Although there are fertility issues from a male perspective, this article focuses on women who are trying to conceive.
Infertility is defined as the inability to become pregnant after one year of trying, although it is recommended that a woman older than 35 discuss fertility with her physician after six months of trying to conceive. On average, 30 percent of couples trying to conceive become pregnant in about one month; 60 percent become pregnant within three months and 80 percent within six months. On the other hand, 10-18 percent of couples have difficulty conceiving.
The necessary steps to becoming pregnant, naturally
For a natural pregnancy to occur, a woman must first release an egg during ovulation. Ovulation typically lasts one day and is in the middle of a female’s cycle, which is about two weeks before she can expect to start her period. An egg passes down the fallopian tube toward the uterus where it can be fertilized with sperm. If the egg is successfully fertilized, then it must become implanted in the uterine wall.
In addition to the timing of ovulation, there are many female hormones related to this process that, if not at normal levels, can adversely impact the likelihood of becoming pregnant. These hormone levels can be checked and monitored by you and your health-care practitioner:
- Follicle-stimulating hormone (FSH) stimulates your ovaries to release one egg each month. A higher than normal FSH level can cause fertility issues. The best time of the month to check your FSH level is on day three of your cycle (day one being the day you start your period).
- Luteinizing hormone (LH), when it is elevated during the month, triggers ovulation and signals the corpus luteum to secrete progesterone, which preps the uterine lining for the possibility of implantation and pregnancy.
- Progesterone, a hormone released from the corpus luteum in the ovary, is responsible for several physiological functions depending on whether the egg is fertilized.
- Estradiol, a form of estrogen controlled by the ovarian follicles, thickens the walls of the uterus in case there is an embryo implantation. Estrogen levels naturally decrease as a woman approaches menopause, which can be a cause of infertility.
- Testosterone, usually thought of as a male hormone, is necessary for females too because it plays a role in stimulating the release of an egg from the ovarian follicles. Lower testosterone levels occur with aging, along with several other hormones, and is seen in women having difficulty conceiving. DHEA levels, a precursor to testosterone, may also be low and contribute to fertility issues.
- Anti-müllerian hormone (AMH) is a measure of a woman’s remaining egg reserve. The more ovarian follicles a woman retains as she ages, the more AMH she will produce.
Signs you could have fertility issues
An irregular menstrual cycle is a classic sign of potential problems with fertility. The average cycle is 28 days, plus or minus a day or two, but the key is personal regularity – what is normal for you? Having no menstrual cycle, or a change in cycle duration, can be a sign of abnormal hormone levels, too much exercise or stress, malnutrition, or a condition called polycystic ovary syndrome (PCOS).
A painful or heavy period can be a sign of endometriosis, a condition where the uterine lining is growing into the pelvic region outside of the uterus. Endometriosis is usually associated with pain and discomfort throughout the month or during intercourse and results in unfavorable implantation.
Other hormone fluctuating symptoms can arise, including changes in libido, hair growth or loss, skin changes, or weight gain, and can often be evaluated with simple lab tests.
It is estimated that one-third of infertility cases are related to female issues, one-third are related to male issues (for example, a low sperm count), and one-third are unspecified or a combination of male/female issues.
How to be healthy when trying to conceive
Men and women should focus on practicing healthy habits when trying to conceive and maintaining these healthy habits throughout a pregnancy.
Obtain and maintain a healthy body weight.
Being too overweight or underweight can negatively affect the likelihood of becoming pregnant and of having a healthy pregnancy. Overweight women have a higher incidence of menstrual dysfunction. Overweight and obese women are at higher risk for reproductive health issues including infertility, lower conception rates, miscarriage, and pregnancy complications.1 For men, emerging research shows obesity impacts reproductive potential by reducing sperm quality and altering the physical and molecular structure of cells in the testes and ultimately mature sperm. Male obesity also impairs offspring metabolic and reproductive health. It is thought that health cues are transmitted to children most likely via the sperm.2
Evaluate caffeine intake.
Abstaining from caffeine during pregnancy is recommended because of caffeine’s unknown effects on mom and baby, although women may also want to cut down its intake before conceiving. There is evidence that suggests spontaneous miscarriage rates increase with daily caffeine intake at or above 200-300 mg.3 The latest research suggests some men can also experience negative reproductive effects from excessive caffeine intake, including decreased semen volume, sperm count, and concentration, resulting in prolonging time to conception.4
Begin an exercise routine before pregnancy and continue it throughout pregnancy. A consistent exercise routine can improve fertility in women, including women with PCOS and who are overweight.5 Similarly, research reveals that one hour, three times a week, of low-to-moderate intensity exercise can reduce the risk of miscarriage6 and increase implantation and live birth rates.7 During pregnancy, exercise provides benefits for mom and baby. Mothers-to-be will see a reduced risk of excessive weight gain, gestational diabetes, preeclampsia, preterm birth, varicose veins, and deep vein thrombosis,8 while babies tend to be of a healthier birth weight and continue to experience benefits throughout childhood.
While it is recommended to avoid alcohol during pregnancy, you might also help fertility by avoiding it pre-conception. Alcohol intake is associated with reduced testosterone, LH, and FSH levels in women, and decreased rate of sperm production, gonadal atrophy, impotence, and infertility in men. The higher the alcohol intake, the more likely the negative consequences for fertility.9
Sleep more soundly and keep stress to a minimum.
Research suggests sleep disturbances and stress can contribute to infertility by negatively affecting hormone levels, particularly those that influence natural circadian rhythms.10 The best solution is to minimize stress and try to establish a normal sleep pattern – ideally high-quality sleep for at least eight hours nightly to help stabilize hormones, metabolism, mood, and energy levels.
And don’t forget your prenatal multi-vitamin.
If you have the leisure of planning ahead, then it is recommended to start taking a prenatal multi-vitamin six months before conception and continue it throughout pregnancy and breastfeeding. The Mayo Clinic, American Pregnancy Association, and others suggest supplementing an otherwise healthy diet with additional folic acid to prevent neural tube birth defects and iron to support normal growth and development.
Because a certain percentage of the population has a genetic variance that can interfere with converting folic acid to its active form 5-MTHF, Thorne recommends including this active, tissue-ready form of folate in a preconception and pregnancy supplement regimen. Other vitamins and minerals are also recommended, including vitamins D, C, A, and E, iodine, calcium, and magnesium. An omega-3 fatty acid supplement, containing EPA and DHA, can also be included, particularly if you do not eat a lot of fish.
- Dağ Z, Dilbaz B. Impact of obesity on infertility in women. J Turk Ger Gynecol Assoc 2015;16(2):111-117.
- Palmer N, Bakos H, Fullston T, Lane M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis 2012;2(4):253-263.
- Lyngsø J, Ramlau-Hansen C, Bay B, et al. Association between coffee or caffeine consumption and fecundity and fertility: a systematic review and dose-response meta-analysis. Clin Epidemiol 2017;9:699-719.
- Ricci E, Viganò P, Cipriani S, et al. Coffee and caffeine intake and male infertility: a systematic review. Nutr J 2017;16(1):37.
- Rich-Edwards J, Spiegelman D, Garland M, et al. Physical activity, body mass index, and ovulatory disorder infertility. Epidemiology 2002;13(2):184-190.
- Rao M, Zeng Z, Tang L. Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reprod Biol Endocrinol 2018;16(1):11.
- Kucuk M, Doymaz F, Urman B. Effect of energy expenditure and physical activity on the outcomes of assisted reproduction treatment. Reprod Biomed Online 2010;20(2):274-279.
- Evenson K, Barakat R, Brown W, et al. Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med 2014;8(2):102-121.
- Gude D. Alcohol and fertility. J Hum Reprod Sci 2012;5(2):226-228.
- Kloss J, Perlis M, Zamzow J, et al. Sleep, sleep disturbance, and fertility in women. Sleep Med Rev 2015;22:78-87.