sperm that can’t swim as desired (motility problems)
- sexual difficulties, including erectile dysfunction and premature ejaculation
- low libido
- prostrate conditions
- undescended testes, varicocele
ART/IVF Support
Assisted Reproductive Technologies (ART) may be required to achieve a pregnancy because of medical conditions or because you are using donor eggs or sperm. Whilst these can provide the longed for outcome, it can also be a challenging process. Naturopathic support can help and work alongside ART to obtain the best results and reduce side effects form treatment. Goals of treatment will vary depending on the individual circumstances but may include aiming to:
- ensure optimal nutritional status
- reducing inflammation
- reducing cramping and pain
- reduce emotional stress
- supporting mitochondrial function
- supporting optimal DNA integrity