One of the advantages of infertility treatment is that it focuses the woman on the imminence of conception and thus provides a unique opportunity for both partners to optimize their health, as well as the health of their potential offspring.

The objective of pregnancy should be to maximize the quality of life after birth. Since most women do not plan for and are unaware of when they conceive they seldom modify or, adjust their lifestyles to prepare for this the most important event in determining the well being of their future offspring. Undoubtedly, embryonic and fetal growth are highly susceptible to nutrition and lifestyle choices around the time of implantation and through the first 12 weeks of pregnancy (the 1st trimester). Many women are unaware that they have conceived until around the 5th or sixth week, a time period when the early embryo is most vulnerable to environmental influences, especially to aberrations in blood flow, metabolic influences, a dysfunctional hormonal environment, and to the toxic effects of tobacco, alcohol and “recreational” narcotics.

While isolated poor health choices are not as detrimental to the developing conceptus as protracted exposures to an adverse environment, there are certain things that a woman can do to prepare for conception, improve her fertility potential, and optimize the quality of life after birth should she conceive:

1. Institute a balanced diet and nutrient supplementation, and maintain a healthy body weight.

A balanced diet should incorporate high protein and moderate carbohydrate intake. Fresh fruits and vegetables and modest meat consumption is advisable. The ideal calorie intake is around 2,500 calories per day.

It is advisable for the woman contemplating having a baby to start taking vitamins in preparation for pregnancy. Adequate supplementation with preparations that contain Vitamins A, B-complex, C and D as well as iron and folic acid is important. Folic acid consumption deserves special mention because it reduces the risk of neural tube defects in the baby. Vitamin D (daily consumption should range from 400-1000 IU per day) is also very important as more than half of pregnant women are deficient. This vitamin protects against the development of certain malignant diseases, helps reduce the risk of hypertension and diabetes mellitus, and helps prevent osteoporosis by improving calcium and magnesium absorption. In addition, Vitamin D may lower the incidence of type 1 diabetes.

There seems to be a trend emerging for women who are trying to conceive to take “Chinese herbs.” I’d like to go on record as saying that while some of these might indeed be helpful, there is no scientific data to support there being any real benefit. Of greater concern is the fact that little is known about the ingredients present in some of these preparations. As a result, there is not only no assurance that they are helpful, but a possibility that some might even be harmful. In my opinion, simply passing the use of “Chinese herbs” off by saying “they won’t do any harm” is an oversimplification and could be potentially dangerous.

More recently, the use of DHEA as an attempt to improve egg quality has come in to vogue. I personally consider this to be potentially harmful – especially in women who are in their 40’s and beyond, as well as women with diminished ovarian reserve. In such cases, I believe that this male hormone, by being converted to more potent androgens such as testosterone, could even compromise egg and embryo quality. Supplements such as pycnogenol, myo-inositol, carnitine, DHA (note: this is not the same as DHEA) and co-enzyme Q might be beneficial but the benefits still remain unproven. However, I doubt that their use would be harmful.

2. Maintain a healthy body weight and BMI

Being either overweight (BMI over 30 kg/ml) or underweight (BMI less than 18.5>

Polycystic ovarian syndrome (PCOS) a condition that is often characterized by a high BMI and is commonly associated with insulin resistance, infertility and dysfunctional or absent ovulation. PCOS represents a classic example of how excessive body weight might complicate conception and pregnancy. It should be borne in mind that it is inadvisable to attempt weight loss during pregnancy, thus the emphasis falls on trying to achieve a normal BMI prior to conception.

It is also harmful for women contemplating pregnancy to be underweight, because such women are more likely to experience nutritional deficiencies that might deprive the developing conceptus of the nutrients necessary for healthy growth and development. In addition, underweight women are also more susceptible to pre-term labor, compromised placental development (placental insufficiency) with intrauterine growth retardation, and low birth weight babies.

Exercise Regularly

Women preparing for pregnancy should initiate a disciplined and regular exercise regimen. This will help them maintain an optimal body weight, strengthen the cardiovascular system and reduce stress. I advise women contemplating a family to join a health fitness club so as to ensure a safe and structured exercise program. The regimen should be modified during pregnancy.
Women undergoing ovarian stimulation should avoid “high impact aerobic exercise” while undergoing treatment. It should go without saying that exercise must be avoided around the time of ovulation or egg retrieval and until a pregnancy is confirmed by ultrasound or discounted through blood testing. Once pregnant, the exercise regimen should be modified to exclude “high impact aerobics” and the woman should be advised not to try and push herself beyond her tolerance level. Simply stated, pregnancy is not the time to push for that “extra lap” or “extra set “ that could establish a relatively anaerobic state that might compromise oxygen and nutrient delivery to the developing baby.

3. Avoid smoking, excessive alcohol use and/ or “recreational drugs”

It goes without saying that smoking is a no-no! Cigarette smoke harms egg and sperm development. On the other hand, alcohol in small amounts is probably not that harmful when preparing for pregnancy. However, it is important to emphasize that alcohol, along with all non-prescription drugs not given under proper medical supervision, should be avoided following conception and throughout pregnancy. There is irrefutable evidence that alcohol and tobacco use during pregnancy can and do adversely effect fetal growth and development. Drugs such as methamphetamines, speed, cocaine and narcotics such as oxycontin, vicodin, etc. are all positively harmful and should under NO CIRCUMSTANCES be taken without a prescription and medical supervision.

4. See your primary care physician to ensure your health care is current

It is important to be up-to-date with pap smears, mammograms and annual physical examinations. In the same vein, women preparing for pregnancy should make sure that, if required, they have been properly immunized against German measles (rubella) more than 8 weeks prior to conception, against Chicken Pox (varicella) and vaccinated against influenza – especially during the flu season. It is also advisable to be checked for rarer but serious viral conditions such as hepatitis B, hepatitis C and HIV, all of which have the potential to infect the developing baby. That is not to say that if a woman has had one of these infections she cannot have a baby. Rather, she should be made aware of the fact that there are associated risks, and these should be explained to her and be taken into consideration before conceiving.

Another condition that can be screened for is the presence of the Cystic Fibrosis gene, where the risk of being a carrier is approximately 4%. Both partners should be checked for this gene, which, if present in the man and the woman, places any offspring at serious risk. The same consideration is applicable with regard to identifying conditions such as Sickle Cell Disease or traits which are most commonly seen in people of African descent, and Thalassemia, which is most commonly seen in individuals of Mediterranean extraction. Then there is the increased risk of Tay Sachs Disease, especially in individuals of Jewish Ashkenazi extraction.

5. Prioritize medications taken prior to pregnancy
It is very important to weigh the cost-benefit ratio of taking any medications prior to or during pregnancy. Please refer to the following link, which provides “FDA ratings for prescription drug use during pregnancy, active ingredients in common over-the-counter drug products.” The classifications showed range from Category A (safest drugs) to Category X where fetal anomalies are prevalent with use. Most of the drugs prescribed prior to conception or in pregnancy and which most physicians feel relatively comfortable recommending, fall into Categories A and B. Category C drugs need further consideration. It should be clarified here that women who have certain chronic health conditions will often need to continue taking their medications, even though they might not ordinarily be recommended. Examples where this might apply include seizure disorders, disease such as ulcerative colitis or Crohn’s Disease, tuberculosis, and bipolar disorders. It is important to confer with your physician if you are taking maintenance doses of any medication while contemplating a pregnancy.

6. Reduce stress and optimize mental health

Without exception, women experiencing infertility will experience stress. The longer they have been trying unsuccessfully to conceive and the older they are (and thus more likely to be confronted by a rapidly advancing biological clock), the more important it becomes to find an effective method of stress reduction. As stated above, getting moderate exercise and joining an infertility support group as well as establishing a very healthy and open relationship with her partner will go a long way toward reducing stress. Intense exercise or alcohol use as stress remedies are not recommended. Other helpful ways to address the problem are yoga classes, Pilates, gardening, massage therapy, taking walks and acupuncture.

Above all, taking the time to concentrate on personal needs is vital. Getting adequate sleep (8 hours per night), rest, and quiet time are also important.