Planning for Pregnancy
By Dr. Alexsia Priolo
Planning for pregnancy can be an exciting time for many! It’s also a time to surround yourself with accurate information as you begin this journey. You might find that you don’t become pregnant on the first try – which is incredibly common. Statistics show that 84% of couples will become pregnant within 1 year of trying and 92% will get pregnant within 2 years.
Subfertility is the inability to conceive after a year of regular, unprotected intercourse. This is not an irreversible state, as you may become pregnant in the future.
Nevertheless, you may want to bring this up to your healthcare provider if you haven’t gotten pregnant after:
1 year of trying and you’re under 36 years old
6 months of trying and you’re older than 36 years old
Sooner if either you or your partner have experienced recurring miscarriages, or other causes of infertility like absent periods, removal of the fallopian tubes, previous ectopic pregnancy, absent sperm or other causes.
Menstrual History:
Assessing your menstrual cycle is an important part of understanding what’s going on. In particular, an emphasis is placed on menstrual status, how often you have a period, and the length of your cycles.
Conditions That Affect Fertility:
For fertility to occur as normal, you must regularly ovulate and have unobstructed fallopian tubes.
Some conditions that may affect ovulation are:
PCOS: A condition that may cause anovulation in women, or irregular periods
Diminished ovarian reserve: Fewer eggs remaining in the ovaries than normal
Hypothalamic functional amenorrhea: Symptoms include low body weight, excessive stress and exercise
Premature ovarian insufficiency: Premature menopause (before you turn 40), your ovaries are unable to function normally
Menopause: A decline in ovarian function, usually when you are in your 50’s
An egg needs to pass through a fallopian tube to be fertilized. But some conditions may cause obstruction. These include:
History of pelvic infection
History of sexually transmitted infections like chlamydia and gonorrhea
Endometriosis
History of abdominal surgery
Risks of Infertility:
In women, risks include:
Age
Smoking
Excessive alcohol intake
Extreme weight gain or loss
Excessive physical or emotional stress
Testing:
Blood work should be considered in women hoping to achieve pregnancy. Some of these tests include:
Lutenizing Hormone: Measured on cycle day 3, a higher level is associated with PCOS, low level is associated with no periods or hyperprolactinoma
Follicle Stimulating Hormone: Measured on cycle day 3, high levels may be associated with premature ovarian insufficiency
Estrogen: Measured on cycle day 3, lower levels may be associated with no period, hyperprolactinoma, or premature ovarian insufficiency
Progesterone: Measured 7 days after ovulation, to confirm ovulation
Sex Hormone Binding Globulin: Lower levels may be associated with PCOS
Prolactin: Measured in the morning, high levels may be associated with no periods
Timing Intercourse:
Pregnancies can usually be attributed to having sex about 6 days before ovulation to the day of ovulation, although highest rates are around 2 days before ovulation. Having regular, unprotected intercourse around 2-3 times per week, as sperm can survive in the vaginal canal between 5-7 days. Around mid-cycle, it takes about 15 minutes for the sperm to reach the fallopian tubes
How to Begin Planning for a Pregnancy:
Folic Acid
To reduce the risk of a neural tube defect, you may want to begin taking a prenatal supplement, which has at least 400ug of folate. Not all prenatal vitamins are considered equal, especially due to the forms of vitamins and minerals used, so speak to our Naturopathic Doctor to find the best prenatal for you.
Keep in mind some people need more than 400ug of folate, especially if they have diabetes or are taking anti-epileptic medication. Speak to your health care provider to determine your right amount.
Find out if and when you’re ovulating
Ovulation is also important, because this is when your body releases an egg, where it can be fertilized by sperm.
Like many people, you’re likely using an app to track your period and it’ll usually give you an idea when you’re ovulating. Although you app says you’re ovulating, this doesn’t mean that (a) that’s the actual day it happens and (b) your ovary releases an egg.
Cervical Fluid
Cervical fluid might not be something you entirely understand or pay attention to, but it’s an important sign that indicates that your estrogen levels are getting higher in preparation to cause a surge in lutenizing hormone (LH).
Cervical fluid has a distinct role in fertility that includes: protecting the sperm in an otherwise acidic vagina, nourishing the sperm, and allowing sperm to move freely.
Your cervical fluid changes based on where you are in your cycle. As you approach ovulation (5-6 days before), the texture and colour of cervical fluid begins to change. Fluid can be yellow, white, or cloudy and have a sticky or tacky texture. About 2-3 days before ovulation, you may notice an abundance of cervical fluid. It looks clear and slippery just like an egg white, and will typically stretch in-between your fingers. Be mindful that: arousal and semen can imitate this.
Ovulation Predictor Kits (OPKs)
OPK’s are used to determine when LH is surging. When LH peaks during your cycle, this causes your ovary to release an egg. The LH surge usually happens around 24-36 hours before ovulation.
Once your egg has been release, it has about 12-24 hours to be fertilized by sperm. If no fertilization happens, the egg dies and your next chance to get pregnant will be at your next ovulatory cycle.
You might want to start using OPKs around the same time as the change in your cervical fluid, when it’s clear and stretchy. When using these tests, you may notice 2 days that have a positive test – this is because the test is capturing both sides of the LH peak.
Basal Body Temperature (BBT)
BBT is a measure of your temperature first thing in the morning (with at least 3 hours of sleep). When you ovulate, the hormone progesterone is produced and will cause your temperature to slightly increase.
BBT is most useful if you track your temperature all throughout your cycle. This is because you’ll get an idea about: when you’re ovulating, progesterone production, and the length of the second half of your cycle.
Lifestyle Changes
Smoking
A large study reported that women who smoked, had higher infertility risks, as it might accelerate follicular depletion. It’s also been shown to be linked to miscarriage in both naturally conceived and IVF pregnancies.
Marijuana may also have harmful effects on fertility, but more research is needed to better understand this link.
Alcohol
Studies are conflicting when it comes to alcohol consumption during the preconception period. A study in Sweden reported that women who consumed 2 servings of alcohol per day, reported a higher risk for infertility than women who have 1 serving of alcohol per day. Yet a Danish study showed there was a shorter time to pregnancy for women who drank wine compared to no drinking.
Nevertheless, guidelines state that drinking more than 2 servings of alcohol daily are best avoided.
Caffeine
Consuming over 500mg of caffeine per day, has been associated with decreased fertility. While caffeine hasn’t been shown to cause any birth defects, guidelines do recommend limiting caffeine intake to about 150-200mg per day, as there isn’t any evidence suggesting it may negatively impact fertility.
If you find yourself drinking large amounts of coffee to function at your best and get through the day, you may want to work with a Naturopathic Doctor to determine why that may be.
Endocrine Disrupting Chemicals
These are chemicals that have ability to mimic or block our own hormones, which can lead to unwanted health outcomes. Bisphenol A (BPA) and phthalates are commonly found in food processing, personal care products, and cosmetics.
BPA has been shown to effect egg quality, implantation, embryo and placental development. While most products list themselves as BPA-free, some of the substitutes like BPA S are just as bad. Consider limiting your plastic exposure (food and water containers), and switching to glass and stainless steel when possible. Avoid canned foods stamped with the number 7 on the bottom.
Phthalates are often found in high amounts in women with endometriosis. In people undergoing IVF, a high concentration of phthalates lead to lower number of egg retrieval, lower pregnancy rates and higher risk of pregnancy loss. Avoiding plastic containers, choosing “fragrance-free” products, and cooking at home may reduce phthalates in your diet.
Next Steps
Overall, a lot of energy can go into pregnancy planning. If you’re a planner, I recommend adopting any of the applicable lifestyle changes, looking into a suitable prenatal vitamin, and supporting your menstrual health if you think that improvements could be made.
References
Optimizing natural fertility: a committee opinion. (2013). Fertility and Sterility, 100(3), pp.631-637
Segal, T., & Giudice, L. (2019). Before the beginning: environmental exposures and reproductive and obstetrical outcomes. Fertility and Sterility, 112(4), 613-621. doi: 10.1016/j.fertnstert.2019.08.001
Thurston, L., Abbara, A., & Dhillo, W. (2019). Investigation and management of subfertility. Journal Clinical Pathology, 79(9), 579-587. doi: 10.1136/jclinpath-2018-205579