March is Fertility Month!

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.

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