Optimizing Fertility

November 14, 2018

 I recently attended Tori Hudson's Fertility and Preconception seminar, which was a great refresher and packed full of useful new information I'm excited to integrate into my practice! Working with couples on preconception planning and fertility is one of my absolute favorites. If you are trying to conceive, or planning to TTC in the next year now is the time to come in and start working on your overall health to support pregnancy. Women are born with all of the eggs we will ever have (crazy, right?), but in the 3-6 months before we ovulate that egg is going through major prep. How we treat ourselves during this time has a huge impact on our offspring and their lifelong health. For the future dads it takes about 3 months to make fully mature sperm, so they should be working on health for 3 months before conception as well. We often leave men out of preconception prep but they are a key component! The most important things for both partners to be doing are lifestyle: no smoking (including cannabis), limited alcohol, keeping a regular sleep cycle (melatonin is very important for ovarian health), and taking a multivitamin that includes folate. 


80% of couples will conceive within the first year of trying with the female partner being <35 years old and male partner <50 years old. If you have been trying without success here's a few things to think about:

Timing: Women can only conceive within a 5 day window every cycle, and our most fertile time is right before ovulation. Ovulation normally occurs on day 14 of a 28 day menstrual cycle, however we don't know for sure without testing or tracking signs of ovulation! At a minimum you should be having sex every other day during the middle of your cycle. It is amazing how many couples have been missing their fertile time every month.


Ovulation: We have to make sure you're actually ovulating. Many women use apps to track their menses now, which is great, but no guarantee that you're ovulating when your phone says you are. My favorite resource for learning about your menstrual cycle and signs of ovulation is the book Taking Charge of Your Fertility by Toni Weschler. Great options to track ovulation include basal body temperature, ovulation predictor kits (when used correctly), tracking cervical fluid, and testing progesterone levels in your blood. If you have an irregular cycle, or if it is regularly <21 or >35 days there is a good chance you're not ovulating regularly. We can support ovulation through lifestyle, herbal medicine, and ovulation stimulating prescriptions if needed. 


Egg Quality: We have no control over how many eggs a women has, however there is a lot we can do to support egg quality. This deserves its own full post- so stay tuned for this info next week!


Male factor: The male partner is the cause of infertility 40-50% of the time! We often put all of the pressure on women to undergo testing and tracking before at all considering the male factor. Having a semenanalysis done is the best way to determine sperm count and health. There are different ways to address low sperm count, altered morphology (shape), or low motility. The good news is that this is often very treatable once identified. Men should also have a full physical exam to check for varicocele (enlarged veins in the scrotum) which is a major contributing cause to infertility. Sperm are very heat sensitive- so avoid hot tubs, saunas, or setting your laptop directly over your lap. 


I hope this basic review was helpful! There is so much more nuance depending on your specific situation. If you are trying to conceive or planning to try to conceive I'm happy to work with you on an individualized assessment and plan to support fertility.


Happy baby-making!


Dr. Mailloux

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