We often think of antioxidants as awesome for our health. They're great for our hearts and our skin. They're also extra great for our ovaries and sperm, which means they're super awesome for makin' babies!

Oxidative stress causes free radicals. These are little molecules that go around bumping into the cells nearby and causing them damage. It's a bit more complex on a biochemistry level, but you get the point and it's not a good one. Stress, high blood sugar, and smoking are probably the worst offenders when it comes to oxidative damage. I've talked a lot about stress in previous posts, so I'll give my spiel on smoking here: don't smoke. (That's the whole spiel.)

Unfortunately, we're all subjected to free radicals as our body normally does produce some, and the environment we're in doesn't often help. Here's where antioxidants come to the rescue! They sop up those free radicals bumping around and prevent any damage they can cause. We get a lot of these from an oh-so-healthy diet, rich in brightly-coloured fruits and veggies. These will help you age gracefully and keep your cardiovascular system in tip-top shape (with healthy exercise, of course). 

How does this all hinder fertility? That super space-age-looking blob in the picture is one of your mitochondria. These are the little powerhouses of energy that help each and every cell function. As we age, these guys don't work as well. All of those free radicals damage the DNA production that your mitochondria are in charge of. This is pretty serious when trying to make a whole new person. DNA integrity is of the utmost importance! Damage here will not allow a cell to replicate. 

Ladies, your ovaries love coenzyme Q10 (CoQ10). This is a major mitochondrial antioxidant. Higher levels of CoQ10 in the ovary result in higher quality eggs and better pregnancy and IVF outcomes. Same with zinc, another great antioxidant, though speak with someone before supplementing as it comes with some risks. 

Gents, your sperm love zinc and selenium, and vitamins C and E. These are awesome antioxidants that help prevent defects in motility and morphology. They also help preserve the sperm's DNA and protect it from any free radicals flying around. 

Keep in mind, these aren't designed to offset those cigarettes and there really isn't enough antioxidants in the world that can do so. Reduce that level of damage by managing stress (breeeeeeeeeathe), don't smoke or be around smoke, and keep that blood sugar stable. Pump in the berries and veggies. 

Love your mitochondria. 

References:
Abad C, et al. Effects of oral antioxidant treatment upon the dynamics of human sperm DNA fragmentation and subpopulations of sperm with highly degraded DNA. Andrologia. 2013 Jun;45(3):211-6.
Buhling KJ1, Grajecki D. The effect of micronutrient supplements on female fertility. Curr Opin Obstet Gynecol. 2013 Jun;25(3):173-80.
Grieger JA, Clifton VL. A review of the impact of dietary intakes in human pregnancy on infant birthweight. Nutrients. 2014 Dec 29;7(1):153-78.
Ko EY, Sabanegh ES Jr, Agarwal A. Male infertility testing: reactive oxygen species and antioxidant capacity. Fertil Steril. 2014 Dec;102(6):1518-27.
Mori R, Ota E, Middleton P, Tobe-Gai R, Mahomed K, Bhutta ZA. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2012 Jul 11;7.
Singh AK, Chattopadhyay R, Chakravarty B, Chaudhury K. Markers of oxidative stress in follicular fluid of women with endometriosis and tubal infertility undergoing IVF. Reprod Toxicol. 2013 Dec;42:116-24.
Uriu-Adams JY, Keen CL. Zinc and reproduction: effects of zinc deficiency on prenatal and early postnatal development. Reprod Toxicol. 2010 Aug;89(4):313-25.
Grindler NM and Moley KH. Maternal obesity, infertility and mitochondrial dysfunction: potential mechanisms emerging from mouse model systems. Mol Hum Reprod. 2013 Aug; 19(8): 486–494.

Probably the most incorrect thing to say to anyone trying to conceive: just relax, it'll happen. 

This is an incredibly stressful time, especially if you've been trying for a while. Unfortunately, with chronic stress comes a domino-effect on your hormones and this can impact your ability to become pregnant. Which, of course, is a stressful thing to hear. Which, of course, doesn't, help. So how do we interrupt this cycle? 

Understanding what's going on in your body is always step one. What actually happens to your hormones when you take deep breaths? How does that impact your ability to become pregnant? Well, like most stress-worsened problems, it all comes back to that jerky cortisol. 

Cortisol is your stress hormone. It increases during your fight-or-flight mode, which is likely going all the time. It's made in your adrenal glands which sit right on top of your kidneys. These glands not only produce cortisol, but also your estrogen, progesterone, and testosterone. The problem is that these aren't all made separately: cortisol is actually made from progesterone. Progesterone is what sustains a pregnancy and keeps that little egg going! So, if you're stressed out and your body thinks it's in danger, cortisol takes the front seat in terms of hormone production and progesterone levels can suffer. 

This is when chronic stress really starts to alter the periods. Your cycle may lengthen or take a while to really get going (i.e. spotting) which is a good sign that your progesterone might be a bit low.  

But wait! Unfortunately, there's more. When cortisol is too high, it can inhibit your thyroid hormone production which usually makes people feel quite crappy since your metabolism and internal thermostat drop down. When thyroid hormones are too low, this can interfere with ovulation. A great way to see if your hormones are affected by your thyroid is to do basal body temperature tracking. First thing in the morning, roll over and take your temperature. Write a big neon post-it note on your nightstand to remind you. Get a thermometer with a last-temperature memory so that you can still roll over and doze off without having to write down the number or remember. Monitor this across the entire cycle and chart it. There's tons of apps that help you with this, and makes it quite clear to see how your thermostat's doing. If all is well, you should see a prolonged spike in temperature over 2-3 days, or, ideally, over the rest of the cycle. That's the happy spike of ovulation!

So, just in case you've gotten a bit stressed out, take 5 deep breaths. Right now. Separate your shoulders from your earlobes. And just like that, you've dropped your cortisol levels down, given your body time to make some progesterone, and helped your thyroid to function and get you ovulating! There's a wonderful TED Talk by Amy Cuddy on how your body language can drop your cortisol levels...channelling your inner Wonder Woman will also help you do all of those things! As will long walks. And massages. And acupuncture (unless you're terrified of needles, of course). And guided meditations. And epsom salt baths. And yoga. And laughing. 

The best part is that all of these tools are already in your medicine cabinet, be sure to make time for them. 

References:
Walter KN, et al. Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women. Thyroid Res. 2012;5:13.

Maruo T, et al. A role for thyroid hormone in the induction of ovulation and corpus luteum function. Horm Res. 1992;37 Suppl 1:12-8.

The prenatal vitamin: when you shouldn't just be buying what's on sale. 

I talk with a lot of my moms-to-be about why they're taking a prenatal to begin with. Mostly, they heard it was a good idea and need the folic acid. There's a lot more to a prenatal than just folic acid and if you're trying to get pregnant, now's a good time to pick one up. 

You can check out my head-to-head comparison of 7 different brands over in the downloads section, and see how yours compares. Want yours on the list? Just let me know!

Dose: 
Are you getting enough of what's needed depending on your baseline nutritional status, age, and general health status. A lot of prenatals are quite low doses with the exception of a bit more folic acid and iron. Maternal blood volume will nearly double by the end of the pregnancy, so definitely more iron will prevent anemia. Anemia will make you tired, and you're going to need all the energy you can get when that baby comes!

Folic acid helps prevent defects in the neural tube, spinal cord, and body structure. This helps prevent chromosome abnormalities such as Down Syndrome, congenital deformities such as cleft palates, and thus reduces risk of miscarriage. Risk of these problems increases with maternal age, so if any of you baby-mamas-to-be are over 30, you may need more than the standard 1 mg. 

Bioavailability: 
This refers to how well your body can absorb and assimilate the nutrients you're giving it. This matters most with the B-vitamins and minerals. 

Back to that important folic acid! There's a fairly large subset of people who have a genetic problem with the activation of folic acid. This  genetic defect shuts down methylenetetrahydrofolate-reductase, which is the enzyme that turns regular ol' folic acid into 5-methyltetrahydrofolate (5-MTHF). Ladies, 5-MTHF is where the magic happens. This same enzyme activates vitamin B12 into methylcobalamin and low levels of both of these vitamins are linked to infertility. You need B2 and B6 in this big reaction so those Bs certainly are important! Definitely add an ND to your fertility team to see which forms and doses of these are right for you. 

With minerals, I like to use magnesium as a good example. Magnesium hydroxide (aka milk of magnesia) is a laxative. It's designed not to absorb, but to stay in the bowels and  cause you to poop. Magnesium bisglycinate, on the other hand, may cause a slightly looser stool in high doses, but often it doesn't affect the bowels too much even then. Why? Because it's absorbed and doesn't come out the other end in large amounts. The same is true for all minerals. They must be bound to something, and that something will determine its bioavailability. 

Antioxidants:
Oxidative stress is a major cause of DNA mishaps. Antioxidants such as vitamins C and E, selenium, zinc, and coenzyme Q10 soak up all of these damaging free radicals. Research shows a shorter time to pregnancy, much better egg quality, and greater success with IVF treatments with antioxidant supplementation. Where can you find all these? In your awesome prenatal!

And a quick note for the fellas: research shows antioxidants preserve the DNA integrity in sperm and make it easier to fuse with the egg. And if that sperm isn't getting into that egg, you bet there isn't going to be a baby! 

And the other stuff:
Ah, those 'non-medicinal ingredients'. They're non-medicinal, so they don't matter, right? WRONG! 

I'm always a glass-half-full kinda gal, so I always say that those not-great prenatals really do have great binders! Your gut, however, needs to break all that apart and get those nutrients out in a quick manner so having a well-bound vitamin isn't the best thing. Many also have harmful chemicals such as BHT and sodium lauryl sulphate among their long list. 

An honourable mention here goes to red dye... because a pink prenatal must make a... prettier... baby? I got nothing. 

It's almost spring! Happy March to all and I'm happy to bring one of my most favourite topics around to the blog this month - fertility! Spring fever tends to bring a lot more people into the clinic for this very purpose, so it seems fitting. Plus, I've had the most awesome privilege of working with some of the top-notch (and nicest) fertility gurus around and I'm more than happy to share some tips to help boost your baby-makin' abilities! 

With all of my patients, I address the diet and lifestyle first and foremost, so let's start with that today to get a good foundation. Stay tuned for prenatal multi evaluations, an entry on the different forms of folic acid, we'll get to know your mitochondria, and, of course, everyone's favourite stress hormone: cortisol! It's going to be an exciting month!

Now then, for preconception care, I generally recommend the following rules:

1. No processed food. Take a cooking class and buy 10 new cookbooks if necessary. White sugar, brown sugar, processed fructose (HFCS, agave), artificial sweeteners, trans-fats, additives, and preservatives are all off the menu. If it was invented, it's off the menu. 
2. Model your diet after the Mediterranean Diet. There's good evidence indicating this model increases outcomes for pregnancy, especially if you're going through IVF. Grains can stay in, so long as their whole ('whole grain' cookies don't count) and don't constitute a huge proportion of the diet. Whether or not grains are right for you is a difficult answer. If you have PCOS, try taking them out. Once pregnancy is confirmed, you'll want to limit your fish and seafood intake to once per week, with absolutely no sushi. If you're getting really hungry, evaluate your protein and fat intake as these will both enhance satiety since they take longer to breakdown in the body. Pay attention to your energy levels as this will be a good indicator as to whether or not your body has enough to spare to make a mini-you.
3. Eat regularly. Skipping meals can lead to blood sugar and cortisol dysregulation. Since the ovaries are sensitive to both of these, keeping healthy snacks on hand such as nuts and seeds can prevent blood sugar dips and spikes, not to mention top you up with healthy fats. Cortisol is our stress hormone, which causes blood sugar, blood pressure, and adrenaline to increase. Think about it: if your ovaries are guessing whether or not it's a good food day, or if they think they're in danger, why would they want to try and make a baby? 

These guidelines represent a portion of the picture and we might chat about specific recommendations for you depending on what's going on. Let's go into what else you can do, outside of the diet.

1. Sleep well. Disruption of your circadian rhythm such as in shift work can have a negative impact on your fertility. Melatonin and cortisol patterns certainly do impact hormone levels, and you need optimal functioning of this sleep-wake cycle to keep your ovaries in tip-top shape. If you're in shift work, talk to your ND about possibly supplementing with melatonin and how to find a dose that's right for you.
   
2. Track your temperature. Monitor your BBT and other fertility signs over the course of a couple of months to really get to know your cycle. This is helpful information for us, in addition to your lab work, to get a good handle on each phase of your cycle, whether or not you're ovulating, and if there are any other glands such as your thyroid which may be involved. Keep a thermometer beside your bed so that you can grab it when you wake up. Tip: buy one that has a last-reading memory in it so that you don't have to write it down right away. Fertility friend is a great site for tracking, and there are lots more out there! You may get a whole new perspective on what your "pretty normal" is. 
3. Exercise. I feel like a broken record, but I'll say it again: move your body! Exercise has been shown time and time again to regulate cortisol levels, improve stress and mood, and correct insulin resistance. Keep it at a level that you're used to, or if you're new to exercise, keep it light to moderate. 
4. Try acupuncture. There's conflicting evidence on whether or not this improves pregnancy outcomes, but we do know that it's effective for anxiety, stress,  depression, and reducing cortisol. Some studies show an increase in pregnancy outcomes specifically, some don't. There's also some studies showing benefit for PCOS and endometriosis, and it is traditionally used to regulate menstrual cycles and induce ovulation.  
5. Stop smoking. Like, yesterday. There isn't a cell in your body that likes oxidative stress, least of all your ovaries. If you're a smoker, I recommend being nicotine-free for at least 3 months before trying. 

These may seem basic, but they really are the foundations of getting you as healthy as you can be in order to make an ultra awesome healthy baby. Stay tuned for the nitty gritty on prenatal multivitamins!


References:
Vujkovic M1, de Vries JH, Lindemans J, Macklon NS, van der Spek PJ, Steegers EA, Steegers-Theunissen RP. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril. 2010 Nov;94(6):2096-101.

Toledo E, Lopez-del Burgo C, Ruiz-Zambrana A, Donazar M, Navarro-Blasco I, Martínez-González MA, de Irala J. Dietary patterns and difficulty conceiving: a nested case-control study. Fertil Steril. 2011 Nov;96(5):1149-53.

Reiter RJ, Tamura H, Tan DX, Xu XY. Melatonin and the circadian system: contributions to successful female reproduction. Fertil Steril. 2014 Aug;102(2):321-8.

Johansson J, Redman L, Veldhuis PP, Sazonova A, Labrie F, Holm G, Johannsson G, Stener-Victorin E. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43.

Domar AD, Meshay I, Kelliher J, Alper M, Powers RD. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril. 2009 Mar;91(3):723-6.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002 Apr;77(4):721-4.