The journey to achieving and maintaining a healthy pregnancy can look extremely different for people; for some, it’s quite straightforward, but for others, it can be riddled with all kinds of obstacles. While there are a few components of your fertility care you may be able to have some semblance of control over, there are many things that are out of your hands.
We’ve made great strides in reproductive technology, fertility care, prenatal screening, and medicine. However, we have much to learn and understand still. For now, we’ll start with the basics, so you can understand some of the factors and options available to you.
FERTILITY BASICS
For fertilization to occur, we need egg and sperm to meet. Then, we need a uterine lining for the fertilized egg to implant into. We also need placental development and adequate progesterone to maintain the pregnancy. And we can’t forget about our basic nutrients (like folic acid) and healthy habits (like exercise), which support a healthy pregnancy.
It’s important to note that oftentimes, the factors that contribute to difficulty in conceiving can also put us at higher risk for pregnancy loss, complications, and future health issues in babies. So, fertility care isn’t only about a positive pregnancy test—it’s also about setting your family unit up for success in the long run. Even then, we must try to support what we can with the understanding that many aspects of our health and fertility are beyond our control.
MENSTRUAL CYCLE
A good place to start for menstruators is to take inventory of their menstrual cycle and figure out when ovulation is occurring. Ovulation is the process of your body releasing an egg. It happens approximately mid-way through the menstrual cycle, but the timing can vary. There are a few ways you can determine when you might be ovulating:
- Cervical mucus: This is discharge that can be seen throughout the menstrual cycle in varying amounts. Close to ovulation time, many menstruators note an increase in cervical mucus that is stretchy, higher in quantity, and more egg-white in texture. After ovulation, this cervical mucus may become tackier, denoting the end of the fertile window.
- Basal body temperature: Body temperature can rise after ovulation. Using a two-decimal point thermometer, you can take your temperature in the morning upon waking. This method may offer insight about ovulation for some, but it isn’t always reliable.
- Ovulation predictor kits: These kits measure luteinizing hormone (LH), which is the hormone that rises right before ovulation, in preparation for the egg to be released.
- Mittelschmerz and other signs: Sharp lower abdominal pain (called mittelschmerz) and other symptoms, like headaches or changes in bowel function, can all be signs of the change in hormones accompanying ovulation.
Other ways to check ovulation include imaging and testing luteal phase progesterone (approximately seven days after ovulation).
TESTING & IMAGING
Screening and diagnostic testing can tell us about your health. Routine annual testing is always recommended to make sure your overall health is good. Some specific considerations include:
- Iron (tested as ferritin): Iron is an extremely important mineral, especially during pregnancy, so we want to make sure it’s at an appropriate level before getting pregnant.
- Vitamin D: Deficiency and insufficiency of the sunshine vitamin has been associated with various hormonal and menstrual conditions, as well as infertility.
- Thyroid testing: Thyroid-stimulating Hormone (TSH) is the screening test used for checking thyroid function. Elevated TSH can be seen in hypothyroidism and can contribute to infertility, pregnancy loss, and menstrual cycle irregularities. Testing for thyroid antibodies can be relevant for many menstruators as well, especially if you’ve been trying to conceive for some time, have a family history of high TSH, or have a history of autoimmunity.
Depending on where you are in your fertility journey and your presentation and age, other tests like testosterone, prolactin, insulin, DHEA, LH, FSH, progesterone, and more can be considered. For sperm, a semen analysis is the way to go; however, routine testing is still important here.
Pelvic and transvaginal ultrasounds aren’t necessarily a part of routine testing, but many of you might be tested semi-regularly for issues such as pelvic pain, painful periods, ovarian cysts, fibroids, heavy bleeding, polycystic ovarian syndrome (PCOS), and other conditions. If you’re having difficulty conceiving, imaging should be part of your workup.
If working with a fertility clinic, a full workup typically includes a robust blood work assessment that includes the hormones listed above, as well as imaging at multiple points in the menstrual cycle. A semen analysis is also performed.
LIFESTYLE FERTILITY SUPPORT
For general fertility support, the foundations are laid by our day-to-day routines. Fertility recommendations are the same as those for general health:
- Eat plentiful plant foods that contain fibre, vitamins, minerals, and antioxidants, including whole grains, fruits, vegetables, nuts, and seeds.
- Get adequate protein, especially from lean proteins and plant-based sources like legumes and lentils.
- Consume healthy fats like omega-3s, nuts, seeds, and olive oil.
- Eat adequately to energize your body, as under-fuelling and over-fuelling both impact the release of our hormones.
- Minimize consumption of ultra-processed foods.
- Avoid alcohol.
- Exercise regularly: start where you are and work your way up from there. Based on current pregnancy guidelines, you can start with 150 minutes per week spread over at least three days, which is the equivalent of approximately 20 minutes of walking per day.
- Get plentiful sleep and rest for your body, mind, and soul.
- Don’t forget about pleasure and mindfulness: connect with your family and friends; do the things you love, go out in nature, be present, and do what brings you joy.
SUPPLEMENTS
There’s a lot of information on what may or may not be helpful on the internet. It’s important to note that it is possible to disrupt menstrual cycles and interfere with fertility medications with certain supplements. The best practice is to seek out care from your healthcare team.
- A prenatal is a good place to start since it will provide the nutrients that are generally needed for embryonic development. The two nutrients we specifically want in a prenatal are folic acid and choline.
- An omega-3 that has adequate DHA in it is important, especially during pregnancy.
- Vitamin D, which is usually found in a prenatal, is an important vitamin for fertility and pregnancy. Additional supplementation should be based on testing and your history. The maintenance dose in Ontario is 2500 IU per day.
- For sperm health, compounds like carnitine, coQ10, zinc, vitamin C, and melatonin are considerations.
- For egg quality, antioxidants like coQ10, melatonin, and NAC are considerations.
- Acupuncture can be supportive for general fertility support and has been shown to improve success rates of assisted reproductive technologies like IVF and IUI.
- For a diagnosis of unexplained infertility or recurrent pregnancy loss, progesterone prescribed by a medical or naturopathic doctor can be supportive.
- Other therapies, whether medication or supplementation, will depend on your personal history.
Fertility issues can come up for anyone, and there is no shame in it. Common conditions and states that may interfere with fertility include PCOS, hypothalamic amenorrhea, endometriosis, hypothyroidism, and poor sperm quality.
Seek out support sooner rather than later—get some testing done, advocate for a fertility clinic referral, expand your healthcare team to include a naturopathic doctor, and work on some of the foundations of health, like sleep and movement. Even if you are going through a fertility clinic, there are ways to support that process to slightly increase the chance of success.
This article is simply a starting point. There are many factors to consider as you go through your fertility journey, and hopefully this offers some food for thought, as well as a nudge to discuss your fertility plans with your healthcare team.
