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    Fertility & Pregnancy Support

    When starting out in your fertility journey, it can become easy to feel overwhelmed with the abundance of information available.  There is no shortage of information on how to become pregnant and maintain a pregnancy.  As the word ‘natural’ is thrown around as a marketing buzzword, let’s not forget that safety should be our first priority.  A supplement or dietary intervention may be deemed more ‘natural’, yet it would not imply its safety or efficacy.

    With that said, achieving and maintaining a pregnancy can be a significant life stressor, as you may be trying to do all that you can, to set yourself up for a successful pregnancy.  If you are feeling overwhelmed, let’s focus on just the aspects that will make a notable difference in your chances for a successful pregnancy, and bringing home a healthy baby.

    HOW TO PREPARE YOUR BODY FOR A FUTURE PREGNANCY

    The best way to prepare for a future pregnancy for most people, likely will not involve an extensive or elaborate plan.  Rather, optimizing your current health status, and assessing for possible concerns that would require additional special care.  If you are wondering what ‘optimal’ health means, here are five questions to ask yourself:

    1. Are you tired all the time? If you are exhausted with brain fog or difficulties focusing, use this as a sign to assess iron status and dive deeper into your dietary habits.  Optimally speaking, you should feel like you have sustained energy throughout the day, not relying on caffeine to power your day.
    2. How is your stress? Trying to conceive can be stressful endeavor, without question.  Spend time reflecting on aspects of your life that may be contributing to increased stress levels.  If we do not adequately support the stress response, we are more likely to see stress manifest physically, with implications on hormonal health and troubles with conception.
    3. When you reflect on your diet, can you say you eat fairly balanced and in moderation? We want to avoid any eating pattern that is overly restrictive, both in the type and amount of food.  Trying to conceive is not the time to significantly restrict calories, as this in itself can suppress our reproductive efforts.
    4. Do you experience any irregular cycles, or significant PMS? Concerns related to menstruation can tell us more about hormonal status, and other fertility concerns that would require special attention.  This brings us to our last point.
    5. Do you have a health concern that requires additional fertility support? Concerns such as PCOS, Hashimoto’s, endometriosis, premature ovarian insufficiency or an autoimmune concern, require special care when trying to conceive.  With any concerns you may have, bring them up with your healthcare provider.

    Here are some fundamental aspects we know to be of benefit, when trying to conceive:  

    1. Supplementing with a prenatal. Taking a prenatal vitamin is associated with a reduction in risk of low birth weight1, as well as a slight reduction in preterm births2. Folic acid is an ingredient within prenatal vitamins, that has shown to reduce the risk of neural tube defects3and congenital heart defects4

    SmartPrenatal is a complete prenatal multivitamin and mineral supplement. SmartPrenatal contains foundational nutrients that offer support for proper growth and development from pre-conception to breastfeeding.

    1. Assessing for Vitamin D status. For those trying to conceive, we need adequate vitamin D levels for numerous fertility reasons.  One in particular, is the impact that vitamin D has on egg count as it improves AMH levels and even prolongs levels as we age6.
    2. Assessing for iron by testing ferritin. We need optimal levels for both fertility and pregnancy, with a minimum level of ferritin no less than 30 ug/L7, with optimal levels above 60 ug/L.
    3. Supporting egg quality. Antioxidant support may come to mind when we think of supporting egg quality.  Aside from supplementation, we must also ensure blood sugar has been adequately controlled, as part of our metabolic health.  When our metabolic health is poor, we see an increase in oxidative species, which has the opposite effect of an antioxidant8.  In other words, we do not want our efforts of consuming an antioxidant-rich diet, to be hindered by suboptimal metabolic health. 
    4. Alcohol should be avoided when trying to conceive. One study showed that women who binge drink (4+ drinks in one occasion) more than twice weekly, showed a 26% lower AMH reading, compared to those who did not binge drink9.
    5. The Mediterranean diet showing benefit when trying to conceive. A40% increased pregnancy rate was seen in those who had a high rate of adherence to the Mediterranean diet10undergoing IVF/ICSI 

    To reiterate, we want to only be adding in dietary and supplemental support that we know will be both safe and effective during the prenatal phase.  If you are not sure if a particular intervention is either safe or effective, it’s always best to err on the side of caution, and seek support from your healthcare provider.

    HOW TO TRACK YOUR CYCLE & TIME OVULATION

    If you are not yet tracking your cycle using a phone app, starting to is a convenient way to assess for patterns over time.  Keeping in mind, your phone app will not be able to tell you when ovulation is happening, unless it is also asking you for this additional information11:

    1. Tracking your cervical mucus. We want to be seeing fluctuations in your cervical mucus, throughout your cycle.  This can give us insight into your estrogen status, as cervical mucus is heavily influenced by estrogen.  Leading up to ovulation, we ideally want to see more of an egg white cervical mucus, that may feel slippery or watery.  This type of mucus is necessary to keep the sperm viable and for a quick transportation towards the egg.
    2. A surge in your LH hormone tells us ovulation is near. LH ovulation predictor kits can be extremely useful for many, trying to pinpoint when ovulation will likely happen, to time intercourse appropriately.  In most cases, ovulation occurs 24-28 hours after an LH surge.  An important consideration for those with PCOS and a high LH to FSH ratio, is to not rely solely on these LH ovulation strips, if you see multiple LH peaks throughout your cycle.
    3. Basal body temperature (BBT) tracking. After ovulation, we will see a slight increase in basal body temperature for the second half of the cycle, until menstruation occurs where we see a drop again until the next ovulation occurs. Pairing BBT tracking with cervical mucus and LH ovulation predictor kits is how we can better pinpoint ovulation.

    HOW TO MANAGE IRREGULAR CYCLES

    It’s important that we address irregular cycles and other menstrual irregularities before we start trying to conceive.  Of particular note, we want to ensure that we have enough progesterone in the second half of the cycle, and that the endometrial lining is able to respond adequately to the progesterone that is being produced.  Under-eating is oftentimes associated with this luteal phase defect12, where we see a direct correlation with not eating enough or having a low body weight, to alterations in the menstrual cycle. 

    When it comes to period pains, there are a few nutrients that have shown to significantly reduce the frequency and severity of menstrual pain:

    • Calcium supplementation for at least two menstrual cycles, showed a significant decrease in intensity of period pain, along with less psychological and mood related PMS symptoms13.
    • Vitamin D has many benefits to fertility and hormonal support, including the reduction in average period pain score once vitamin D deficiencies had been corrected for14.
    • Zinc supplementation for 12 weeks showed an improvement in both the physical and psychological aspects of PMS15.
    • Curcumin has anti-inflammatory benefits, likely responsible for the decrease in period pains16.
    • Vitex,also known as Chaste Tree,is a common herbal supplement used for correcting irregular cycles and reducing period pains, showing a 2.5 times greater rate of PMS remission, compared to those not supplementing with vitex17. It’s important to note that since vitex is an herb with significant potential to alter the menstrual cycle, special caution should be put in place for those trying to conceive, as it should be used under the supervision of a healthcare provider.
    • To get your cycles back on track, try Cyclesmart. It contains Chaste Tree which has been used in herbal medicine as a hormone normalizer, to stabilize menstrual cycle irregularities. Cyclesmart can not be taken during pregnancy.
    • Inositolis considered by many to be the most beneficial supplement for polycystic ovary syndrome (PCOS), with numerous benefits including improving insulin sensitivity18. Two out of the three criteria must be met, for a diagnosis of PCOS19, (1) irregular cycles, cycles longer than 32 days in length or less than 10 periods per year, (2) elevated testosterone on lab work, or the presence of testosterone symptoms such as facial hair growth, hair loss on the top of the head, or cystic acne, and (3) the presence of cysts on ultrasound. Glucosmartby Smart Solutions offers D-chiro-inositol and helps manage PCOS symptoms by reducing serum testosterone and promoting normal ovulation.

    HOW TO SUPPORT A HEALTHY PREGNANCY

    Here are some nutrients we want to support during pregnancy:

    • Ensuring sufficient calcium intake through diet, to prevent maternal bone resorption and a lower bone density for the offspring20.
    • Addressing magnesium deficiency symptoms common during pregnancy, such as constipation and muscle cramping. Magnesium supplementation during pregnancy, has also been shown to potentially help reduce preterm birth21.
    • To ensure we get the full health benefits of vitamin D, testing should continue during pregnancy. Initial investigation into vitamin D status should begin during the preconception phase22.
    • Ginger in supplement form, has been shown to significantly lessen nausea symptoms. Ginger is included in SmartPrenatal to aid in nausea relief.
    • Heartburn is a common occurrence for many during pregnancy, which can be alleviated by consuming more frequent and smaller meals, and less peppermint, chocolate, and caffeine.23

    Most importantly, continue to see your healthcare provider for routine blood work and physical exams, to ensure we are not missing anything crucial, and your pregnancy remains as healthy as can be.

    REFERENCES

    1. Goto E. (2019). Effectiveness of Prenatal Lipid-Based Nutrient Supplementation to Improve Birth Outcomes: A Meta-analysis. The American journal of tropical medicine and hygiene101(5), 994–999. https://doi.org/10.4269/ajtmh.19-0287
    2. Keats, E. C., Haider, B. A., Tam, E., & Bhutta, Z. A. (2019). Multiple-micronutrient supplementation for women during pregnancy. The Cochrane database of systematic reviews3(3), CD004905. https://doi.org/10.1002/14651858.CD004905.pub6
    3. Grosse, S. D., & Collins, J. S. (2007). Folic acid supplementation and neural tube defect recurrence prevention. Birth defects research. Part A, Clinical and molecular teratology79(11), 737–742. https://doi.org/10.1002/bdra.20394
    4. Cheng, Z., Gu, R., Lian, Z., & Gu, H. F. (2022). Evaluation of the association between maternal folic acid supplementation and the risk of congenital heart disease: a systematic review and meta-analysis. Nutrition journal21(1), 20. https://doi.org/10.1186/s12937-022-00772-2
    5. Zhang, M. M., Zou, Y., Li, S. M., Wang, L., Sun, Y. H., Shi, L., Lu, L., Bao, Y. P., & Li, S. X. (2020). The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Translational psychiatry10(1), 193. https://doi.org/10.1038/s41398-020-00886-3
    6. Grzechocinska, B., Dabrowski, F. A., Cyganek, A., & Wielgos, M. (2013). The role of vitamin D in impaired fertility treatment. Neuro Endocrinology Letters, 34(8), 756–762.
    7. Garcia-Casal, M. N., Pasricha, S. R., Martinez, R. X., Lopez-Perez, L., & Peña-Rosas, J. P. (2021). Serum or plasma ferritin concentration as an index of iron deficiency and overload. The Cochrane database of systematic reviews5(5), CD011817. https://doi.org/10.1002/14651858.CD011817.pub2
    8. Gu, L., Liu, H., Gu, X., Boots, C., Moley, K. H., & Wang, Q. (2015). Metabolic control of oocyte development: linking maternal nutrition and reproductive outcomes. Cellular and molecular life sciences : CMLS72(2), 251–271. https://doi.org/10.1007/s00018-014-1739-4
    9. Hawkins Bressler, L., Bernardi, L. A., De Chavez, P. J. D., Baird, D. D., Carnethon, M. R., & Marsh, E. E. (2016).Alcohol, cigarette smoking, and ovarian reserve in reproductive-age AfricanAmerican women. American Journal of Obstetrics and Gynecology, 215(6), 758.e1- 758.e9.https://doi.org/10.1016/j.ajog.2016.07.012
    10. Vujkovic, M., de Vries, J. H., Lindemans, J., Macklon, N. S., van der Spek, P. J., Steegers, E. A. P., & Steegers-Theunissen, R. P. M. (2010). The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertility and Sterility, 94(6), 2096–2101.https://doi.org/10.1016/j.fertnstert.2009.12.079
    11. Su, H. W., Yi, Y. C., Wei, T. Y., Chang, T. C., & Cheng, C. M. (2017). Detection of ovulation, a review of currently available methods. Bioengineering & translational medicine2(3), 238–246. https://doi.org/10.1002/btm2.10058
    12. Koltun, K. J., De Souza, M. J., Scheid, J. L., & Williams, N. I. (2020). Energy Availability Is Associated With Luteinizing Hormone Pulse Frequency and Induction of Luteal Phase Defects. The Journal of Clinical Endocrinology and Metabolism, 105(1).https://doi.org/10.1210/clinem/dgz030
    13. Arab, A., Rafie, N., Askari, G., & Taghiabadi, M. (2020). Beneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature. International journal of preventive medicine11, 156. https://doi.org/10.4103/ijpvm.IJPVM_243_19
    14. Arab, A., Golpour-Hamedani, S., & Rafie, N. (2019).The Association Between Vitamin D and Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Current Literature. Journal of the American College of Nutrition38(7), 648–656.https://doi.org/10.1080/07315724.2019.1566036
    15. Jafari, F., Amani, R., & Tarrahi, M. J. (2020).Effect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Biological trace element research194(1), 89–95.https://doi.org/10.1007/s12011-019-01757-9
    16. Bahrami, A., Zarban, A., Rezapour, H., Agha Amini Fashami, A., & Ferns, G. A. (2021). Effects of curcumin on menstrual pattern, premenstrual syndrome, and dysmenorrhea: A triple-blind, placebo-controlled clinical trial. Phytotherapy research : PTR35(12), 6954–6962. https://doi.org/10.1002/ptr.7314
    17. Csupor, D. et al (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary therapies in medicine, 47, 102190.https://doi.org/10.1016/j.ctim.2019.08.024
    18. Facchinetti, F., Orrù, B., Grandi, G., & Unfer, V. (2019). Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology35(3), 198–206. https://doi.org/10.1080/09513590.2018.1540578
    19. Williams, T., Mortada, R., & Porter, S. (2016). Diagnosis and Treatment of Polycystic Ovary Syndrome. American family physician94(2), 106–113.
    20. Tihtonen, K., Korhonen, P., Isojärvi, J., Ojala, R., Ashorn, U., Ashorn, P., & Tammela, O. (2022). Calcium supplementation during pregnancy and maternal and offspring bone health: a systematic review and meta-analysis. Annals of the New York Academy of Sciences1509(1), 23–36. https://doi.org/10.1111/nyas.14705
    21. Zhang, Y., Xun, P., Chen, C., Lu, L., Shechter, M., Rosanoff, A., & He, K. (2021). Magnesium levels in relation to rates of preterm birth: a systematic review and meta-analysis of ecological, observational, and interventional studies. Nutrition reviews79(2), 188–199. https://doi.org/10.1093/nutrit/nuaa028
    22. Hollis, B. W., & Wagner, C. L. (2022). Substantial Vitamin D Supplementation Is Required during the Prenatal Period to Improve Birth Outcomes. Nutrients14(4), 899. https://doi.org/10.3390/nu14040899
    23. Gregory, D. S., Wu, V., & Tuladhar, P. (2018). The Pregnant Patient: Managing Common Acute Medical Problems. American family physician98(9), 595–602.
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