Pre-conception and Fertility: Where to Start?
Whether you’re months or years into your fertility journey, it can be heartbreaking, overwhelming, devastating, and at times, very isolating, and I’m here to remind you that you’re not alone.
Let’s focus on some simple but powerful strategies that can maximise your chances of conceiving naturally, and can also support the success of IUI/IVF.
Here are some of my foundational preconception and fertility guidelines that stems from a decade of clinical experience, homeopathic philosophy, nutrition and lifestyle medicine (with the latest evidence-based research).
If you always thought it’d be fairly straight forward when it comes to getting pregnant, ie. stop using contraception- easy! (it is because we have been told our whole life that we can fall pregnant at the drop of a hat!), yet, here we are… each month it can feel like disappointment, grief and self-blame when each period comes. It can become so painful that you wonder if it’ll ever happen… or if its ‘meant to happen’. Or, perhaps you’ve just started trying to conceive or you’re years into your fertility journey - you may have have been told everything is “fine” and you have unexplained infertility, or you’ve had numerous appointments with specialists. Maybe the right investigations actually haven’t been done (yet!) You may have tried medication like Clomid and tried other therapies, with little success. Perhaps you’ve had miscarriages, you’re coming off the oral contraceptive pill after years of use and/or you’re wanting to prioritise preconception planning or you’re wanting to optimise your fertility before/during IVF . Whether you’ve been trying to conceive for a few months or a few years, you can spend hours and even days, scrolling, looking for answers, downloading all the things, and trying to make sense of it all.
I’ve spent over ten years helping people with preconception, balancing hormones, enhancing fertility, through healthy pregnancies and post-partum. Another clinical and education focus of mine is the gut and vaginal microbiomes, as I have seen many cases where this has held the key! Most fertility clinics won’t look at the microbiome for fertility, but there is great evidence to suggest that it really is essential! if you want to look at some of the research here, here, here, here, here.
With over 1 in 6 couples now experiencing infertility, the global birth rates dropping and sperm rapidly decreasing, there’s a number of issues impacting our fertility that can be addressed to improve your chances of a healthy conception, including lack of cervical mucous (often due to long term oral contraceptive pill use, or low levels of natural oestrogen), not ovulating, hormonal imbalances such as high oestrogen and/or low progesterone, high androgens (PCOS subtypes), thyroid dysfunction (including auto-immune thyroiditis) endometriosis, issues with sperm production/quality etc, nutrient deficiencies (including B vitamins, iron, vitamin D and zinc), high stress, high sugar or inflammatory diets, recurring gut issues or vaginal dysbiosis, and lifestyle factors including lack of good quality sleep, caffeine, alcohol, drugs and environmental toxins, which can drive oxidative damage impacting sperm health and egg quality, and impact fertility.
Here are a few key points to consider:
Health assessment and fertility pathology : Hormone imbalances and “unexplained” fertility are often misunderstood or under investigated. I see this ALL THE TIME. 3 of most commonly overlooked fertility pathology tests/results: 1. Low progesterone - low progesterone is known to impact fertility and pregnancy loss ie progesterone helps up to ‘hold’ a pregnancy. Low progesterone can be involved with irregular menstrual cycles, spotting, heavy menstrual bleeds, mood swings, headaches, PMT, endometriosis, PCOS and fertility challenges. This hormone imbalance can be confirmed by a simple hormone test, at the right time of your menstrual cycle - see my hormone testing guide here. 2. Thyroid dysfunction- elevated TSH and thyroid antibodies can directly impact fertility and recurrent miscarriages. Elevated TSH is associated with subclinical hypothyroidism, which may also be associated with other symptoms including fatigue and inability to lose weight/weight gain. For example TSH >2.5 can double the chance of miscarriage. Research here. Iron overload is associated with sexual dysfunction and infertility for men - research here. So preliminary blood tests for both parties is important.
If your practitioner/doctor hasn’t discussed these factors or done these tests yet, I highly recommend you chat to them about it. My fertility consultations include a thorough health assessment and fertility evaluation so I can understand the couples whole health picture and determine underlying factors, deficiencies and imbalances, that may be contributing to fertility challenges. Where necessary, I refer patients for further testing, such as thyroid testing, nutrient levels - iron, Vitamin B12, folate and Vitamin D, as well as hormone testing and sperm testing.
Fertility diet and lifestyle : The “Fertility Diet”: Research shows nutrition and lifestyle has a huge impact on hormonal health and fertility for both men and women. A review in 2022 found that the Mediterranean-based anti-inflammatory diet improves female fertility, assisted reproductive technology and sperm quality in men. There’s some typical culprits like smoking and alcohol that can impact fertility. Research shows >6 drinks/week of alcoholic beverages is associated with reduced odds of conception. Research shows daily alcohol consumption can results in a worsened semen quality, particularly in terms of the semen volume and the sperm morphology. I encourage my patients to focus on drinking good quality water daily, eating 5+ veggies a day, enjoying protein with every meal and snack, focusing on eating an abundance of omega-3 fats like avocado, olive oil and oily fish, and including fibre regularly to help with elimination of excess hormones and detoxification pathways.
Low-toxic living: I also highly encourage you to embrace low-tox living, where possible. There’s certain environmental toxins that contain endocrine-disrupting chemicals (think of these as hormone messer-up-ers) that can interfere with female and male fertility, such as BPA, phthalates, PCB and parabens, which can be found in commonly bought conventional beauty, hygiene and cleaning products. You may also consider your environment: reducing exposure to EMFs, radiation and heavy metals. I have some detox information in the resources tab. Another thing I highly recommend, is avoiding plastic as much as possible, it is insidious, but we do our best. ie not eating/drinking out of plastic, opt for natural fibre clothing as much as possible, filter your water, and cook in non-tox pans etc like stainless steel or cast iron (check out SolidTekniks)
Vitamin D - the “sunshine vitamin” is a KEY fertility hormone. Vitamin D can support follicle development, progesterone production and promote health cycles. Vitamin D benefits male reproductive health, particularly through a better sperm motility. You can test your Vitamin D levels through your GP or health practitioner. If you're in Australia you can order a test here, or here. Please note acceptable Vitamin D levels are 50 nmol/L, which is enough to stop you going into a deficient state BUT optimal Vitamin D levels for fertility, mood and health are estimated to be closer to 75-100 nmol/L. You see, Vitamin D acts like a hormone in the body, and impacts fertility and outcomes in IVF.
I can’t not mention Homeopathic medicine! Homeopathy is often an untapped avenue when it comes to balancing hormones and optimising fertility. If you’re a newbie to homeopathy or you’re wondering how it actually works - let me explain...Homeopathy is a medical system that was developed over 200 years ago, and is the second largest form of medicine in the world, according to the World Health Organisation. Homeopathy stimulates the body’s natural healing response. Homeopathy has a long history of use for balancing hormones, stimulating ovulation, improving libido, regulating a cycle and supporting fertility. I LOVE Homeopathy for also clearing ‘blocks’. A German clinical trial showed TWICE as many women taking homeopathic medicine fell pregnant, compared to those that didn't take homeopathy. For example, Folliculinum, a key fertility homeopathic medicine used in my Fertility Program, is a key part of naturally stimulating ovulation and balancing oestrogen & progesterone. This homeopathic remedy is made from natural oestrogen, and helps with the oestrogen surge leading up to ovulation, which is why folliculinum stimulates ovulation & helps with improving cervical mucous production. Without healthy stringy cervical mucous, mid-cycle, the sperm cannot swim up to fertilise the egg. Folliculinum is applicable if there's a history of irregular/missing cycles, PCOS, fibroids, oestrogen dominance, hormonal imbalances and fertility challenges. It's also useful for lower oestrogen levels, which can occur in perimenopausal. You can learn more about the homeopathic medicines used in fertility here.
Fertility awareness & education: Given there’s only a handful of days each month you can conceive, we want to pinpoint exactly when you’re ovulating, or as close to as possible. We are led to believe that most women ovulate on day 14 of their cycle (day one being the first day of the menstrual bleed), which means a lot of women think they’re most fertile around day 14 of their cycle, but this is not accurate! Only around 10% of women actually ovulate on cycle day 14. The best thing you can do from now, it to track your cycle (properly!). Identify your fertility window using effective fertility awareness methods. The best technique to predict ovulation and give you insight into your fertility window are changes to your basal body temperature changes throughout the month. you can pair this with LH strips. I use a basal body temperature like natural cycles or temp drop, or use a certified wearable like the Oura ring. Remember that your fertility window is typically 5 days leading up to ovulation and the day of ovulation - we want to pinpoint when your ovulation is likely to occur, so you can predict your fertility window. You can investigate these further, and work with a practitioner to understand your fertility awareness techniques. So, if you’re wondering when are the best days to have sex when trying to conceive? Every second day from day 8 of your cycle to day 24, plus your most fertile days, based on your signs and symptoms of ovulation, (as above). *note, day 1 is day 1 of your menstrual bleed. Remember, this might not be accurate for you if you have a 35 day cycle. you may ovulate on day 18 of your cycle! and it can take a few months to get into the rhythm if you are new to this type of cycle tracking.
Top 5 Fertility Foods:
Avocados - a rich source of hormone balancing and inflammatory fighting omega-3 fats, that nourish the nervous system and balance hormones.
Oily fish - Wild caught oily fish like herring and sardines, are all wonderful sources of unsaturated fats and hormone supportive nutrients including calcium and B vitamins, which are also known asas your 'energy vitamins'. The Heart Foundation recommends all Australians should aim to eat 2-3 serves of fish, including oily fish, per week. I personally use a good quality fish oil, as I find environmentally friendly fish options very few and far between these days, and there is a microplastic issue here. Please don’t buy tassie salmon. Look into the Bob Brown Foundation and Green Peace for more info.
Eggs - Think of eggs as 'Nature's Multivitamin'; jam-packed with protein, fat and nutrients to keep you satiated, improve metabolic health and balance hormones. Most healthy adults benefit from an egg a day! again, make sure you go local, pasture-raised and antibiotic free if possible. Most egg companies will say ‘no growth hormones’ but will use certain antibiotics to the same effect.
Linseeds and Chia seeds- amazing source of fibre and nutrients, which can help with the detoxification of excess hormones (like oestrogen) and cholesterol, and promote healthy hormones. A handful of any nuts/seeds a day can be beneficial as it provides a powerhouse of nutrients and antioxidants.
Blueberries, blackberries, dragonfruit etc - Polyphenols, prebiotics and full of antioxidants, which support a healthy gut microbiome. they contain Vitamin C and a powerful phytonutrient known as anthocyanin, which can support egg and sperm health, reduce inflammation and boost fertility. *opt for organic berries!
If you would like to go deeper and get a tailored approach, please get in touch!
Em