Ljupka Peev Naturopath, Nutrition, Herbal Medicine for women's health and fertility.

PREPARING FOR PREGNANCY

Prep-for-PregnancyWhether trying to conceive on your own, or with medical help, preparing for pregnancy is important for the health of the mother and baby. It is important to remember that conceiving a baby includes the union of a sperm and an egg, and so preconception care must involve the male as well as the female partner. Pre-pregnancy health not only improves the chances of a healthy pregnancy and baby, but can also improve your chance of becoming pregnant.

Chance of conception
Understand your menstrual cycle
Timing intercourse
Already been timing intercourse?
Fertility assessment
Pre-pregnancy checklist
Lifestyle tips to help maximise your chance of conceiving
Preconception consultation
References

 

Chance of conception

In normally fertile couples aged 25-30, 75% will conceive naturally within 6 months if they time intercourse during their fertile period. As we age, however, the chance of conceiving drops to 25% in couples aged 35-39.[1] Given that the average age of people having children is rising in Australia, it is important to not only understand when your most fertile time is each cycle (as this will vary for individuals), but also to do everything we can to help improve your chances of conceiving.

 

Understanding you menstrual cycle

You may have noticed that most of the information about the menstrual cycle and fertility on the internet and through apps is based on a standard 28-day cycle. However, every woman is individual and her menstrual cycle length may not be 28 days! A “normal” menstrual cycle ranges from 21 to 35 days. A cycle length outside of this suggests that there may be a problem with ovulation.

An easy way to estimate when ovulation occurs is to subtract 14                  days from the length of you menstrual cycle. For example, if your      cycle is usually around 25 days, you are most likely to ovulate on day 11. Whereas, if your cycle is normally 32 days, you can expect   ovulation to occur on day 18.

 

Timing intercourse

Although knowing when you ovulate is the first step to timing intercourse, there are a few facts which are also key in understanding when to time intercourse. Once you ovulate and release an egg, this egg is only viable for fertilisation for about 12-24 hours. Sperm, however, are capable of fertilising an egg anywhere from 3-5 days after intercourse (depending on the individual male’s semen and sperm quality). Therefore, it is most important to time intercourse before ovulation rather than after. In fact, the majority of pregnancies occur when intercourse takes place within the 3-day interval just prior to ovulation.[2]

 

Already been timing intercourse?

There are more accurate ways of pinpointing ovulation and if you have already been timing intercourse unsuccessfully, these can be used to determine if in fact, the timing has been correct and can provide information about your cycle that might be affecting your chances of conceiving. Ljupka provides her patients with these tools, as well as cycle-by-cycle advice on when to time intercourse to optimise your chance of conceiving each cycle.

 

Fertility assessment

An assessment of your fertility, done early, can help spare you months of trying and the consequential stress this causes. Often, given that most couples will conceive naturally by 6-12 months, a medical assessment wont be undertaken until after this time. However, a clinical assessment can help to identify any factors that may impede your chances of conceiving (or that may warrant further investigation) and thus can be used to help improve these chances.

The major causes of infertility in couples are usually attributed to around:

  • 40% male problems
  • 40% female problem
  • 10-20% unexplained or “unusual” problems.[3]

This is also described as:

  • 30% male only problem
  • 30% female only problem
  • 30% both male and female problem
  • 10% unexplained.

Therefore, assessment of both the male and female partners is vital. Ljupka conducts fertility assessments on men and women wanting to conceive. For more information, see Fertility Assessment services.

 

Pre-Pregnancy Checklist

Once you have made the decision to start a family, there are other practical concerns that need to be addressed. Here is a checklist of some things to think about:

Women:

  • Ensure you are up to date with your pap smear and breast checks.
  • Have a blood test to check:
    •  your immunity status for things like rubella, chicken pox, hepatitis A and B, so that if you need any vaccinations, you can have these done before you fall pregnant;
    • your blood group;
    • for any infectious diseases.
  • See your dentist for a check up and make sure any x-rays or fillings are completed before you are pregnant.
  • Start taking folic acid 500mcg daily. Ideally you should start this 3 months before you are pregnant to help reduce the risk of neural tube defects in baby.
  • You will also need adequate iodine, selenium and omega 3 levels for optimum fertility and for baby’s thyroid and nervous system development. There are many pregnancy multivitamin formulas on the market and some are better than others. Fish oil supplements also vary in doses and in quality (see Nutritional Medicine for more information on quality issues). Most importantly, your specific needs for these nutrients  will depend on factors including your dietary intake and your current health status. See your naturopath for individualised advice concerning your supplemental needs and advice on quality of supplements.
  • See your naturopath for an assessment of your current nutrient status, including iron, vitamin D, calcium, and others, so that any deficiencies can be corrected.
  • If you have or are considering private health insurance, check the pregnancy cover as many providers will only cover you if you have been a member for at least a year before the baby is born.

Men:

  • See your naturopath for a Fertility Assessment. Sperm can be damaged by many environmental and occupational pollutants or toxins, but luckily there is often much you can do to correct this. Because sperm takes about 3 months for your body to produce, seeing your naturopath early is important to allow enough time for any treatments or lifestyle changes to take effect.
  • Have a blood test to check for any infectious diseases.
  • Avoid hot baths, sauna or spas. In these situations your body is immersed in heat and so will be your testicles, making your scrotum ineffective at regulating their temperature. As is well known, heat can damage sperm so avoid these while you are trying to conceive.

Both Men & Women:

  • See your naturopath for a general health screen and to address any current health complaints or conditions.
  • If you are taking prescription medication, discuss these with your doctor, concerning any impact these may have on your fertility or their safety in pregnancy.

 

Lifestyle tips to help maximise your chance of conceiving

There is much you can do on your own to help improve your general health and your fertility. Along the way, your naturopath and others can provide you with further help and guidance. Here are some lifestyle tips to get you started:

Diet

Enjoy a balanced diet with adequate protein, low-GI carbohydrates and “good” fats. Your naturopath can give you specific individualised advice and help make simple changes where needed. As a general rule, avoid packaged and processed food and aim for fresh food and lots of vegetables. For quick healthy recipes and some inspiration, see Recipes and sign up to the newsletter for new recipes as they become available.

Exercise

Maintaining your fitness will help your general health as well as that of your pregnancy and can lower the risk of problems at birth. Exercise is great for stress reduction and improves mood and energy. Excessive exercise, however, can be a problem for men and women, with the potential to effect sperm and ovulation. For more information, see Exercise – How, What, When.

Weight

Maintaining a healthy weight is important for fertility for both men and women. In women, being over or under-weight can disrupt ovulation and increase risks in pregnancy and during birth. In men, being overweight can reduce sperm count and motility.[4]

Smoking

In women, smoking can effect hormones and ovulation, increase the risk of miscarriage and premature birth, and reduce the weight of baby.[5] In males, smoking damages DNA in sperm and can decrease sperm count, motility and the ability of the sperm to fertilise the egg.[6] Planning a pregnancy is often a great motivator to help you stop smoking. There are lots of different strategies and finding the right one might be the key to your success. Many people have “kicked the habit” with the help of the popular book Alan Carr’s Easy Way To Stop Smoking. For many others, hypnotherapy has proved to be the key. Dr Bruce Alexander has helped countless people stop smoking through hypnotherapy. See his website for more information. Quit Victoria provides lots of help and resources through their website as well as a free telephone support service called “Quitline” (cost of a local call).

Recreational Drugs

These can cause significant problems in hormone production, fertility, during pregnancy and in newborn babies, and are often stored in the body or exert effects for prolonged periods of time after cessation of use, thus it is imperative that any recreational drug be avoided. There are many sources of information and help available, whether you have stopped and have questions or are trying to stop using recreational drugs. The Victorian Government Health Website provides a list of treatment and support services for drug and alcohol, including information services.

Over-the-counter medication and supplements

Some over-the-counter (non-prescription) pharmaceutical medications may have effects on sperm, ovulation or pregnancy. Similarly, some herbal and/or nutritional supplements should be avoided. See your naturopath for advice.

Caffeine

Minimise or avoid caffeine. Caffeine sources include coffee, some teas, cola and other soft drinks, and chocolate. Moderate to high caffeine intake (>1 cup coffee + 1 cup tea) in women has been linked with increased risk of miscarriage and reduced growth of baby, and in men, increases damage to DNA in sperm.[7]

Alcohol

Limit alcohol. In women, alcohol intake is associated with fertility, with high or frequent intake effecting ovulation and increasing the rate of menstrual disorders.[8] During pregnancy, alcohol should be avoided as it may reduce baby’s birth weight and be detrimental to baby’s brain development. In males, increased alcohol affects sperm numbers, motility and morphology (shape), as well as affecting testosterone and oestrogen levels.[9]

Stress

We all experience stress at times and whilst low levels of occasional stress are normal, persistent moderate or high levels of stress can effect both our general physical and emotional health, as well as our fertility. This is because the stress response produces hormones that interact with reproductive hormones in both men and women. In females, this might be seen as symptoms that occur before your period, like marked mood change (PMS), or as prolonged cycles or “missed” periods. In males, erectile dysfunction or premature ejaculation might be the result of “emotional/social” stress or the physical result of the ability of stress to reduce testosterone. Additionally, this may also cause a reduction in sperm production.

Managing stress can seem easier said than done, but there are many resources and tools available to us. Often, the key is to be able to first recognise when we are stressed and how it effects us. Counselling can be very useful here in both helping us to identify stress as well as teaching us ways to manage it.

 

Preconception Consultation

Consultation with Ljupka for preconception care is available by appointment.

A preconception consultation involves:

  • Full clinical history to assess for any factors that may impede chances of conceiving and to determine current health status.
  • Blood test referral. This is necessary for screening women for immunity to certain illnesses, such as chicken pox and rubella (German measles). Women and men are also assessed for STDs, such as hepatitis B and C, and HIV. Blood group is also determined, if it hasn’t already been done so. Baseline nutritional testing, such as iron and vitamin D, may also be done through blood testing, in order to correct any deficiencies before pregnancy.
  • Semen analysis
  • Accurate, individualised, cycle-by-cycle advice on timing of intercourse (no body temperature testing required).
  • Dietary assessment and advice, including advice on which supplements may be necessary and in what doses (such as folate, iodine, selenium, fish oil).
  • Lifestyle assessment and advice
  • For people undergoing IVF or ART, additional assistance is provided (see IVF support).

Please call 0488 995 474 or email ljupka@naturopathy.melbourne for appointments.

Ljupka is currently specialising in reproductive health in men and women through a Master of Reproductive Medicine. Read more about Ljupka Peev.


References

[1] Dunson DB, Colombo B, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction. 2002 May; 17(5):1399-403. Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of intertility. Human Reproduction. 2003 Sep;18(9):1959-66.

[2] Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med. 1995 Dec 7;333(23):1517-21.

[3] Fritz, Marc A and Speroff, Leon. Clinical gynecologic endocrinology and infertility. 8th ed. 2011. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

[4] Hammoud AO, Wilde N, Gibson M, Parks A, Carrell DT, Meikle AW. Male obesity and alteration in sperm parameters. Fertil Steril. 2008 Dec;90(6):222-5.

[5] Mlynarcikova A, Fickova M, Scsukova S. Ovarian intrafollicular processes as a target for cigarette smoke components and selected environmental reproductive disruptors. Endocr Regul. 2005 Jan;39(1):21-32.

[6] Vine MF, Tse CK, Hu P, Truong KY. Cigarette smoking and semen quality. Fertil Steril. 1996 Apr;65(4):835-42. Pollard I, Substance abuse and parenthood: biological mechanisms—bioethical challenges. Women Health. 2000;30(3):1-24.

[7] Pollard I, Substance abuse and parenthood: biological mechanisms—bioethical challenges. Women Health. 2000;30(3):1-24. Schmid TE, Eskenazi B, Baumgartner A, Marchetti F, Young S, Weldon R, et al. The effects of male age on sperm DNA damage in healthy non-smokers. Hum Reprod. 2007 Jan;22(1):180-7.

[8] Jensen TK, Hjollund NH, Henriksen TB, Scheike T, Kolstad H, Giwercman A, et al. Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy. BMJ. 1998 Aug 22;317(7157):505-10.

[9] Muthusami KR, Chinnaswamy P. Effect of chronic alcoholism on male fertility hormones and semen quality. Fertil Steril. 2005 Oct;84(4):919-24.

 

 

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