Whether or not a couple is struggling to conceive, proper preparation for pregnancy is essential to ensure that the health of their baby is maximized. When a couple has had difficulty conceiving or carrying to term, preconception care can make all the difference.
Several lifestyle factors have been identified which can promote optimal fertility, including dietary behaviors, stress management, and maintenance of a healthy weight. In addition, adequate nutrient status can influence not only the ability to get pregnant, but the health of the egg and sperm, and thus the health of the child born to those parents. The following interventions can greatly influence fertility, and it is recommended that all couples trying to conceive consider these interventions, whether they have trouble with fertility or not.
The Mediterranean diet is a dietary recommendation based off of the traditional dietary patterns of Crete and the rest of Greece, southern Italy, and southern France[i]. The diet emphasizes an abundance of plant foods, especially fruits and vegetables, and a low intake of red meat. Generally, fat makes up 25-35% of total calories, with low intake of saturated fats and high intake of monounsaturated fats such as that in olive oil and omega-3 fats such as in fish. The primary fat consumed in this diet comes from fish, poultry, and olive oil. The diet is high in legumes and whole grains and suggests low to moderate consumption of dairy products and red wine.
The Mediterranean diet has, of course, been studied for its positive effects on cardiovascular disease and overall mortality.[ii] It has been researched for its effects on diabetes, depression, cognitive function, cancer, weight loss, and much more.[iii] Of note here is the diet’s effect on fertility. Observation of 2,154 Spanish women aged 20-45 years showed that those women with the greatest adherence to a Mediterranean diet pattern (versus western diet) showed the lowest difficulty of getting pregnant.[iv] Additionally, a 2010 study of 161 Dutch couples undergoing in-vitro fertilization (IVF) or in-vitro fertilization with intracytoplasmic sperm injection (IVF with ICSI) found that Mediterranean diet adherence increased the probability of pregnancy (odds ratio 1.4).[v] Mediterranean diet adherence was also associated with higher folate and vitamin B-6 levels in red blood cells and in follicular fluid in the same study.
Dietary approaches should also support a couple getting into a healthy weight to maximize fertility.
A prenatal multivitamin provides key nutrients necessary for both mom and baby throughout fetal development. These include iron, calcium, folate, and zinc. Studies have demonstrated significantly improved pregnancy rates in women on multiple micronutrient supplements compared to folic acid alone. (66.7% versus 39.3% achieved conception after 3 menstrual cycles, 60% versus 25% ongoing pregnancy rate).[vi] Consumption of a prenatal multivitamin has also been associated with significantly improved birth outcomes compared to consumption of folic acid and iron alone, including healthier birth weight of babies, and decreased rate of stillborn and miscarriage. A nonsignificant trend of decrease in neonatal deaths has also been observed.[vii] The same study also reported, not surprisingly, that mothers who took a prenatal vitamin had better micronutrient status postpartum.
Fish oil is another key supplement to include in a preconception protocol for every couple who is contemplating pregnancy in the next 6 months. It has been observed that fertile men tend to have higher blood and sperm levels of omega 3 fatty acids as well as lower serum ratios of omega 6 to omega 3 compared with infertile men.[viii] Fish oil supplementation has also been correlated with increased superoxide dismutase (SOD)-like and catalase-like activity, which both demonstrate an increased ability to withstand oxidative stress, as well as positive nonsignificant improvements in sperm motility and morphology. [ix]
While there are many additional interventions to support a couple through preconception, the most essential include the consistent use of a prenatal vitamin and fish oil in conjunction with the Mediterranean Diet.
[i] Kushi, LH, Lenart, EB, Willett, WC. Health implications of Mediterranean diets in light of contemporary knowledge. Am J Clin Nutr. 1995 Jun;61(6 Suppl):1407S-1427S.
[ii] Knoops KT, deGroot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004 Sept 22;292(12):1433-9.
[iii] Martinez-Gonzales MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ;336(7657):1348-51.
[iv] Toledo E, Lopez-del Burgo C, Ruiz-Zambrana A et al. Dietary patterns and difficulty conceiving: a nested case-control study. Fertil Steril. 2011 Nov;96(5):1149-53.
[v] Vujkovic M, de Vries JH, Lindemans J et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril. 2010 Nov;94(6):2096-101.
[vi] Agrawal R, Burt E, Gallagher AM, et al. Prospective randomized trial of multiple micronutrients in subfertile women undergoing ovulation induction: a pilot study. Reprod Biomed Online. 2012 Jan;24(1):54-60.
[vii] Sunawang, Utomo B, Hidayat A et al. Preventing low birth weight through maternal micronutrient supplementation: a cluster-randomized, controlled trial in Indramayu, West Java. Food Nutr Bull. 2009;30(4 Suppl):S488-95.
[viii] Safarinejad MR, Hosseini SY, Fafkhah F, et al. Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr. 2010 Feb;29(1):100-5.
[ix] Sarafinejad MR. Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic antioxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: a double-blind, placebo-controlled, randomized study. Andrologia. 2011 Feb;43(1):38-47.
By Jaclyn Chasse, ND