I'm going to dive into the topic of what to focus on in the 3-6 months before you start trying to conceive aka preconception health. I'm really passionate about women's health and specifically fertility and preconception health. I've worked with many women trying to get pregnant and women struggling to get pregnant. It's a period that can leave you feeling like you have no control. Focusing on your health, through nutrition and lifestyle changes, can empower women. It gives you something you CAN control that can ultimately have a HUGE impact on your health and the health of your future baby. In this article, I'll share the 5 pillars of fertility that I work on with clients in my practice - the top things to focus on in the 3-6 months before trying to get pregnant to improve your chance of conceiving and having a healthy pregnancy.
While I work most often with women and this article is more female-focused, it is worth noting that most of this is equally relevant, important and beneficial for male fertility so share it with your partners and the men in your life!
What is preconception health?
What exactly am I referring to when it comes to preconception health and what exactly are we hoping to improve with nutrition and lifestyle changes? Put simply: egg and sperm quality! Eggs and sperm both take ~3-4 months to mature, meaning the changes you make now have the most impact on your egg and sperm health in about 90-100 days. You have an incredible window of ~100 days before you get pregnant to make simple changes that can boost your fertility, increase your odds of a healthy pregnancy and impact your future child's health. These changes can also help women achieve a regular cycle, ovulation, and a healthy and receptive uterine lining -- all things necessary for pregnancy! And for men, these changes can directly influence sperm parameters such as count, motility and morphology.
Why is preconception health important?
Focusing on preconception health can increase your likelihood of getting pregnant, staying pregnant and having a healthy pregnancy. It can also help prevent a lot of potential issues - nutrient status, diet, and lifestyle all influence outcomes for mom and baby such as infertility, miscarriage risk, neural tube defects, gestational diabetes, gestational hypertension, risk of preterm birth, and perinatal and postpartum depression. As far as fertility statistics go, about 15% of couples will have trouble conceiving, about 9% of men and 10% of women reported infertility problems in the US and the use of assisted reproductive technology (ART) such as in-vitro fertilization (IVF) is increasing by 5-10% per year.
5 Pillars of Fertility
Preconception health is multi-faceted and there are typically many pieces to the puzzle for each person. When I start working with a fertility client, whether they are just coming off of birth control or in the middle of fertility treatments, there are 5 components of their health that I assess and support depending on their health history.
The 5 pillars of fertility are:
Overall dietary pattern
Overall Dietary Pattern
There is a significant amount of evidence that dietary pattern plays a role in hormone health. fertility and pregnancy outcomes. A few clear patterns in research show that overall macronutrient composition, the Mediterranean diet, antioxidants and omega-3 fatty acids are all key areas to focus on when thinking about dietary pattern and changes to best support preconception health.
Overall macronutrient composition is the balance of carbohydrates, protein and fats in your diet. A great place to start with this is following my balanced plate method:
While macronutrient composition is important, quality and what you're eating in each category is equally as important. This is where the Mediterranean diet is helpful. It emphasizes minimally processed foods, fish, olive oil, legumes and veggies and can naturally be high in antioxidants and omega-3 fatty acids. In a study of women undergoing IVF, those that followed the Mediterranean diet for 3-6 months prior to their cycle were 40% more likely to become pregnant.  For more information on the Mediterranean diet, check out my article here.
Metabolic health is your body's ability to make energy from the food that you eat and support organ function. This involves your body's ability to maintain optimal levels of blood sugar, insulin, weight, body composition, blood lipids (cholesterol) and blood pressure. Any disruption in these metabolic processes can result in insulin resistance, abdominal obesity, hypertension, elevated blood lipids and has been shown to disrupt hormones and fertility. What you eat directly influences metabolic health. Bloodwork and labs can be a great starting point to help you understand your metabolic health status. These labs include: fasting glucose, fasting insulin, hemoglobin a1c, cholesterol, triglycerides and blood pressure.
There are key vitamins and nutrients that play a role in fertility and support blood sugar, gut health, detoxification, hormones, menstruation, ovulation, thyroid function, immune function, and egg and sperm maturation. If any of the aforementioned processes are out of balance, a nutrient deficiency may be contributing. Getting lab work can help inform how we can optimize levels through both food and supplementation. I offer both bloodwork as well as functional testing options in my practice to access nutrient status. Here are a few critical preconception vitamins/nutrients to assess:
Omega-3 Fatty Acids
I also recommend that everyone thinking about conceiving start a high quality prenatal vitamin ideally at least 3 months before trying to get pregnant. My recommended prenatal is FullWell - they make both a male and female formulation! You can use discount code "ABBY" for 10% off your first order.
Hormone health is closely linked to gut health. The gut microbiome influences your hormone levels, menstrual cycle, ovulation, thyroid, detoxification, mood, immune system and nutrient status. For example, estrogen imbalances can lead to conditions such as PCOS or endometriosis, two conditions that directly affect pre-conception health, and estrogen levels are metabolized and regulated by gut bacteria. By improving gut health, we can often improve estrogen levels and overall hormone balance.
A great place to start to assess your own gut health is to begin to monitor signs and symptoms such as: bloating, indigestion, gas, constipation, diarrhea, skin concerns, difficulty losing weight, sensitivity to foods/chemicals/caffeine/alcohol. Any of these symptoms would warrant further investigation/support and potentially further testing.
There are 4 major lifestyle factors that influence fertility:
Toxin and paraben exposure can directly affect hormones and pre-conception health. Toxins include alcohol, cigarettes, and pesticides. Parabens are chemicals used in cosmetics and pharmaceuticals. Minimizing these exposures can be hugely beneficial for fertility and overall health.
Stress management is important for lowering stress hormones, such as cortisol. Try incorporating meditation, mindfulness, breathwork, or yoga into your daily routine.
For movement, it's important to find the right balance and intensity for you. Research is mixed on exactly how much and how intense your movement should be. Regular, moderate exercise seems to be most beneficial for fertility outcomes while too much vigorous exercise may actually decrease fertility. 1-5 hours of moderate exercise/week seems to be most beneficial for fertility outcomes.  Of course what is considered to be 'moderate exercise' is very individualized. Work with your health practitioner to determine what is moderate for you.
Sleep is critical for hormone balance, ovulation, and sperm health, and just about everything else in life. Aim for 7 hours or more of sleep consistently per night. Check out my article "Top Tips for Optimizing Sleep" here for more info on sleep!
Wherever you are in your own fertility journey, I know that it can be exciting, overwhelming, stressful and emotional. My goal is to support and empower women and men at all stages of the process.
If you have any questions, please send me an email at firstname.lastname@example.org. You can learn more about my one-on-one coaching services here and/or schedule a free consult call here. I would love to support you!
 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;94(6):2096–101.
 McKinnon, C., Hatch, E. et al. Body Mass Index, Physical Activity and Fecundability in a North American Preconception Cohort Study. Fertil Steril. 2016.