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Trying for a baby begins when you start taking care of your own health

When you decide that you want to start trying to become pregnant the general advice is to see your doctor for a check-up and to start the conversation about trying to conceive. This enables your doctor or healthcare practitioner to discuss key areas and lifestyle factors that are important for conceiving and to assess if any adjustments or changes that need to occur to ensure you and your partner are as healthy as possible to achieve your goal of starting a family. However, our doctors tend to have limited time to discuss in detail all aspects of preconception health to the standard needed to help people be thoroughly informed. We also barely get taught great sex education in high school and by the time you want to try for a baby you have long forgotten any of the information that was ever discussed. And getting pregnant is far more complicated than just having sex each and every month. This is why I want to highlight and discuss important areas of preconception health that everyone should know and be informed about.


What needs to occur to achieve a pregnancy?


To break it down for you:

  • A woman or person with ovaries needs to be ovulating a genetically normal mature egg every month, ideally on a consistent basis.

  • The fallopian tubes must be patent to capture the ovulated egg and assist in transporting the egg, sperm or embryo (sperm that has fertilised an egg) along its journey.

  • Genetically normal sperm must be deposited near the cervix around the time of ovulation through vaginal intercourse and be able to travel via the fallopian tubes to meet the egg and have the capacity to fertilise the egg.

  • The uterus must be receptive to enable the embryo to implant and be capable of supporting the ongoing growth and development of the foetus.

As you can see, a lot must align in order for a pregnancy to occur. But more so than that, it’s important to prepare your body well before you even start trying. A healthy pregnancy starts with a healthy egg and sperm, therefore, by focusing on preconception health around 3-12 months before getting pregnant can help your chances of conceiving, reduce pregnancy complications or impaired growth or development of the baby and improve the overall short-term and long-term health for both the mother and child born. So, if you are unsure where to start to prepare your body, please find in-depth recommendations below:


Lifestyle


Folate: Folate is from the vitamin B family and is found in dark green leafy vegetables, fruit, whole grains, seafood, and eggs. Folic acid is the manmade artificial form of folate found in pregnancy supplements and vitamins and has been proven to reduce the risk of neural tube defects such as spina bifida. It is recommended to start taking these supplements at least a month prior to conception and during pregnancy. The recommended dose is 400 -500mcg (0.4-0.5mg) a day unless you have a family history of neural tube defects, cleft palate or are taking epilepsy medications, speak to your doctor as a higher dose may be recommended for you.


Iodine: Iodine is an important mineral that is found in bread with iodised salt, dairy products, seafood, eggs, and some vegetables and is another recommended vitamin during pre-conception, pregnancy, and breastfeeding. You need higher levels of iodine than usual during these times as it’s essential for a baby’s brain development. The recommended dose of iodine is 150mcg every day, as low levels during pregnancy can affect a baby’s physical and neurological development and can result in pregnancy loss.


Another important role of iodine is that it is essential for healthy thyroid hormones. The thyroid gland is found in the lower part of your throat and uses iodine to make thyroid hormones that are vital for controlling the rate at that your body uses energy when resting as well as the growth and development of your brain and body. If your diet is low in iodine, this can affect your thyroid gland and the production of thyroid hormones, ultimately affecting your menstrual cycle, ovulation and can cause issues getting pregnant. Because of its importance, thyroid hormone levels should also be tested and potentially monitored during pregnancy. Please note, for any woman or person that menstruates who has a pre-existing thyroid condition, you should seek advice from a medical professional before taking an iodine supplement.


Reduce alcohol: Alcohol is a known teratogenic, which means that it can impact the development of an embryo (early stages after an egg and sperm meet) or foetus and result in pregnancy loss (miscarriage), premature birth, stillbirth or result in birth defects. It’s important to note that any alcohol consumed at any point of pregnancy can travel via the placenta to the developing baby. There are critical moments during a pregnancy that are more vulnerable than others, such as early pregnancy when the brain starts developing or during the development of key organs (heart, kidneys, and lungs). However, consumption has been shown to impact all stages of pregnancy including fertilisation, implantation, and development of the embryo, foetus, and placenta as well as the ongoing function of the placenta.


From the moment you find out you are pregnant; you are already 4 weeks pregnant (if you have 28-day cycles)! Hence why whatever you do during these 4 weeks is critical for your babies’ development. There is no safe type or limit of alcohol during pregnancy, hence why the moment you start trying is the moment you should stop drinking, for more information and advice, please refer to every moment matters website: https://everymomentmatters.org.au/




There are also more and more alcohol-free wines and spirits being produced, so if it’s the physical need of drinking something when being a part of gatherings or social events then this is something that you can look further into.


Stop smoking and recreational drugs: Smoking and recreational drugs are also known teratogenics and are harmful to unborn babies.


Smoking affects fertility in both genders as it impacts the quality of eggs and sperm and can cause issues when trying to conceive. During pregnancy, smoking can be harmful to the placenta which is crucial for providing nourishment to the baby which could result in growth restrictions and an increased risk of miscarriage. It is recommended that both partners cease smoking and if assistance is needed to quit, seek help from a medical professional.


Recreational and illicit drugs are best avoided if you are planning to get pregnant and during pregnancy because of their harmful nature. Illicit drugs can also impact sperm and egg health and may make it harder to conceive. Drugs such as marijuana and anabolic steroids may also affect men or people with testes’ sex drive and sperm counts.


Nutrition and movement: Eating a well-balanced diet from various food groups and exercising regularly are positive ways to boost your fertility and ensure a healthy pregnancy.


This means eating fresh unprocessed food with plenty of fruit, vegetables, whole grains, lean meats, dairy products and avoiding processed foods as they can contain high levels of saturated fats, sugar and salt. This ensures your diet contains all of the essential vitamins and minerals for proper reproductive functioning.


If you need assistance to make dietary changes or help you take the right steps for your fertility, seeking help from a dietician could be valuable.


Participating in moderate regular exercise can improve fertility and the chance of having a baby. Studies looking at the effects of exercise on fertility have found that vigorous exercise reduces the risk of ovulation problems. And moderate exercise decreases the risk of miscarriage and increases the chance of having a baby among women or people that menstruate who undergo IVF. Light or moderate-intensity exercise also improves the quality of life and emotional well-being of both genders.


There is no evidence of any harmful effects of participating in moderate-intensity physical exercise in the preconception period or during pregnancy. Although studies show excessive exercise may actually reduce fertility and the chance of having a baby as well as be harmful to sperm quality.


So, the take-home message is, any form of physical activity is better than no physical activity, ensuring that the intensity is between light to moderate and not excessive.


Dental check-up: It is recommended to see your dentist for a check-up and any dental work before pregnancy as some procedures such as X-rays and certain issues such as gum disease can affect you and your baby’s health during pregnancy. As infections and inflammation in the mouth during pregnancy have been linked to an increased risk of developing preeclampsia, premature birth, and having a baby with a lower-than-normal birth weight.


Stress: Try not to stress about stress. Stress can affect a woman or person who menstruates by increasing the risk of irregular cycles, causing a short luteal phase (second half of the menstrual cycle) and anovulatory (no ovulation) cycles. And for men or people with testes, stress can impact sperm count, motility (how they move) and morphology (how they look). If stress is a factor, looking at how you can try and reduce your stress can have a beneficial impact on your menstrual cycle or sperm health. Look for ways to relax that you enjoy and be sure to include this self-care into your daily routine.


Endocrine-disrupting chemicals (EDCs): Some chemicals mimic oestrogen and disrupt hormonal activity. These chemicals have the potential to reduce fertility and increase the risk of miscarriage and loss. EDCs can be found in household cleaning products, pesticides, paints, glues, personal care products, plastics, skincare and cosmetics, and food and drinks in tin cans. Reducing your overall exposure to these chemicals can have a beneficial impact on your reproductive health and fertility. Now don't worry about changing everything, even small changes make a big difference to the overall level of your exposure.


Some tips include:

  • eat fresh not processed foods

  • reduce foods/drinks from tin or plastic containers

  • Switch personal care products to free from phthalates (fragrance-free) and the same with cleaning products

  • Avoid pesticides eg fly spray

  • Switch plastic Tupperware containers that come in contact with hot food or drinks to glass containers

  • Avoid reusable plastics or swap for stainless steel

  • Wash hands after handling receipt paper


Things to discuss with General Practitioner (GP)


General check-up: Seeing your doctor prior to conceiving gives them a great opportunity to do a general check-up and ensure everything is working in order. For example, checking your blood pressure, breast examination and cervical screen if due, (although this can be safely completed in early pregnancy). Your GP can also complete any necessary preconception screening via blood tests if required. They can test your immunisation status and for any infections that may impact your chances of conceiving.


Medical conditions and medications: This can also be a great opportunity to also ensure that any medical conditions are well controlled or to make adjustments based on your plan to conceive. If you suffer from a chronic medical condition (diabetes, epilepsy, thyroid dysfunction, heart defect, allergies or inherited conditions) or are currently taking prescribed or over-the-counter medications, a review with your GP or specialist is essential prior to conception to ensure no potential effect on conceiving or pregnancy and all potential modifications to medications or treatment plans can be discussed thoroughly.


Vaccinations: Screening for immunity to certain conditions such as measles, mumps, rubella and varicella zoster (chickenpox) should be performed prior to conceiving as no immunity puts you and your baby at risk. If a woman or person carrying a pregnancy is not immune to rubella and contracts rubella before the first 20 weeks of pregnancy, it can have serious health consequences for the developing baby, as it can cause hearing impairment, deafness, blindness, cardiovascular defects and brain damage. Chickenpox can also be more serious for the mother or person carrying the pregnancy as well as the baby if contracted before 28 weeks. Causing skin lesions and scarring, eye damage and neurological defects.


Hence why routine screening is important before conceiving so people who aren’t immune can be immunised to protect themselves and their future babies. If rubella or varicella immunisation is needed, it’s important to know that pregnancy should be avoided for a month due to the live nature of the vaccine and the low potential for transmitting the virus to a susceptible developing baby.


Semen analysis: It takes two to create a family, so male partners or sperm providers should consider a general check-up, focus on a healthy lifestyle and see their doctor for a semen analysis. A semen analysis is a test performed to check the quality and health of sperm, assessing how the sperm move, how they look and how many are in the total sample. Sperm take 3 months to develop and make their way to epididymis prior to ejaculation, hence whatever happens over that 3-month period can impact the quality of the sperm. Achieving a pregnancy or even having issues conceiving is not just about the female or egg provider, men or the sperm provider play a very vital part in the process too, so looking after their health is just as important.


Genetic carrier screening: All people planning to conceive or those who find out they are pregnant should be offered genetic carrier screening. There are hundreds of inherited genetic conditions that can affect future children, although most are very rare. You may not know that you carry are gene that could cause a genetic condition because carriers are generally healthy and because both egg and sperm providers need to carry the same specific gene in order to have a risk of passing a condition onto their children. An example of a genetic condition that can be inherited this way is cystic fibrosis. Hence why genetic carrier screening is relevant and so important for everyone considering starting a family, regardless if a family history of a known genetic condition is noted or not, as you may not even be aware that you are at an increased risk.


General advice


Start monitoring your cycle: Conception can only occur from intercourse during the fertile time - a 6-day window, starting from the earliest time sperm can survive and that ends the day of ovulation. By learning to track your menstrual cycle you can learn to identify the subtle changes in cervical mucus and temperature that can help you identify when the fertile window opens (possible chance of conceiving) and when it closes (no longer able to conceive that cycle). Having intercourse at the right time in your cycle optimises your chances of conceiving. Fertile cervical mucus is the body's way of identifying the best possible time to conceive without the need for any fancy apps or testing. The fertile window is dependent on ovulation and ovulation can vary from month to month (it's not always day 14 like you may hear). Hence, learning fertility awareness also allows you to learn about your body’s subtle changes in cervical mucus and temperature, relying on what you see and feel each day to then be able to plan intercourse more precisely. It can take some time to learn and with the help of an instructor, like me, you can take the guesswork out of conceiving and learn to understand your menstrual cycle and body so much more!


Things can take time: Please know that getting pregnant doesn't always happen right away for everyone and it can take time. This doesn't necessarily mean something is wrong. In the general population, 80% of couples conceive after 1 year of trying and 90% after 2 years, if under the age of 40 and are having regular intercourse without contraception. And if you really want to break it down, if you had a regular 30-day menstrual cycle, you only have 12 chances a year to conceive. It’s really not a lot of chances and remember how many things need to align each month for conception to occur, this delicately timed and balanced reproductive system and hormones can be interrupted or fail at any time during any month for a number of reasons eg. if you have irregular menstrual cycles (this would again reduce the number of chances to conceive each year). And the opportunity for intercourse also needs to be there, so all these things could further limit the number of chances you get.


Support: Ensure you look after your own mental health while trying to conceive, take time to focus on self-care and plan to do things that help you relax and take your mind off “trying”, as sometimes it can feel like it’s taking over your life. And even though the getting pregnant part and when you will conceive is out of your control, remember all the things above that you do have control over, and that can go a long way in helping to achieve a pregnancy. Also make sure you have enough support around you, whether it’s through your partner, family, friends, a counsellor or your own personal fertility nurse. Having someone to talk to, vent to, ask questions or just listen to you can be very helpful on any fertility journey. Especially as sometimes some things don’t go to plan, 1 in 6 couples struggle to conceive, and 1 in 4 pregnancies can end in loss. All these statistics make it common but don’t make it any easier if you do experience them. Surround yourself with a great support network to help with what YOU need during your fertility journey, and know you can never have too much support.


And finally, if you are starting out on your journey to try to achieve a pregnancy, remember to try and enjoy it, connect with your partner and make it fun! Sex can be funny, messy and pleasurable (know that it’s completely normal to lose part of the ejaculation from gravity, why do you think an ejaculation contains millions of sperm? Only a few hundred actually make it to the egg). Just be sure to have a towel or tissues handy, just in case! And no, lying with your legs up against the wall, won't increase your chances of conceiving or make it any less messy. It is a good way to relax though and calm the nervous system! Anyway, I wish you all the best and hope that this information has provided some insight and helped you understand what you need to do before you start trying.


Pre-pregnancy checklist (1)
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References

1. The Royal Women's Hospital, Preparing for a healthy pregnancy [Internet] Available from: https://www.thewomens.org.au/health-information/pregnancy-and-birth/preparing-for-pregnancy/a-healthy-start

2. Foundation for Alcohol Research and Education (FARE), Every moment matters [Internet] Available from: https://everymomentmatters.org.au/

3. The Thyroid Foundation, Pregnancy and Your ThyroiFoundationd Health [Internet] Available from: https://www.thyroidfoundation.org.au/Pregnancy-&-Your-Thyroid-Health

4. Better Health Victoria, Pregnancy and diet [Internet] Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet

5. Royal Australian and New Zealand of Obstetricians and Gynaecologists, Planning for pregnancy [Internet] Available from: https://ranzcog.edu.au/wp-content/uploads/2022/06/Planning-for-pregnancy-pamphlet.pdf

6. Your Fertility [Internet] Available from: https://www.yourfertility.org.au/

7. Royal Australian and New Zealand of Obstetricians and Gynaecologists, Reproductive Carrier Screening [Internet] Available from: https://ranzcog.edu.au/wp-content/uploads/2022/06/Reproductive-carrier-screening.pdf

8. Australian Government Department of Health and aged care, Immunisation Handbook [Internet] Available from: https://www.health.gov.au/resources/publications/the-australian-immunisation-handbook

9. Jane Knight. The Complete Guide to Fertility Awareness. London: Routledge, 2017.

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