90 Days Preconception: Habits for Optimal Fertility and a Healthy Pregnancy

The most common questions I hear when a new couple comes to my office are “Will I get pregnant?” and “When?”  Typically by the time patients make an appointment with me or my colleagues they have been trying for months, sometimes even years, and are burdened with the anxiety and stress of infertility and their resolve is to get into the doctor’s office and to get pregnant.

However, instead of jumping immediately into a treatment plan, I believe in treating the whole patient.  My partners and I find that patients are most likely to successfully get pregnant when their physical and mental health is at its best.

Patients should consider their health and lifestyle habits 90 days before conception.  This is about more than fertility health.  This includes nutrition, mental health, stress management, physical activity… all of it affects a person’s fertility and, upon conception, it affects the health of mother and baby.

Some of our patients are able to get pregnant simply by changing their lifestyle habits – without assisted reproductive technology.  As little as a 5 percent reduction in weight can lead to more regular ovulatory cycles, improved insulin sensitivity and an improved chance of pregnancy.  Sometimes patients are too lean and their hormonal balance can be restored with weight gain.

Here are examples of how to improve lifestyle habits (and therefore improve fertility while decreasing the risk of birth defects) from the checklist that we use with our patients at Reproductive Medicine Associates of Connecticut (RMA of CT). 

Nutrition

• Eat a balanced diet that exemplifies the USDA’s balanced plate full of vegetables, fruit, whole grains, lean protein, heart healthy fats
• Test for risk factors: hemoglobin A1c, vitamin D, blood pressure, cholesterol – these are simple tests that can be performed by your family doctor
• Start to take prenatal vitamins (800 mcg of folic acid)
• Drink water (not soda and minimize caffeine).
• Boost important vitamins and minerals: calcium (dairy, leafy greens), folic acid (citric fruit, fortified breads, lentils), iron (spinach, beans), omega-3 (low-mercury fish such as salmon)

Lifestyle Habits

• Limit alcohol
• Quit smoking
• Avoid exposure to environmental risk factors (e.g., gardening chemicals, cleaning products)
• Lower caffeine intake to less than 150 mg per day, which is equivalent to two 8 oz cups of coffee
• Try to get to a healthy weight and body mass index (BMI)
• Be physically active with low impact activities such as swimming, walking and restorative yoga

Mental Health & Partner Relationship

• Identify stress management method (e.g., yoga, meditation)
• Communicate with your partner about your dreams of a family
• Identify your network of friends and family – and consider talking to them when you are stressed
• Talk to a professional when going through extreme challenges or making life-changing decisions
• Consider support groups with other fertility patients. RMACT has monthly free support groups for fertility patients
• Check your health insurance. Is family planning covered?  Are there restrictions (e.g., age)?

Reproductive Health:

• Schedule a preconception visit with your OB/GYN and be up to date on PAP smear and mammogram
• For women: FSH and/or AMH, which are simple blood tests that help guage ovarian reserve; hysterosalpingogram (HSG), which is a non-invasive test to check the fallopian tubes and uterus
• For men: schedule a semen analysis, limit alcohol, quit smoking, work towards a healthy weight

Simple lifestyle changes have the power to improve fertility and the health of the baby.  Sometimes assisted reproductive technologies are still needed for a couple to get pregnant.  But improving a couples’ health (yes, the woman and the man) doesn’t have a downside.  Best of all, many of my patients like being proactive – this is something within their control.