Preparing for pregnancy is an exciting time! It can also be nerve-wracking for couples who worry that they will run into difficulty. This fear seems to be more common than the actual difficulty couples experience and is probably related to the fact that most women are waiting till later in life to have children. In fact, women 35-39 are the fastest growing group of expectant moms! And although there are some risks to Mom and Baby with advanced age, most women over 35 have healthy, happy babies!
When a couple seeks out support for natural preconception, I remind them that fertility is a team approach. Assessing both partners is essential for comprehensive natural treatment. Often times, I will see a female partner whose husband is ‘healthy’ or has had a ‘normal’ semen test. A ‘healthy’ male may still have other factors affecting fertility and a ‘normal’ semen test does not necessarily predict fertility. In fact, semen quality is so variable from test to test that a stand-alone test is often not enough to rule out a male factor issue with fertility. Completing a full assessment of both partners is the best way to provide holistic fertility care. Couples should work together during fertility preparation to optimize health!
A little preparation can go a long way! But the actual length of preparation depends on each individual’s health. The question of when to begin is best answered in a naturopathic visit but here is a general guideline I use when making recommendations:
Healthy Men & Women: For men and women consuming a mostly Mediterranean Diet (high intake of fruit and vegetables, fish, chicken, plant-based oils) who are active and (for women) who are menstruating on a 28-35 day cycle preparing for 3 months is recommended. It is also advisable during this time to reduce/cut out alcohol and caffeine as well as start fertility promoting supplements such as fish oil and multivitamin for both men and women. This time also provides an opportunity to teach women how to track the menstrual cycle and identify the most fertile days.
Irregular Menstruation: For healthy women (as described above) who are not menstruating regularly preparing for 6-12 months is recommended (depending on the length of time that menstruation has been absent). This allows an opportunity to run labs and imaging as well as assess nutritional and hormonal factors that may be contributing to menstrual issues.
Pro-Inflammatory Diet: For men and women with a diet high in red meat (more than 1x per week), refined grains, sugar and low in fruit and vegetables or other fiber based foods, 6-12 months is recommended for pregnancy prep. Although 12 months may not be required it allows you to slowly build up habit changes that are sustainable and fertility promoting. If individuals can make dietary and lifestyle changes easily then 6 months is more than enough time.
Overweight: For men and women who are overweight, it is recommended to work towards a healthy Body Mass Index (BMI). This can help improve fertility for men and women but also reduces the risks of complications during pregnancy/delivery to Mom and baby. The recommended time depends on the individual.
Birth Control Detox: For women who have recently stopped the Birth Control Pill (BCP) or other form of hormonal birth control, 3 – 6 months is generally recommended to re-establish a healthy menstrual cycle and to build up nutrients depleted by the BCP such as B6 and Magnesium. Having said this, I have seen many women who have been surprised by pregnancy immediately after stopping the BCP. Make sure you use other forms of birth control while you gently detox your body and prepare for pregnancy!
Low Sperm Count: For men with abnormal sperm analysis results, a full work-up with your conventional doctor is required to rule out causes. This is essential for your general health – not just fertility. From a naturopathic perspective, 6 months is recommended, to work on dietary and lifestyle factors that can affect healthy semen levels. After 6 months, a second sperm analysis should be run.
Polycystic Ovarian Syndrome: For women with Polycystic Ovarian Syndrome (PCOS) preparing for 12 months is recommended. Exploring fertility with PCOS often involves working to re-establish a regular cycle while using a therapeutic diet and herbs. A low glycemic index/ high protein diet is often recommended. Women with established PCOS who are on the BCP (or injections or IUD) to control symptoms and regulate the cycle will need to discontinue this treatment. Naturopathic care can be complimentary to working with a family doctor, endocrinologist or fertility expert.
Fibroids or Endometriosis: For women with Endometriosis or Fibroids 12 or more months is recommended. This plan often involves establishing an estrogen balancing diet and working with herbs to optimize liver function and provide some hormonal balance. Naturopathic care is often complimentary to working with a family doctor, endocrinologist or fertility expert. Although endometriosis and fibroids are known to be common causes of infertility – women can still conceive naturally as it depends on the location of the endometrial tissue or fibroid(s) within the uterus.
Above 40: Men and women of advanced maternal age (above 40) often do not want to wait while preparing for pregnancy and although time is certainly a factor, 1-3 months is generally recommended as a minimum to make some basic dietary changes and begin supplementation.
Fertility Treatment: For women who are between fertility treatments, it is recommended to wait 3 months (where possible) between IVF or medicated IUI cycles before trying again. It can take 3 months for a healthy, natural uterine lining to build back up again. This also creates mental space for you to manage stress and maintain general health. This may be different than the advice given at the fertility clinic as most docs are comfortable trying again immediately so long as the hormone levels are ideal. Although, this can often lead to a successful pregnancy, it doesn’t give the body (and mind) a chance to rest, rebalance and thrive.
Prior Miscarriage: For women who have experienced miscarriage, it is recommended to wait 3-6 months while preparing for another pregnancy. This length of time is a physical recommendation only, to help your body build back up a healthy uterine lining and to build general wellness. To process emotions such as sadness or grief – take the time you need to feel good about your next pregnancy. Seek out a skilled counsellor where needed.
Surrogate Eggs or Sperm Donation: For couples choosing to conceive with fertility treatment using sperm donation or using surrogate eggs - preparation is still helpful. Ensuring healthy hormone balance and adequate nutrition is still essential for pregnancy and beyond. The guidelines listed above can be used to determine length of time recommended for fertility preparation.
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