The preconception period is the timeframe before you become pregnant. Your health during this time is very important as it has a direct influence on your overall fertility. The goal with preconception care is to thoroughly assess an individual’s current health status, identify any risk factors, and create a treatment plan that will optimize fertility outcomes.

Why should you seek out preconception care?

It is estimated that 1 in 5 individuals in the US experience infertility. Infertility is defined as one year without successful conception for those under the age of 35 and 6 months without successful conception for those 35 years or older.

It can often take up to one year before any further fertility investigation is provided. Waiting up to one year before receiving any additional support can take a physical and emotional toll on those trying to conceive.

This is why a preconception care plan is such an important and empowering way to start your fertility journey. It is proactive care that involves putting together a personalized strategy that will address any barriers beforehand that may impact one’s ability to conceive and carry a healthy baby to term.

What should a preconception care plan focus on?

A preconception care plan will look different for each person, but there are some key areas that should be focused on for every individual.

Health history intake and comprehensive lab testing

A preconception care plan should always begin with a detailed health history intake to determine one’s current health status and fertility goals. This should include a review of past and current health concerns, relevant fertility history, current medications or supplements, family medical history, as well as lifestyle assessment.

Lab testing is also extremely vital to understanding a person’s overall health. General preconception lab testing should include:

  • Complete blood count + differential
  • Nutrient status: Ferritin, Vitamin B12, Vitamin D
  • Reproductive hormones: Day 3 FSH, LH, Estradiol & 7 days post ovulation Progesterone
  • Metabolic health: Fasting insulin and glucose
  • Thyroid function: TSH, free T4, free T3, Thyroid antibodies
  • Other: AMH, hsCRP, prolactin

Additional testing relevant to your current health status may be warranted. These additional tests will be determined by your health care provider.

Supplementation

With so many fertility supplements on the market, it can be confusing to know which ones to incorporate into a preconception plan. Supplementation is truly personalized and will be different for each person, but there are two key supplements that should be included:

  • High-quality prenatal
  • Omega 3 supplement with DHA


Beyond that, specific supplements may be recommended for specific fertility needs. For example, this could include supplements such as melatonin to support egg quality during fertility treatment, inositol for PCOS and ovulation support, or additional folate/folic acid for the prevention of neural tube defects. It’s important to consult with your health care provider to learn more about which supplements are best suited to your health and fertility needs.


Lifestyle

Lifestyle habits play an extremely important role in one’s overall fertility. A preconception care plan should work to optimize each of the following areas:

Diet: Research has highlighted that a Mediterranean-style diet may have the best fertility outcomes. This diet incorporates a variety of vegetables and fruits, protein sources from seafood, poultry, and legumes, whole grains, and mono and polyunsaturated fats from sources such as olive oil and nuts.

Sleep: Good quality sleep is also critical for fertility. Poor sleep may cause disruption with reproductive hormone production and communication, cycle irregularities, and poor egg quality.  Implementing sleep hygiene strategies may help improve overall sleep quality. These strategies could include avoiding caffeine in the afternoon or evening, avoiding exercise in the evening, limiting screen time 1 hour before bed, ensuring consistent bedtime and wake up times that provide 7-8 hours of sleep, and creating a calm, dark, cool bedroom setting.


Exercise
: Exercise is another important lifestyle factor for overall health and fertility. Too little or too much, however, can create problems. Repetitive high-intensity exercise may increase the risk of ovulatory dysfunction by putting the body into a negative energy state. Whereas minimal to no exercise can increase the risk of obesity, type 2 diabetes, and other health concerns that may impact fertility.

Stress Management: When the body is chronically exposed to stressors, this can negatively impact reproductive hormone communication, hormone production, and ovulation. Fortunately, there are many stress management strategies to incorporate into your daily life. Finding the right strategies that are most effective for you will offer immense benefit to your overall health and fertility.

Toxin exposure: Exposure to environmental toxins from the air, water, food, cleaning supplies, personal care products, clothes, etc., can have a negative influence on your overall health and fertility. Many of these chemicals are hormone disrupters and hormone mimickers, while also impacting egg development and quality. Making the switch to fewer toxic products can reduce the body’s overall burden. The Environmental Working Group is a great resource that provides many non-toxin product recommendations.

What about my partner’s health?

The health of one’s partner is often overlooked, but is equally as important for improved fertility outcomes. Research suggests that approximately 1/3 of infertility is attributed to male factors, 1/3 attributed to female factors, and in 1/3 of couples, no cause can be identified. This highlights the importance for one’s partner to also be assessed and treated before conception.


When should I implement a preconception care plan?

​A preconception care plan timeline is unique to every person. Your current health status will influence how much time is needed to appropriately prepare you for conception. At least 3-4 months prior to actively trying to conceive is usually recommended, but more time may be warranted depending on which health goals are trying to be accomplished.

Disclaimer: This blog post is meant for educational purposes only and should not be viewed as medical advice. Please speak to your health care provider for more information on how to support your overall health and fertility.

References:

Infertility FAQs

Espino J, Macedo M, Lozano G, Ortiz Á, Rodríguez C, Rodríguez AB, Bejarano I. Impact of Melatonin Supplementation in Women with Unexplained Infertility Undergoing Fertility Treatment. Antioxidants (Basel). 2019 Aug 23;8(9):338. doi: 10.3390/antiox8090338.

Pundir J, Psaroudakis D, Savnur P, Bhide P, Sabatini L, Teede H, Coomarasamy A, Thangaratinam S. Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomised trials. BJOG. 2018 Feb;125(3):299-308. doi: 10.1111/1471-0528.14754

Karayiannis D, Kontogianni MD, Mendorou C, Mastrominas M, Yiannakouris N. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Hum Reprod. 2018 Mar 1;33(3):494-502. doi: 10.1093/humrep/dey003

Caetano G, Bozinovic I, Dupont C, Léger D, Lévy R, Sermondade N. Impact of sleep on female and male reproductive functions: a systematic review. Fertil Steril. 2021 Mar;115(3):715-731. doi: 10.1016/j.fertnstert.2020.08.1429

Turner KA, Rambhatla A, Schon S, et al. Male Infertility is a Women’s Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed. Cells. 2020;9(4):990. Published 2020 Apr 16. doi:10.3390/cells9040990

Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001 Jul;170(1):3-11. doi: 10.1677/joe.0.1700003

Dağ ZÖ, Dilbaz B. Impact of obesity on infertility in women. J Turk Ger Gynecol Assoc. 2015;16(2):111-117. Published 2015 Jun 1. doi:10.5152/jtgga.2015.15232

Pizzorno J. Environmental Toxins and Infertility. Integr Med (Encinitas). 2018;17(2):8-11.

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Dr. Sam Bowen, ND

Dr. Sam Bowen, ND

Dr. Sam Bowen is a licensed naturopathic doctor practicing in Vancouver, BC. Her clinical passion is to support individuals with menstrual cycle irregularities, infertility, digestive concerns, and burnout. Her approach to medicine focuses on correcting the root cause of health concerns while taking into consideration the many aspects that contribute to optimal health. She also believes that patient education and empowerment is a foundational component to any treatment plan.