Preconception care plays a significant role in ensuring both mother and baby will have a healthy pregnancy. Preconception care defines care that occurs before pregnancy. Preconception care commonly goes undiscussed due to higher emphasis placed on pre and postnatal care. While pre and postnatal care are extremely vital to limiting health complications during pregnancy, preconception care is key in fertility and preparing the body for future pregnancy. Fertility is an issue many people face each day. In fact, about 10% of women of reproductive age in the United States have issues with fertility (Brazier, 2018). Infertility issues in men can be caused by low sperm count, erectile dysfunction, excess alcohol and drug use, and side effects of medication and in women, can be caused by ovulation disorders, uterine abnormalities, endometriosis, being overweight, and infection (Mayo Clinic Staff, 2021). It is important to speak with your doctor if you and your partner are having issues conceiving to assess what may be causing infertility. Your doctor can help to make sure that both you and your partner are at your healthiest prior to becoming pregnant to increase your chances of success. There are also things that you can do on your own prior to becoming pregnant that may also help increase fertility.
What Influences Fertility?
To increase your chances of becoming pregnant, its recommended that women reach a healthy weight prior to pregnancy. Making dietary changes, managing preexisting medical conditions, and increasing physical activity can help you to maintain and/or reach a healthy weight for pregnancy. It may be beneficial to measure and assess your current weight status. Body mass index (BMI) can be a helpful and easy-to-use tool to determine if you are at a healthy weight. For more information on how to calculate your BMI, see this article. After determining where your current weight lies you can then begin making healthy lifestyle changes. Reaching and maintaining a healthy weight before pregnancy can help with fertility by lowering your risk of hormonal imbalances, ovulation issues, and menstrual disorders (Mayo Clinic Staff, 2021). Hormonal imbalances can include common disorders like Polycystic ovary syndrome (PCOS) which can cause enlarged ovaries and the formation of cysts, or thyroid disorder, which can make it challenging to conceive due to interference with ovulation (Mayo Clinic Staff, 2021). Individuals with a BMI higher than 25 or lower than 19 prior to becoming pregnant are at a greater risk of reduced pregnancy and higher miscarriage rates (Mayo Clinic Staff, 2021). In patients with no other fertility related medical conditions, a higher BMI extended the time it took to conceive and decreased the success of infertility treatment (Silvestris et al., 2019). Having a healthy weight lowers your risk of developing complications such as gestational diabetes, high blood pressure, miscarriage, and early term delivery during pregnancy (Department of Health & Human Services of the State Government of Victoria, Australia, 2021). To limit the consequences of having a high weight prior to pregnancy on fertility, try choosing healthy foods that are low in calories but high in vitamins and nutrients, having regular physical activity, and limiting and/or avoiding use of alcohol and drugs (Brazier, 2018).
Healthy foods that are low in calories but high in vitamins and nutrients can help you to reach a healthy weight and have the adequate nutrition needed for your body to support a growing fetus. How much you should intake each day will be dependent on your starting weight, diet, physical activity, and weight goals. Women may need to gain or lose weight prior to pregnancy to help them reach a healthy weight. Using the recommended dietary guidelines can help you to identify what foods you may need more of in your diet. The dietary guidelines for adult women can be found at Dietaryguidelines.gov. See Table below for dietary recommendations for U.S. adults (aged 14-55 years of age). Strive to obtain the recommended number of servings for each food group each day. It is also important to limit foods high in fat and sugar. Our body also requires adequate amounts of water. Water is required for almost all bodily functions such as protecting our organs and tissues, balancing toxins, and carrying nutrients to different parts of the body (Watson, 2016). During preconception, water is also important for hormones and cervical mucus production (Weschler, 2002). Cervical mucus is important for protecting sperm as it travels to the uterus and creates a favorable environment for sperm to reach the egg (Weschler, 2002). When dehydrated, cervical mucus can instead become a harmful environment in which sperm may not be able to survive (Weschler, 2002). Hormones and other nutrients travel through the body via water and there are many hormones necessary for conception. Hormones likes estrogen, progesterone, and human chorionic gonadotropin hormone (hCG), all play major roles in pregnancy. The amount of water your body needs depends on several factors including age, weight, physical activity, and health status (Watson, 2016). In general, adult women should consume about 8 cups of water per day (Watson, 2016).
Specific Nutrients that Boost Fertility
Research is still ongoing on identifying which foods help to boost fertility specifically. A study by Silvestris et al. (2019) examined the effects of nutrition on fertility. The female reproductive system involves many bodily processes and can be complicated to understand. In summary, the female reproductive system produces egg cells through oogenesis. The ovaries produce these egg cells which are known as ova (Cleveland Clinic, 2019). Once the egg cell reaches the ova stage, the egg cell sits dormant until ready for fertilization by male sperm (Cleveland Clinic, 2019). The fertilized egg then moves to the uterus where it eventually becomes an embryo and then develops into a fetus around the 11th week of pregnancy (Cleveland Clinic, 2019). Infertility can interfere with many of these important phases of pregnancy including ovulation, inability of the fertilized egg to reach the fallopian tubes, and physical issues relating to the uterus (Mayo Clinic Staff, 2021). Poor nutrient intake can also negatively impact ovulation, sperm production, and implantation of an embryo (Silvestris et. al, 2019). A 2006 study on 12,579 participants found that female and male nutritional status prior to pregnancy impacted fertility and the development of complications during pregnancy (Silvestris et. al, 2019). Inadequate consumption of macro and micronutrients including carbohydrates, fatty acids, proteins, vitamins, and minerals, were found to negatively affect ovulation and sperm production (Silvestris et. al, 2019).
Omega-3 Fatty Acids
Silvestris et al. (2019) also found that in individuals who conceived via in-vitro fertilization (IVF) and followed a diet rich in omega-3 fatty acids such as Alpha-linolenic acid, and Docosahexaenoic acid (DHA) were associated with higher pregnancy rates (Silvestris et. al, 2019). Other studies echo the effect of omega-3 fatty acids on fertility, including improved embryo implantation, decreased premature labor, and positive effects on fetal brain development (Meldrum, 2020). In men, higher intake of omega 3-fatty acids was associated with enhanced sperm count, sperm motility, and sperm morphology (Meldrum, 2020). Omega-3 fatty acids can be found in seafoods such as salmon and tuna.
Other nutrients found to play an important role in fertility are antioxidants. Antioxidants help to rid the body of free radicals (Silvestris et. al, 2019). Free radicals can be harmful in large amounts. Excessive amounts of free radicals are associated with increased rates of heart disease, cancer, and impaired fertility in men and women (Silvestris et. al, 2019). Antioxidants help to limit the toxic effects of free radicals. Antioxidants have been found to improve egg quality, increase fertilization rates, and produce higher-quality embryos (Meletis, 2021). Some common antioxidants include vitamin E and vitamin C. Excellent sources of antioxidants are blueberries, strawberries, kale, beets, and spinach.
Folic acid is another important vitamin needed prior to and during pregnancy. Folic acid is important during the first trimester of pregnancy and beyond and during preconception due to the importance of folic acid in preventing birth defects. Folic acid is also associated with better embryo quality, improved chances of pregnancy, and reduced risk of infertility (Silvestris et. al, 2019). Your doctor may recommend a folic acid supplement of 400 µg per day, but folic acid can also be found in many foods we eat such as whole grains, eggs, spinach, broccoli, and peanuts, to name a few (Stanford Children’s Health, 2021). Silvestris et al. (2019) also found that a diet rich in fish, legumes, vegetables, and low in carbohydrates specifically, was positively related with higher levels of folate and vitamin B6 in blood and a 40% increase in the success rate of IVF. The results of their study demonstrated that a diet including omega-3 fatty acids and vegetables, and low in sugar-containing foods is beneficial to obtaining adequate amounts of folic acid before and during pregnancy (Silvestris et. al, 2019).
The body also needs other minerals in increased amounts during pregnancy such as iron and calcium (Stanford Children’s Health, 2021). Ensuring you have a balance of these nutrients prior to becoming pregnant can help to prepare your body for the best health outcomes during pregnancy. Iron specifically is important for healthy blood during pregnancy. Iron is important for our body to be able to carry oxygen to our organs and tissues (Stanford Children’s Health, 2021). During pregnancy, our blood volume is increased as we need additional blood for the growing fetus. It is not uncommon for women to have low iron prior to becoming pregnant due to menstruation and/or poor dietary intake. Making sure that you have adequate iron levels before becoming pregnant can help to prevent future iron deficiency. Iron deficiency can increase fatigue, increase your chances of becoming sick, and sometimes results in pica or the consumption of non-food items such as ice or cornstarch. If you crave large amounts of ice or cornstarch, talk with your doctor about checking for a possible iron deficiency. Excellent sources of iron include liver, beef, chicken, turkey, beans, spinach, bread, rice, and cereal.
Calcium is necessary for muscle function and for healthy bones and teeth (Stanford Children’s Health, 2021). During pregnancy, the fetus is forming which increases the amount of calcium needed in mother’s diet. Without adequate amounts of calcium in mother’s diet, the developing fetus may take from mother’s calcium stores (Stanford Children’s Health, 2021). This could lead to weaker bones or osteoporosis later in life (Stanford Children’s Health, 2021). It is also not uncommon for pregnant women to develop oral health conditions such as cavities or gingivitis. Pregnancy hormones can affect your teeth and gums, and oral health conditions can result in negative health outcomes in pregnancy. It is recommended that women hoping to become pregnant have adequate calcium intake and proper dental care. Additionally, many people now prefer to drink milk alternatives such as almond or soy milk, which can also play a role in how much calcium we intake each day. Dairy products such as cow’s milk, cheese, and yogurt have more readily available calcium compared to other milk alternatives. Reading nutrition labels can help to ensure you obtain the right amount of calcium. If your diet is low in calcium, your doctor may recommend a calcium supplement.
Making sure you follow a well-balanced diet before becoming pregnant can help to increase fertility and ensure your body has all the necessary nutrients needed for pregnancy.Having the correct balance of proteins, carbohydrates, fats, antioxidants, folate, iron, and calcium in your daily diet will help you to achieve optimal health and reduce the risk of infertility (Silvestris et al., 2019). If you plan to become pregnant, schedule an appointment with your doctor to see what individual nutrient requirements may help to benefit you, what other things you can do to increase your fertility, and to prepare mother and baby for a healthy pregnancy.
Brazier, Y. (2018). Infertility in men and women. Medical News Today. https://www.medicalnewstoday.com/articles/165748
Cleveland Clinic (2019). Female reproductive system. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/9118-female-reproductive-system
Department of Health & Human Services, State Government of Victoria, Australia (2021). Weight, fertility and pregnancy health. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/weight-fertility-and-pregnancy-health#bhc-content
Mayo Clinic Staff (2021). Infertility. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317
Meldrum, D. (2020). Supplements to aid fertility. Fertility Center of San Diego. https://www.fertilityclinicsandiego.com/understanding-fertility/wellness-and-fertility/supplements-to-aid-fertility/
Meletis, C. D. (2021). Boost your fertility with supplements. American Pregnancy Association. https://americanpregnancy.org/getting-pregnant/infertility/boost-your-fertility/
Safarinejad, M. R., & Safarinejad, S. (2012). The roles of omega-3 and omega-6 fatty acids in idiopathic male infertility. Asian Journal of Andrology, 14, 514-515.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720081/pdf/aja201246a.pdf
Silvestris, E., Lovero, D., & Palmirotta, R. (2019). Nutrition and female fertility: An interdependent correlation. Frontiers in Endocrinology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6568019/
Stanford Children’s Health. (2021). Nutrition before pregnancy. StanfordChildrens.org.https://www.stanfordchildrens.org/en/topic/default?id=nutrition-before-pregnancy-90-P02479
Watson, S. (2016). Why staying hydrated is good for both conception and pregnancy. Ovulation Calculator. https://www.ovulationcalculator.com/hydration/
Weschler, T. (2002). Taking charge of your fertility. New York, NY: HarperCollins Publishers Inc
Author- Mercedes Martin
Editor- Kaitlyn Longstaff
Public Health Scientist- LaCher E-W, MPH