Female Fertility

If you are finding it difficult to get pregnant, it can be a confusing and worrying time. There are lots of possible causes so here we outline first steps right through to improving your chances during IVF.

First steps

The first step we recommend is a trip to your GP to get routine blood tests done. If you are younger than 35, it is recommended that you get initial tests done after one year of trying to conceive, or if you are over 36, you should not wait longer than 6 months. Your GP can carry out hormonal blood tests including thyroid function tests.  Your thyroid plays a critical role in your hormonal balance and ability to get pregnant. See more on thyroid conditions here.

We also recommend getting an ultrasound on the ovaries and uterine cavity.  This can help diagnose PCOS or other structural issues that might make it more difficult to get pregnant.  It is best to know about this early on in the process instead of finding out later after more months of trying.  We also highly recommend that the male partner is tested at this point – see more information here.

Diagnosis

As you go through the fertility process, you may find it is difficult to get an exact diagnosis.  There also might be more than one thing going on for you and your partner.  Approximately 10% of couples are described as having unexplained infertility which can be difficult to understand.  We now know that many of these have more complex issues such as immune-related infertility so it is important to discuss all options and testing and get a second opinion if necessary.

The most common cause of fertility issues in Ireland is advanced maternal age which may mean there are reduced numbers of eggs, difficulties ovulating and issues with egg quality.  The second most common cause is PCOS.  Please see links below for specific information on how we can help support your specific issue.

Egg Quality and Advanced Age

PCOS

Endometriosis

Thyroid

Immune related infertility

Fibroids

Can Nutrition Help?

Therefore having a three month pre-conceptual care window is ideal.  However, positive lifestyle changes also greatly improve the chances of a healthy pregnancy outcome so no matter where you are on your journey, making improvements now will help.

Based on large population studies, we know that a fertility friendly diet is high in vegetables, fruit, nuts and seeds.  Fish intake is important, particularly omega-3 rich fish such as wild/ organic salmon, mackerel, sardines, herring and anchovies.  Including more pulses and plant-based foods is helpful and reducing red meat, particularly processed meats is beneficial. A reduction in high fat, high sugar processed foods is recommended. See our meal plans made for Sims IVF here to give you some guidance and recipes for a healthy fertility diet.

Folic Acid

It is known that folic acid can prevent spina bifida or other neural tube defects in your baby, and it is essential that you get plenty both before and during pregnancy. Taking a supplement containing 400ug of folic acid 14 weeks before and 12 weeks into pregnancy is essential.  And that’s not all: folic acid is undoubtedly important, but it is just part of the very important B-complex family of vitamins that are necessary to produce the genetic materials DNA and RNA in the growing embryo. Together with vitamin B12, folic acid works to ensure that your baby’s genetic codes are intact. Remember, it’s not enough to take folic acid alone when you are trying to become pregnant. All of the B vitamins are essential during the pre-conceptual period.

Zinc and Selenium

These minerals are more commonly associated with male fertility but as important antioxidants, they are essential in protecting egg quality and the DNA within.  These minerals are found in nuts and seeds and we recommend that you include a daily portion of mixed varieties.

Zinc also plays a significant role in balancing hormones. It is necessary for how we use our reproductive hormones oestrogen and progesterone and is also involved in thyroid hormone production.  As the master regulator of hormones, the role of the thyroid is extremely important.

Zinc deficiency is common worldwide and often seen in our clinic when tested.  Zinc is found in meat, chickpeas, nuts and seeds.  However, absorption can be difficult and those with poor digestion are at risk.  People on long-term proton pump inhibitors (PPI), which are commonly prescribed stomach acid inhibitors, are at risk from malabsorption.  In addition, those on a high plant diet can also be at risk unless efforts are made to increase absorption in the diet such as soaking, sprouting and fermenting.

Brazil nuts are a great source of selenium, but it’s easy to get too many.  Just one Brazil nut per day can provide over the recommended daily allowance so eat these as part of your diet, but not too often. Selenium is also found in meat, chicken, fish, shellfish and eggs and deficiency often depends on the selenium content of the soil near where you live or source your animal products. Many people we see in clinic have already started consuming Brazil nuts and are high in selenium.  It’s best to check your levels before you supplement.

Vitamin C and E

These are very important antioxidants, particularly in women of advanced age.  They work together, as vitamin C is water soluble and vitamin E is fat soluble.  Egg quality is a major concern as we age and is a critical factor in the success of both natural conception and assisted conception treatments such as IVF.  Vitamin C may also assist where clomiphene citrate is being used (known as clomid). Vitamin E can also support a healthy womb lining to develop.

Vitamin C is found in fresh fruits and vegetables and we recommend aiming for 2 pieces of fruit daily and 5 vegetables. We also suggest to include a wide variety of types and colours. We routinely measure vitamin C levels in clinic and many people do not achieve the optimal levels through diet alone.  We also measure beta-carotene which is used in research studies as a good marker of your intake of fruits and vegetables.  You can then know whether you need to make improvements in your diet.

Vitamin E is found in almonds, avocados, sunflower seeds, salmon, sweet potatoes, olives and olive oil. If you are supplementing, often this can mean that you are high in one form only of vitamin E.  In our tests, we look for both alpha- and gamma-tocopherol, and often find deficiencies here.

Omega-3

These essential fats have a profound effect on every system of the body, including the reproductive system and they are crucial for healthy hormone functioning. Omega 3 fatty acids also control inflammation which may interfere with getting and staying pregnant. In a ‘Western Diet’, we do not get enough omega-3 in our diet.  Eating at least two portions per week of oily fish is recommended.  If you do not eat fish, a supplement containing over 500mg of each of EPA and DHA is useful.

Amino Acids

Amino acids are the building blocks of proteins and so are found in all protein foods. Some amino acids may support fertility such as l-arginine which might support blood flow to the womb lining.  It is usually not necessary to take high doses of amino acids as supplements as a good diet will provide sufficient amounts.

Vitamin D

We know that conception rates increase during the summer which may show a role for vitamin D in fertility and there are receptors for vitamin D in the ovaries and uterus. Be cautious when supplementing with vitamin D; it is important to tailor your supplement levels to meet your needs.  Vitamin D can be toxic at high levels.  While it has a beneficial effect on our immune system at optimal levels, this too can have a negative effect if the levels get too high.  In Winter, approximately 50% of Irish adults may be deficient but we also see people in clinic who have supplemented too much.

CoQ10

Coenzyme Q10 is a very important antioxidant in preserving egg quality, particularly in women of advanced age.  Taking CoQ10 for three months has been shown to improve fertility and outcome of IVF or other assisted conception treatments.

Medicinal Mushrooms

Many women have started to take medicinal mushrooms to support their fertility.  They have powerful immune modulating effects and some can improve hormonal balance. However, the immune balance that we require in pregnancy is quite specific.  Ordinarily we might want to ‘boost’ our immune system to fight off colds and flus and other infections. In pregnancy, we need our immune system to accept a growing embryo and foetus that is not entirely ‘self’.  This requires a delicate immune balance that is specific to pregnancy and necessary for conception.  We only ever recommend medicinal mushrooms in fertility after comprehensive immune testing is carried out.  Otherwise you can’t be sure if you are upsetting this delicate balance. Read more about immune-related infertility here.

Caffeine

There is some evidence to show that caffeine, particularly in the form of coffee, decreases fertility. According to one study, drinking as little as one cup of coffee a day could halve your chances of conceiving and just two cups a day increases the risk of a miscarriage. We recommend limiting caffeine intake in the prenatal care period.

Alcohol

Drinking alcohol can reduce your fertility by half – and the more you drink, the less likely you are to conceive. One study showed that women who drank less than 5 units of alcohol a week (equal to five glasses of wine) were twice as likely to get pregnant within six-months compared with those who drank more. We highly recommend reducing your alcohol intake in the prenatal care period – you will need to stop it completely in pregnancy.  In addition, if you are taking medications as part of assisted conception treatment, we recommended avoiding alcohol altogether.

Smoking

We also recommend that you stop smoking which is linked been linked with infertility in women. It can even bring on an early menopause, which is a particularly important consideration for older women.  Again you would need to stop it completely in pregnancy so best to start now.  Seek out support where you can.

Your environment

Xenoestrogens are essentially environmental oestrogens, coming from pesticides and the plastic industry. When you are trying to conceive, one of the most important things you need to do is to balance your hormones. It is extremely important to avoid anything that might cause an imbalance, and one of the main culprits is the xenoestrogens.  Aim to reduce your plastic exposure, avoid handling till receipts, use more natural cosmetics and personal hygiene products and try to eat as organic produce where you can.

Exercise

Moderate exercise is excellent for weight management, stress reduction and hormonal balance.  Try to keep up moderate and enjoyable exercise during the preconceptual care period.  It is very beneficial to maintain safe exercise levels in pregnancy so start now to give yourself the best preparation possible.  To reduce stress, also consider more gentle forms of exercise such as yoga, walking or gentle swimming.  This might be particularly helpful if you are going through IVF or other assisted conception treatments.

Stress

Stress can contribute to hormonal imbalance. Reducing sources of stress may be useful and your diet can support you here along with specific nutrients such as B vitamins and magnesium.  Include wholegrains instead of refined carbohydrates and sugar and snack on nuts and seeds.  Don’t go too long between meals and try to ensure you are sleeping well.  Consider other stress-reducing therapies such as acupuncture and practices such as meditation and mindfulness.

Tests

Thyroid tests can help to identify whether you thyroid if functioning optimally and we carry out a wide number of tests to support thyroid health.

Certain tests may be carried out by your GP.  We can liaise with your doctor to provide nutritional support.

Where to start?

Start making improvements to your diet as you can.  Take a good quality fertility focussed multivitamin and mineral.  This should provide all of the above mentioned nutrients including 400ug folic acid.  Do not take any one nutrient in excess without testing.  Deficiencies are common and are important to rectify, but you cannot know without testing.  If you need further support or tailored advice, it would be helpful to request an appointment with one of our qualified team.