By: @drmelissacugliari

Fertility varies from person to person and can be impacted by a variety of factors. While some have no problem conceiving throughout their childbearing years, others may have challenges and require assistance, or they may be unable to conceive at all. Regardless, supporting fertility is a worthwhile pursuit if you hope to conceive one day, are currently trying, or are unsure of your plans. 

 

The conversation around fertility includes both sexes. Infertility is caused by male factors in three of ten cases, by female factors in four of ten cases, and two out of ten cases are caused by both the male and female. Although men and women have distinct roles in conception and each requires unique support, there are some overlapping recommendations. Prior to making any lifestyle changes, always consult with your doctor.

 

For Him and Her

 

Smoking and Alcohol Consumption

 

Nicotine and alcohol can negatively impact fertility in both men and women. Stop smoking or vaping prior to trying to conceive and limit alcohol consumption as much as possible. 

 

Stress Management

 

Stress can lead to lower levels of testosterone in men, a hormone that is integral for sperm production. In women, stress can impact ovarian function, leading to fertility challenges.

Stress management looks different to everyone. When I work with patients, something I suggest to actively manage stress is to take things off your plate and to simply say “no” more. If a social engagement or extra work project does not absolutely ignite excitement and joy within you, say no. If your schedule for the week is too busy, reschedule where possible or cancel unnecessary plans. Before saying yes to anything, slow down your reaction time and say you’ll return with a response soon, and before you do, check in with yourself. Ask yourself: “can I handle this right now?” “Do I want to do this right now?” If it’s not a yes right away, it’s probably a no.

 

Protein

 

Adequate protein and fat intake are essential for optimizing fertility as these two macronutrients provide the building blocks for hormones. Without enough of either, many problems can arise including hormonal imbalances that can lead to fertility challenges. Aim for 0.8g of protein per kg of body weight or put simply, select a good source of protein with each meal (at least 20g). Do not neglect animal proteins - organic eggs, beef, organ meats and wild caught fish all provide essential nutrients along with protein and fats that assist the body in a variety of functions, including fertility. When it comes to fats, aim for 2 tbsp of extra virgin olive oil daily or at least three servings of raw nuts or their butters per week.

 

Sleep

 

I speak about this in almost every article I write, but the importance of sleep cannot be overstated. Seven to nine hours of sleep per night is necessary to maintain happy hormones, decrease stress levels, heal imbalances within the body and optimize fertility.

 

Weight Management

 

Maintaining or achieving a healthy weight is an important factor in fertility. Speak to your doctor about what is a healthy weight for you based on your age, height, and medical history. Proper movement, a healthy diet, and stress management are three essential tools in weight management.

 

Fruits and Vegetables

 

Eat a diet rich in fruits and vegetables. The Mediterranean diet holds up in studies for a reason - the foundation is fresh fruits and vegetables. These foods are rich in the vitamins, minerals and other nutrients needed to keep the system healthy overall, which includes maintaining hormonal balance and supporting fertility and pregnancy outcomes. The minimum should be two to three servings per day of fruit and two to three servings per day of vegetables (1 serving = equivalent to approximately 1 cup cooked vegetables or 1/2 cup raw fruit).

 

STIs

 

Get tested regularly for sexually transmitted infections. Certain STIs can impact fertility in both men and women. 

 

For Her

 

There are a number of factors for women to consider. Statistics show that the modern timeframe to have children has risen over the past several decades. In Canada as of 2011, the average age of the first birth for a mother was 28.5 years of age, a sharp increase from the average age of 23 in the 1950s to 1970s. Fertility depends on a woman’s hormones and the quality and quantity of her eggs, which declines with age. A woman’s fertile window starts when she begins menstruation and technically ends during menopause when a woman ceases to ovulate. Fertility culminates at different times for different women, but most sources suggest that fertility starts to decline around the age of 35. Although supporting fertility is absolutely worthwhile for women of advanced maternal age (over 35), I believe that all women who hope to have children should consider fertility support. Below are my top recommendations and considerations.

 

Check In with your Menstrual Cycle

 

If you suffer from menstrual irregularities (eg. absent period, cycles less than 26 days or greater than 32 days, heavy, painful or long periods, abnormal bleeding/spotting, and/or pain or bleeding with intercourse) see a doctor. These symptoms may suggest an underlying imbalance that can lead to fertility issues if they’re left unaddressed.

 

Consider Lab Testing

 

Testing can be helpful to assess conditions that impact fertility. There are several screening tests you can consider prior to trying to conceive or if you are having difficulty. When treated accordingly, fertility can be restored. 

 

Thyroid Imbalances

 

Thyroid imbalances are a common cause of ovulatory dysfunction and infertility. Having testosterone levels assessed can be useful if you have a history of menstrual irregularities, acne, or irregular hair growth (i.e. hair loss on head, hair growth on body) as this can help to rule out PCOS, which is an ovulatory disorder that can cause difficulties with conceiving. Fasting blood sugar and fasting insulin are two great measures to assess for PCOS and/or insulin resistance, both of which impact fertility. If you’re experiencing irregular periods, weight gain or have an inability to lose weight, this is worth investigating. 

 

Considering iron deficiency is the leading nutrient deficiency worldwide and can impact pregnancy outcomes, it is worthwhile to assess and monitor your iron levels. It is much easier to bring iron levels up preconception through diet and the right supplementation. Note: Always seek the assistance of a medical provider and do not supplement iron unless you know you are deficient.

 

Vitamin D

 

Healthy serum vitamin D levels have been shown to promote fertility and assist in better pregnancy outcomes. Typically, supplementing with 1000IUs of vitamin D daily is a good starting point, but getting your blood levels checked can help you to better understand your needs.

 

Prenatal Supplements

 

A prenatal containing vitamin B12 and folate or folic acid is a necessity to ensure a woman is obtaining enough nutrients to satisfy her needs as well as those of her future child. A good prenatal will provide vitamins and minerals that optimize health overall, particularly if you have a poor diet. The right prenatal also helps to ensure healthy growth and development of the baby and it improves birth outcomes. Studies show that essential nutrients like B12 and folate in the right quantities taken pre-conception and during early pregnancy (first trimester in particular) help with the neural development of the baby and helps to ensure the baby is growing properly.

 

While this isn’t related to fertility per se, many women do not realize they are pregnant until they miss a period. As a result, this can mean that they miss this precious window for supplementation in the very early stages of pregnancy. If possible, always start these nutrients before pregnancy and remember, not all supplements are created equal. Always do your research and speak to a functional medicine doctor or naturopathic doctor to assist you in selecting the one that is right for you based on your medical history. 

 

Antioxidants

 

While we consume antioxidants in our diet (primarily through fruits and vegetables), when it comes to optimizing fertility it can be helpful to supplement strategically. The nutrients CoQ10 and pyrroloquinoline quinone (PQQ) have both been shown to improve egg quality in women, likely because of the mitochondrial support these nutrients offer. These typically should be taken for at least three months to see a benefit. When supplementing, look for CoQ10 in its ubiquinol form. Talk to your doctor about the correct dosing for you. 

 

For Him

 

Unlike women, men can create babies through a significantly greater period of their lifespan, with the oldest reported biological fathers in their 90s! For men, conception can depend on the quality and quantity of their sperm, which is dependent on a variety of factors from their diet to lifestyle, medical history, and genetics. See below for some of my thoughts on optimizing fertility in men.

 

Antioxidants

 

As with women, CoQ10 can be helpful in improving sperm quality. As always, speak to your doctor before supplementing.

Temperature

 

Be mindful of temperatures as scrotal temperature can change sperm quality. Avoid heat over the groin (eg. laptops and hot baths).

 

Libido 

 

Check-in with your libido. Difficulty with arousal may indicate a hormone imbalance which could impact your fertility. Lack of erection, inability to climax or premature ejaculation are all symptoms that should be discussed with your doctor.

 

Exercise

 

Consistent exercise helps to boost testosterone levels in men. If you are not already physically active, make this a priority. Consider a balance of weight bearing activity to maintain and improve muscle mass, as well as cardiovascular exercise. 

 

Multivitamin/Prenatal

 

Consider taking a multivitamin or “prenatal” for men. These remedies contain a variety of nutrients to support general health and thus, sperm quality. Nutrients to look for are the B vitamins, vitamin C, vitamin E, and minerals like zinc and magnesium. This is particularly important if you have a poor diet. Speak to a naturopathic doctor to determine your unique nutritional needs.

 

As always, health is not linear and there is no one size fits all approach. What may work for one person may not work for another. Any dietary, lifestyle or supplementation changes should be discussed with your doctor, especially if you are trying to conceive, could be pregnant, are undergoing fertility treatment, and/or are using any medications. If you are 35 years or younger and have not become pregnant within one year of trying, or if you are older than 35 and have not become pregnant within six months of trying, speak to your doctor. 

 

References:

https://www.canada.ca/en/public-health/services/fertility/fertility.html 

https://www150.statcan.gc.ca/n1/pub/11-630-x/11-630-x2014002-eng.htm 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210343/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8684027/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922227/#:~:text=There%20are%20a%20wide%20variety,%2C%20diet%2C%20and%20caffeine%20intake 

https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/fertility/art-20047584 

https://pubmed.ncbi.nlm.nih.gov/23274392/ 

https://pubmed.ncbi.nlm.nih.gov/11172823/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010824/