My Fertility Journey explains the important steps to take when planning a pregnancy to give you the best chance of conceiving and having a healthy pregnancy and a healthy baby. It provides evidence-based information to help prepare your body in the important months before conception. Reliable scientific information underpins everything we do and helps you go forward with confidence as you lay the foundations for the future health of your baby.
Preconception Care and When to Start Planning for Pregnancy
Your health and nutrition before pregnancy have the potential to impact the lifelong health of your child – either positively or negatively – as your diet and lifestyle affects the quality of the egg and sperm cells that will go on to make your baby. Recognising the importance of preconception care in both the father and the mother to the long-term health of your baby is the starting point to help you on the road to pregnancy. If you are proactively planning for pregnancy before you start trying to conceive, you have a unique opportunity to optimise your health for the lifetime benefit of your child and even your grandchildren, as the effects of preconception care can persist for generations. In this section we look at:
- What is preconception care?
- When to start planning for pregnancy
- Your baby’s long-term health
- Preconception care for men
- Important preconception care steps
- The game-changers
What is preconception care?
Preconception care has, until fairly recently, been a term associated only with the most basic of steps for couples including things like taking folic acid. There is, however, a huge research focus and body of evidence on environmental influences on fertility and reproduction, and there is much more you can do. Given that studies demonstrate that a mother’s diet and lifestyle in the year before she conceives impacts the lifelong health of the baby, and that the very immature follicles that contain eggs at the earliest stage of development take about nine months to reach maturity so that they are ready to be released via ovulation, the ideal is to create a healthy environment during that entire development period. For men, it means the sperm that is constantly being produced in the testes are as healthy as possible.
Recent papers published in The Lancet highlight the fact that many women enter pregnancy with low levels of key nutrients that have the potential to impact pregnancy outcomes, again an indication of the significance of the time before conception. So this isn’t an issue restricted to those who have fertility issues: it applies to anyone who may become pregnant. Given around half of pregnancies are unplanned, this does also emphasise the particular importance of good diet for anyone of reproductive age, especially for those who are sexually active and know they would like to have children.
When to start planning for pregnancy
Ideally, you should allow three to six months to work on your diet, general health and nutrient levels before you start trying to conceive, including taking folic acid or folate for at least three months. Given that eggs take nine months to go from dormant, immature follicle to ovulation-ready egg, it will always be helpful to allow longer periods but this is especially important if you have issues such as with your weight, nutrient deficiencies or any underlying health conditions that are not well-managed. We believe that it can be beneficial to start working on your health for up to two years before you conceive if any of these apply to you.
Since many couples either don’t start any kind of preconception care programme at all, or they leave it too late, we would like to encourage all couples who are planning a pregnancy now or in the future to think about optimising their general health and nutrient status as a starting point before trying to conceive. Ultimately, the aim is to feel better, physically and emotionally.
Devoting time to a period of preconception care means you can work on egg and sperm quality, which are affected primarily by age but also by diet, nutrient status and lifestyle. This helps when trying to conceive naturally (they are the “ingredients” to make your baby!) as well as with fertility treatment. Improving egg quality can improve treatment outcomes and we have seen improvements in the number of mature eggs collected, number of eggs fertilised and number of embryos reaching a good stage of development (the five-day stage known as the blastocyst) in repeat IVF cycles after couples improve their diet and lifestyle, for instance, and egg quality is the main thing that impacts IVF success.
Your baby’s long-term health
We know that early life nutrition immediately before you conceive and during early embryogenesis (the process by which your embryo is created and develops) impacts the long-term health of your child. Genes essentially make proteins in the body and it is these proteins that drive the activity of all cells in the body and provide an instruction manual for the development of your baby. Environmental exposures likes diet and lifestyle can change whether genes are “switched on” or not. These so-called epigenetic changes resulting from what you eat and do to your body around the time of conception impact the instructions that genes provide for particular phases of development, subtly altering the course of embryogenesis and fetal development. Pre-implantation development of the incredible early embryo is one of the most critical phases of pregnancy in terms of the future health of the child, as the way development will progress is being established. Cells divide rapidly immediately after fertilisation and then migrate first to form the basis of the embryo and the placenta, and from there to lay the foundations for the different systems of your baby’s body. Key events take place that will affect the baby’s heart, gut, brain and wider nervous system before a woman even knows she is pregnant.
For each of us, this means that during the time immediately before and immediately after conception (the periconception period), you have the potential to influence long-term health risks for your baby, either negatively or positively, through basic lifestyle choices. These choices can impact the risk of things like cardiovascular disease, becoming overweight and mental health disorders for our children later in life.
Preconception care for men
Very little attention has traditionally been focussed on the male partner and yet there is a significant body of evidence to demonstrate the impact of diet, lifestyle and nutrient status on male fertility, the outcome of fertility treatment and child health. Most studies looking at the role of fathers in child health have looked at preconception work-place exposures in men and their impact on the risk of major birth defects and childhood cancers, but we’re learning more about the way more low-level exposures to environmental toxins and poor preconception diet in men may impact child health. We’ll learn more about male fertility, including the impact of paternal diet and lifestyle on child health in our Fertility and Preconception Care course.
Important preconception care steps
The starting point for all couples who are in good health and wish to conceive is to take a series of basic steps three to six months before you start to try for a baby. Don’t worry if you haven’t planned for this; just start whenever you can.
The obvious basic steps that are essential when planning a pregnancy are:
- Stop smoking – aim to stop as early as possible. This is important for both men and women. Smoking can make women lose their eggs more quickly and women who smoke are twice as likely to be infertile as non-smokers, even if you have already been pregnant before. Smoking also reduces the chance of success with fertility treatments including IVF. The risks increase the more you smoke and Women who smoke are twice as likely to be infertile as non-smokers. This is true for women trying to become pregnant for the ﬁrst time and for women who have been pregnant before. Smoking can also affect the success rates of fertility treatment, such as IVF (In vitro fertilisation). Smoking during pregnancy can harm the baby, especially the lungs and brain. Smoking may also increase the risk of miscarriage.
- Watch your alcohol consumption – avoid drinking alcohol altogether for women. High alcohol intake (seven or more drinks a week or more than three drinks on one occasion) is associated with heavy or irregular periods and reduced fertility. Alcohol can also affect ovulation, hormone levels (even where periods appear normal), reduce ovarian reserve and decrease the chance of success following IVF. One study found that women going through IVF who drank one or more drinks a day had more than twice the risk of miscarriage, with an even higher risk when drinking in the week before IVF treatment. One daily drink also reduced both the number of eggs retrieved and pregnancy rates. Alcohol during pregnancy is increases risks to the baby, including having a child with a Fetal Alcohol Spectrum Disorder and lower chance of live birth.
- Do not use recreational drugs – drugs such as cannabis, cocaine, ecstasy, ketamine and amphetamines all have the potential to negatively impact fertility in men and women, including delaying conception in women. They can also cause significant harm if taken during pregnancy. Cannabis can affect hormone balance and therefore may make it more difficult to get pregnant, for instance.
- Take the basic supplements – official guidance recommends taking 400mcg folic acid daily for three months before you start trying to conceive, though many benefit from taking the natural form, folate, and some need higher amounts. Most need to supplement with vitamin D, especially in the winter months.
- Watch your caffeine intake – avoid overconsumption – consensus suggests not drinking more than 2 cups of tea or coffee. This advice holds for men and women (see Chapter xx male fertility). Research looking at the impact of caffeine including tea and coffee consumption on fertility is very mixed, with some studies showing it has an impact at lower levels and others not. A recent analysis found coffee and caffeine consumption did not reduce the chance of getting pregnant naturally or through fertility treatment. Higher levels have been shown to have an impact. Guidance from organisations including the European Food Safety Authority (EFSA) and World Health Organization (WHO) suggest limiting intake to maximum of two to three cups of coffee (200–300 mg caffeine) per day. Studies also show an increased risk of miscarriage with increasing intake of coffee and caffeine during early pregnancy and a recent meta-analysis found there was no safe intake for pregnancy. Opinion is divided however and many national guidelines have maintained advice to limit rather than cut out completely for fertility and pregnancy. On balance, we advise our female patients to limit to no more than one cup daily as a precaution, though some choose to cut caffeine out altogether.
- Optimise weight – aim for a healthy body mass index (BMI) – being underweight or overweight is sub-optimal for fertility and pregnancy and we cover this in our Fertility and Preconception Care course.
- Manage pre-existing health issues – make sure you are assessed, managed and under the care of a suitable doctor for any health problems and discuss any medications with your doctor.
- Have a sexually transmitted infection (STI) check – full screening for both men and women. Ask your doctor for these checks before you start trying to conceive. This includes testing for chlamydia, gonorrhoea and HIV. Chlamydia and gonorrhea are important preventable causes of pelvic inflammatory disease (PID – an infection that reaches and damages the fallopian tubes) and infertility. Chlamydia and gonorrhoea are tested by either urine or a cotton swab that is inserted into the vagina (women). You’ll be prescribed antibiotics if you have an infection. You may also be tested for syphilis and hepatitis. Also seek advice from your doctor if you have any charges to your normal vaginal discharge, an unpleasant or fishy smell from your vagina, itching in your vagina or around your vulva, or burning when you pass urine. These can all be signs of a condition called bacterial vaginosis when there is too much of certain naturally occurring bacteria in the vagina leading to an imbalance. This can be treated with antibiotics.
- Have a smear test – be up to date with smear tests and ensure your latest result was negative. Smear tests screen for changes in the cells of the cervix (that connects the vagina and the womb) that can lead to cervical cancer if left untreated. The most common cause of these cell changes and cervical cancer is infection with the Human Papilloma Virus (HPV). This is not always transmitted through penetrative sex and can be passed on from the hands and mouth of a sexual partner. Smear tests are recommended every three years unless you have had recent treatment for an abnormal smear or have a current HPV infection, which will show up on your smear test. Smear tests are not advised during pregnancy and so if you are due to have a test within the next year, ask your doctor to have this done before you start trying to conceive and monitor the situation if it takes time for you to conceive. Smear tests are the best way to avoid preventable death from cervical cancer, so always ensure you are checked, even if you feel apprehensive about the process.
- Test your rubella immunity – check immunity via blood test via your GP. Rubella or German Measles is a viral infection that is often mild and may not be detected. It is extremely dangerous for the unborn baby and cause birth defects if you are infected during pregnancy. Most people are vaccinated in childhood but immunity can lapse so even if you have had the Measles Mumps and Rubella (MMR) vaccine, women are advised to undergo rubella immunity testing before trying to conceive. If you have not had the MMR vaccine or if testing shows you are not immune, you should be vaccinated.
There is much more that you can do to help give yourself the best chance of conceiving and having a healthy baby beyond these basic steps, however – for both men and women. Once you have addressed the basics we’ve described above, there are 7 steps to a healthy baby, which we cover in our Fertility and Preconception Care course. This includes personalising and optimising your diet, exercise and nutrient levels.
- Adam Balen and Grace Dugdale. The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy. Penguin Random House (Vermilion) 2021
- Preconception health 1: Judith Stephenson, Nicola Heslehurst, Jennifer Hall, Danielle A J M Schoenaker, Jayne Hutchinson, Janet E Cade, Lucilla Poston, Geraldine Barrett, Sarah R Crozier, Mary Barker, Kalyanaraman Kumaran, Chittaranjan S Yajnik, Janis Baird, Gita D Mishra. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health Lancet 2018; 391: 1830–41
- Preconception health 2: Tom P Fleming, Adam J Watkins, Miguel A Velazquez, John C Mathers, Andrew M Prentice, Judith Stephenson, Mary Barker, Richard Saffery, Chittaranjan S Yajnik, Judith J Eckert, Mark A Hanson, Terrence Forrester, Peter D Gluckman, Keith M Godfrey. Origins of lifetime health around the time of conception: causes and consequences Lancet 2018; 391: 1842–52
- Preconception health 3: Mary Barker, Stephan U Dombrowski, Tim Colbourn, Caroline H D Fall, Natasha M Kriznik, Wendy T Lawrence, Shane A Norris, Gloria Ngaiza, Dilisha Patel, Jolene Skordis-Worrall, Falko F Sniehotta, Régine Steegers-Theunissen, Christina Vogel, Kathryn Woods-Townsend, Judith Stephenson. Intervention strategies to improve nutrition and health behaviours before conception Lancet 2018; 391: 1853–64
- Skoracka, K., Eder, P., Łykowska-Szuber, L., Dobrowolska, A., & Krela-Kaźmierczak, I. (2020). Diet and Nutritional Factors in Male (In)fertility-Underestimated Factors. Journal of clinical medicine, 9(5), 1400.
Copyright © 2022 Balance Fertility