The Do's & Don'ts Of Boosting Fertility, According To Women's Health Experts
As a fertility expert and gynecologist, I've probably been asked every question under the sun when it comes to fertility. The decision to start a family is likely the most important you will ever make. And yet, there is still so much confusion and misconception surrounding the topic of fertility. Over the years, I've sat before many individuals who are in tears, fearing that it was something they did or didn't do that caused their infertility or miscarriage. But I can say with confidence: It is almost never your fault.
Here, along with my colleague and fellow reproductive endocrinologist Jaime Knopman, M.D., I'm going to debunk a few widespread fertility myths and share the science-backed do's and don'ts that will actually help you conceive.
Do: Experiment with Eastern medicine.
As Western-trained physicians, we were taught to focus on the reproductive system in isolation. Western medicine is compartmentalized, and there is a specialist for everything. However, we have met many talented clinicians and practitioners who practice all types of medicine, including traditional Chinese medicine. We have been awed by their knowledge, amazed by their patience, and impressed by their skill. We have learned that what you eat really matters, that meditation is more than humming in a dark room, and that acupuncture is more than a bunch of needles. In fact, several studies suggest improved pregnancy rates when acupuncture is combined with a traditional Western fertility treatment like in vitro fertilization (IVF).
Whether you are contemplating starting a family or in the thick of your fertility journey, meeting with an Eastern specialist can be super-useful. They will review your menstrual, bowel, sleep, and eating patterns with you and help you understand how your body functions. Sometimes just the education helps you conceive. We feel strongly that it's important for all practitioners—Eastern and Western—to work as one and listen to each other's opinions to optimize fertility.
Don't: Blame yourself.
In a large study, more than 50 percent of women reported that infertility was the most upsetting experience of their lives. It was likened to a cancer diagnosis. After a failed cycle, most women reported feelings of depression, anxiety, anger, and isolation. They start to point fingers all over but most forcibly at themselves. This blame can affect one's ability to move on and resume fertility treatment. In fact, while it has always been assumed that the individuals who stop fertility treatment do so for financial or medical reasons, data shows that it is actually the emotional stress of the situation.
What is even more of a bummer is that, for most women, the longer you stay in the game, the better your chances are of scoring. So work with a fertility expert, explore Eastern medicine, and seek out the support you need to stick with it if you want to have a baby.
Don't: Smoke or vape (including marijuana).
We all know nothing good can come out of lighting up. Years of data have shown that smoking cigarettes can lead to infertility and early menopause. In fact, women who smoke will go through menopause one to four years earlier than nonsmoking women. Additionally, women who smoke are more likely to miscarry once pregnant, as the chemicals in cigarettes can damage the DNA inside your egg. Needless to say, the same goes for the sperm—so men should avoid smoking too. Plus, women who live with smokers have higher rates of infertility and lower success rates with fertility treatments like IVF.
Now more than ever, we're getting loads of questions about the impact of smoking marijuana and vaping on fertility. While there is little information on vaping available, marijuana use has been associated with decreased sperm count. As a general rule, we recommend both parties abstain from smoking and vaping when trying to conceive, and certainly once pregnant.
Do: Enjoy your morning coffee or matcha.
While caffeine has been deemed the devil in many forums for women struggling with fertility, there is only modest medical data to support this notion. Again, that age-old adage "everything in moderation" is key. Moderate caffeine consumption, defined by the American Society of Reproductive Medicine as one to two cups of coffee a day (or the equivalent of about 100 to 200 mg per day), does not appear to increase a woman's risk of infertility or poor pregnancy outcome. Five cups or more, on the other hand, might. So as long as you're not drinking to excess, don't stress about that morning latte.
Don't: Stress too much about that glass of wine.
Alcohol has been lauded and lambasted when it comes to health issues. And many reproductive-age women find themselves wondering: Does a glass of red a day really keep the baby away? The answer: Unless you have a really heavy hand, it probably doesn't. While alcohol in excess is a no-no for a pregnant woman, there is not much data out there on what it does (if anything) to one's fertility. It has not been shown to decrease egg quantity or quality. Additionally, it has no impact on a woman's ability to ovulate, the function of her fallopian tubes, or her partner's sperm. In moderation, it hasn't been clearly linked to infertility or miscarriage either. And while we'd never tell you to booze up to boost fertility, some studies have shown that women who drank wine conceived at a faster rate than those who didn't.
Do: Get familiar with your cycle.
Fertility tracking apps can be incredibly helpful to individuals and couples who are just starting their baby-making journey. In fact, it may even be advantageous to start using a menstrual tracker in advance of when you want to conceive, as many of these apps become more accurate with the more data they have.
While there are dozens of options to choose from, almost all are based on the basic principles of what we have traditionally called the Fertility Awareness Method (FAM). FAM helps identify your fertile "window" based on the following: your period length, changes in cervical mucus, changes in cervical position, and your basal body temperature (early morning body temp). Some apps, like Clue, ask you to fill in data on your menstrual period, mood, and energy levels while others, like Kindara, take things a step further and pair with a wireless basal body temperature thermometer. By using these various data points, the app will help identify the optimal time to have intercourse to conceive.
While these apps can be super-helpful, I caution women that they are not always 100 percent accurate, particularly if you have irregular menses or ovulation. (They can, however, be a useful tool in determining whether your cycle is irregular or not.) Additionally, they can't replace both the diagnostic and therapeutic tools that we have as fertility specialists. If you are under 35 and have been trying for over a year, if you are over 35 and have been trying for over six months, or if you have erratic or irregular cycles, you should consider seeing a specialist.
Don't: Gain too much or lose too much.
Extremes on the scale, both up and down, can be detrimental to your fertility. In both scenarios, you may develop irregular menstrual cycles and even stop ovulating. Obesity is associated with a host of medical conditions, including diabetes and estrogen dominance, that can throw off your hormones and make conception more challenging—and, once pregnant, increase risk for you and the baby. Studies show that women with a body mass index (BMI) in the obese range have lower success with fertility treatments as well. The good news: Research shows that losing 5% to 10% of your body weight can improve fertility outcomes—that's as little as 7.5 pounds for a 150-pound woman.
Similarly, being underweight can be disruptive to your fertility. Your body is smart and knows when you don't have enough resources (calories and nutrients) to support a pregnancy, and therefore it stops ovulating (and you stop having a period, known as hypothalamic amenorrhea), so it can direct your finite resources to more critical bodily functions. But even before extreme cases where ovulation stops, women may notice shorter cycles, longer cycles, and lighter bleeding. Men aren't immune to the weight issue either—sperm can also be negatively affected by fluctuations in weight.
Do: Keep exercising.
Exercise, in the majority of cases, is a really good thing for your heart, your lungs, your brain, and your baby's future home (your reproductive system)—and even suggesting that exercise is causing one's fertility problem is unfairly placing fault and blame on women. So keep on moving!
And yes, it's true that when exercise becomes excessive, your body senses that the environment is not ideal for pregnancy and stops releasing an egg. But amenorrhea is not the norm, and it's actually fairly uncommon for those of us who engage in exercise, even daily exercise. "Excessive" is hard to define because one size certainly does not fit all. However, when exercise is associated with progressive weight loss and symptoms like hair loss and fatigue, it has gone too far.
Do: Clean up your diet (if you haven't already).
If you are thinking of conceiving, this is the perfect time to start focusing on your food. While there is no "magic" fertility diet, we do know that a diet that is good for your heart, lungs, and brain will be good for your reproductive organs as well. Inflammatory foods (think: gluten, added sugars, and highly processed fats like soybean oil) can exacerbate inflammation in the pelvis, which is related to conditions that can affect fertility like endometriosis. As a general rule, avoid foods that can sit on your shelves for months (or even years!), and steer clear of anything artificial—meaning, go for the butter over the butter-flavored cooking spray every time. These foods can also worsen menstrual cramps and bleeding.
So what should you eat? Common sense is what we preach: fresh fruits, veggies, organic lean meats, and fish—basically, a Mediterranean diet. Whether you are pregnant or considering pregnancy, vitamins are a good thing too. Despite our best efforts to maintain a well-balanced diet, we're usually missing something. A good prenatal is chock-full of essential nutrients (for both you and your baby) that should cover what your diet might miss.
Don't: Skimp on sleep.
While we don't want to sound like your mother, we are going to tell you now is the time to catch some good zzzz's. In fact, your sleep regimen is proving to be just as important for weight loss as your diet and exercise habits. We are also confident that research will soon show healthy sleep habits are correlated with improved fertility. So put away your phone, pick up a book, light a candle, and let your body decompress. Your goal should be seven-plus hours a night.
Do: Use a fertility-friendly lube.
Lubricants can actually be a pretty slippery slope (no pun intended!). Some lubricants inhibit sperm survival and mobility and should be on the "no-buy" list when a couple is actively trying to conceive. Although lubricants are not contraception (with the exception of spermicides containing Nonoxynol-9) and cannot reliably prevent pregnancy, we do recommend that couples trade in their standard lubricant for something more sperm-friendly if they're trying to get pregnant. Pre-Seed and Conceive are both good pH-balanced lubes that mimic your cervical mucus, and even canola oil will do the trick without stopping his swimmers.
As a final word of advice—if you are on this journey, arm yourself with a trusted team. They will make sure you keep moving forward.
Want your passion for wellness to change the world? Become A Functional Nutrition Coach! Enroll today to join our upcoming live office hours.