The Definitive Guide to
Preconception
If you want to get pregnant, you need to read this guide. We worked hard to include all the juicy information we wished we’d had available when we started our preconception journeys—like what to eat (and not to eat), what toxins to avoid, what our partners could do to optimize their fertility…and loads more.
Don’t have time to read the entire guide right now?
Contents
Your Preconception Journey
- If you are embarking on or have recently embarked on the journey to motherhood - welcome!
- We are board-certified family medicine physicians who practice functional medicine. And we’re moms of 3 (each!!), so we’ve been right where you are - lots of times. And it’s overwhelming! It feels like there’s so much to take into account before you take the baby-making leap.
- And truthfully, when the two of us started our respective preconception journeys, even though we were medical doctors, there was a huge chasm of useful information that was missing. We felt lost - and we’re medical doctors!!!!
- This guide is the culmination of a combined 14 years of academic medical training, 23 years of clinical practice, 30 years of scouring medical literature, 20 years of clinical experience in functional and integrative medicine, 8 pregnancies, 2 miscarriages, 6 births, and almost a decade of mamihood between the two of us.
- We hope you find tons of value in our guide - we put all the juicy information that we wished we’d had available when we started our own preconception journeys.
CHAPTER 1
Your preconception journey
Welcome! We are doctors Alejandra Carrasco, M.D. and Christine Maren, D.O.
We’re here to provide a safe, science-based space where conscientious women can find information about their most burning preconception health and wellness questions.
This guide will walk you through everything you need to know to optimize your fertility and set the stage for a healthy pregnancy.
Welcome!
If you are embarking on the journey to motherhood congratulations and welcome!
We are doctors Alejandra (Alex) Carrasco M.D. and Christine Maren D.O., board-certified family medicine physicians who practice functional medicine. We’re also mamis of 3 (each), so we’ve been right where you are many, many times.
Chances are, you have a lot you’re considering with regards to your own health before getting pregnant.
And with all the information out there, coupled with well-meaning advice from friends and family, things can get overwhelming pretty darn fast, can’t they?
In all honesty, when the two of us started our respective preconception journeys, we felt there was a huge chasm of useful information missing for aspiring parents. We felt lost—and we’re medical doctors!
This is what inspired us to launch the Hey Mami community, to provide a safe, science-based space where conscientious mamis can find information about their most burning health and wellness questions (from preconception to mamihood).
We’re honored to share what we’ve learned with you and know you’ll find tons of value in this guide.
It is the culmination of our combined 14 years of academic medical training, 23 years of clinical practice, 30 years of scouring medical literature, 20 years of clinical experience in functional and integrative medicine, multiple pregnancies, multiple miscarriages, 6 births, and almost a decade of mamihood between the two of us.
We worked hard to include all the juicy information we wished we’d had available when we started our preconception journeys—like what to eat (and not to eat), what toxins to avoid, what our partners could do to optimize their fertility…and loads more.
Think of this guide as your secret weapon, here to help you cut through the preconception information clutter and get your family started on the best possible footing.
Focus on your own health to boost fertility
Before you focus on trying to conceive, we encourage you to take some time to focus on your own general health and wellbeing.
This will set the foundation for a healthy pregnancy and a healthy baby, while helping you increase fertility.
How long do you need to focus on you (and your partner)?
Follicles are recruited up to a year in advance!! However, a follicle actively develops into an egg over the course of 90 days.1 Sperm takes between 64-74 days to fully mature. So in an ideal world we recommend you take at least 3 months to focus on YOU (and your partner).
To get started, ask yourself the following questions:
- Do you have a chronic health issue?
- Do you struggle with symptoms like insomnia, skin issues, digestive concerns, etc. (even if they don’t interfere with your life)?
- Do you take medications (even over-the-counter ones)?
- Do you have chronic low-grade stress (even if you handle it well)?
If so, these could interfere with your baby-making ability.
As functional medicine physicians, we work with a lot of women (and their partners) who are trying to optimize their preconception health. Our patients come to us because the functional medicine approach focuses on digging a little deeper than you might have time or space for during a conventional doctor’s visit.
Otherwise your OBGYN, Midwife, or Primary Care Provider can do a prepregnancy exam, check basic labs if indicated, and evaluate for sexually transmitted infections or other vaginal infections that could affect your health and fertility.2
And be sure to address your emotional health too.
Even the World Health Organization acknowledges that “Health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.”3
CHAPTER 2
Lab testing we recommend to support fertility
Preconception lab testing is one of the most proactive things women can do to achieve a healthier pregnancy.
Here’s what you need to know.
Preconception lab testing
We love data and subscribe to the philosophy: test don’t guess.
Your health and nutritional status play a huge role in conception, pregnancy, and in the postpartum period.
We advocate a proactive approach to preconception health and recommend that 3-6 months before conception you take an inventory of your nutrient levels, thyroid function, metabolic and inflammatory markers, genetics, and sex hormones.
If possible, get labs done 3-6 months before pregnancy to test:
- Nutrient levels – including Vitamins A, B12, D, coQ10, homocysteine, iron and zinc.
- Optimal thyroid function – and we’re talking a FULL panel including thyroid antibodies, TSH, free T3, Free T4, and reverse T3.
- Metabolic and inflammatory markers – like fasting blood sugar, fasting insulin, hemoglobin A1C and high sensitivity CRP.
- Unique nutritional needs – we use the Nutrition Genome DNA Kit to understand how genetic differences (like MTHFR, COMT, and PEMT) affect the way we respond to food and our environment (this is called nutrigenomics).
- Sex hormones – while functional medicine testing is our first choice for this, there are useful markers you can check in blood like DHEA-S, SHBG, testosterone and progesterone (when timed after ovulation).
For more information on the best preconception lab work, including our optimal ranges, download our free guide to help you start a conversation with your doctor or midwife.
CHAPTER 3
Understanding your cycle when trying to conceive
- your menstrual cycle
- hormone balance
- tracking your fertility
- and when to have sex if you’re tying to get pregnant.
Understanding your menstrual cycle and ovulation
A regular menstrual cycle is between 25-30 days.4
- The follicular phase (when your eggs mature) occurs during the first half of the cycle.
- Ovulation typically occurs in the middle of the cycle (i.e. for a 30 day cycle, it might occur around day 15), when your egg travels from the ovary through the fallopian tube and into the uterus.
- The luteal phase (where your uterine lining thickens) follows ovulation and characterizes the second half of the cycle.
- Your period comes when you slough off the uterine lining…and then it all starts over again, unless implantation has taken place.
Irregular cycles are usually due to changes during the follicular phase— either the absence of ovulation (called anovulation) or inadequate follicular development.5
Stay tuned for our article that details your body’s cyclical hormonal changes.
Hormone balance for better fertility
If irregular cycles are an issue, it’s especially important to think about hormone balance and how that can influence ovulation.
Symptoms of hormone imbalance include:
- Irregular periods
- Failure to ovulate
- Heavy, painful periods
- Breast tenderness
- Loss of libido
- PMS
- Headaches around ovulation or menses
- Hot flashes
In our clinical practices we see a lot of women with lower than optimal progesterone levels and estrogen dominance. We use speciality functional medicine testing to measure sex hormone levels in the urine, identify the specific imbalance, and address the root cause (which can be related to the detoxification pathways in the liver, digestive issues, nutrient deficiences like magnesium, environmental exposures, etc).
Ovulation trackers and tools
Many women can recognize the signs of ovulation by tracking their cervical discharge, basal body temperature and resting heart rate.
Thankfully, modern technologies have made it a lot easier to track ovulation and fertility.
- Ovulation calendars provide a simplistic predictions of your most fertile days based on the first day of your last cycle and the average length of your cycle (these are most accurate if you have regular cycles).
- Electronic fertility calculators—like Daysy and Ava bracelet—look at additional data like basal body temperature, to help you more accurately monitor ovulation and fertility windows.
- Over-the-counter ovulation prediction kits use urine to detect luteinizing hormone (LH), which typically surges 24 to 36 hours prior to ovulation.6 Click here for the one we recommend.
- Over-the-counter fertility monitors use newer technology to measure both estrogen and LH in your urine. By detecting the rise in estrogen, you’ll have a bigger window of fertility than with an ovulation predictor kit.7 Click here for the one we recommend.
When to have sex to get pregnant
The quick answer: often (more on this coming up).
The technical answer: Your eggs can survive in the fallopian tube for 18-24 hours after ovulation.
Sperm can survive for 3-5 days. That means you can get pregnant anywhere from 5 days before you ovulate to 1 day after. The best time to have sex to get pregnant is just before and during ovulation.8
Now, back to that “quick answer”.
New research has shown that having sex anytime NOT just during ovulation, causes changes in a women’s immune system that increase your chances of getting pregnant.9,10
So, why not take this time to have as much enjoyable sex as possible?
Sure, use the trackers and calendars to help increase your chances, but also be sure to add in a few spontaneous rolls-in-the-hay for good measure (and faster conception).
Want more details and tips for speedier conception? Check out our article Understanding your cycle when trying to conceive (and when to have sex to get pregnant).
CHAPTER 4
Preconception fertility diet
Word is getting out about the critical role nutrition plays in fertility and a healthy pregnancy.
The foods you eat during the 6 months before conception are important determinants of your health during pregnancy, and your baby’s health throughout pregnancy and into childhood.
We’ll give you the scoop here.
Good nutrition can increase fertility and improve pregnancy outcomes
We get so many questions from women about the best fertility diet.
And we think this is freaking awesome because it shows that word is getting out about the critical role nutrition plays in fertility and a healthy pregnancy.
In fact, there is a growing body of evidence that nutritional habits may have a significant effect on both male (that means you, gentlemen) and female fertility.11,12
And a nutrient dense diet high in vitamins and minerals has been shown to support fertility.13
Furthermore, increased antioxidant intake from healthy foods and herbs can result in a shorter time to pregnancy and is positively associated with female fertility.14
What’s more, the foods you eat during the 6 months before conception are important determinants of your health during pregnancy, and your baby’s health throughout pregnancy and into childhood.15
So, preconception is an important time to stockpile your nutrition, support your egg health, and set the stage for a healthy pregnancy and baby.16
But wait, there’s more.
Get ready…
Your maternal nutrition status can influence up to three generations!17
That means that your grandchildren could be impacted by your nutritional status at conception (this phenomenon is called epigenetics).
All that said, most mamis have the good sense to recognize that what they eat matters to their health and the health of their babies.
Bottom line: a nutrient-dense diet is your best ally in creating the ideal conditions for improving fertility and laying the foundation for a healthy pregnancy, baby, and postpartum recovery.18
Poor nutrition can make it harder to conceive
Based on what you’ve just learned, this should come as no surprise.
However, when we refer to “poor nutrition” in this context we’re not talking about a lack of food in general…we’re talking about a lack of quality food.
Specifically, too much processed food, which has (finally) been proven to impact fertility.
Here’s the deal:
- At least one study shows that women who consumed sugar-sweetened drinks, especially sodas, had lower levels of fertility.19
- Another study found that the higher the glycemic index of your diet (AKA: how much the food you eat increases your blood sugar after you’ve consumed it, like refined sugar and carbs), the increased risk of ovulatory infertility.20
- Yet another study found that consuming trans fats instead of healthy carbohydrates, correlated with a 73% increase in risk of ovulatory disorder.21
And finally, another study found that eating fast food was correlated with a higher rate of infertility, as well as an increase in the time it took to get pregnant.22
In other words: keep the junk food off your plate to increase fertility (or at least to a dull, dull roar).
What to eat when trying to conceive
Here’s a bit of good news that should appeal to everyone’s commonsense: there is no perfect diet for everyone.
BUT there is great value in following foundational dietary guidelines for optimal fertility.
We created the Hey Mami Diet to help you understand foundational aspects of nutrition, and how to best support yourself with food during the mamihood years.
In short, we encourage you to follow these 10 principles when it comes to nutrition:
- Listen to your body.
- Choose organic when possible.
- Aim for a variety of seasonal, whole foods.
- Load up on nutrient-dense foods.
- Eat plenty of colorful vegetables with an emphasis on leafy greens and cruciferous veggies.
- Enjoy healthy fats.
- Make clean protein a staple at every meal.
- Make sure your carbohydrates are a good source of fiber.
- Enjoy moderate amounts of whole fresh fruit.
- Stay hydrated.
We recommend avoiding these 10 bad food players:
- Foods high in pesticide residues (check out EWG’s Dirty Dozen list for a quick reference).
- Highly processed and refined foods.
- Refined sugar.
- Fake sugar like aspartame, sucralose, saccharin, etc.
- Trans fats, hydrogenated fats, and refined vegetable oils.
- Factory farmed meat.
- Seafood high in mercury.
- Food dyes.
- Sodas and diet sodas.
- Alcohol on an everyday basis.
We’ll walk you through everything in our article that outlines the Hey Mami Diet.
As doctors and mamis of 3, we know that getting any meal on the table (let alone healthy, whole food) is not always easy.
Even though we prioritize this in our homes, dang if it doesn’t still take some practice, flexibility, and creativity (not to mention patience, self-forgiveness, the willingness to fail, a big glass of wine…etc).
Stay tuned for our article on how to get healthy foods at your doorstep for our favorite resources and mom hacks.
Food intolerances when trying to conceive
A food intolerance or food sensitivity is different than a full-blown food allergy in that it’s a delayed hypersensitivity response.
This response is triggered by IgG antibodies—food antigen and antibody complexes to which the immune system reacts, whereas an allergic reaction is triggered by an IgE-mediated response, which causes symptoms like swollen lips or hives.
In other words: food intolerances are more subtle, or can be delayed to the point you may not make a connection between that cheese sandwich you just ate and the stuffy nose you get the next day.
The most common food sensitivities we see in our clinical practices are gluten, dairy, and (we hate to say it) even eggs.
There is a well established association between celiac disease and fertility disorders.23 But non-celiac gluten sensitivity (NCGS) may also play a role in fertility challenges.24
So, while it can be easy to make fun of all those “gluten-free people” out there without celiac, the truth is many people experience a variety of reactions to gluten, as one example.
This makes sense given what we see in our clinical practices.
In most cases, we are not advocates of long-term uber-restrictive diets.
However, there’s a time and a place for an elimination diet, which can be of great help to uncover hidden food sensitivities.
If you’re struggling with infertility, any chronic health issues or pesky symptoms, we highly recommend giving this a try.
In our practices, we also test for these reactions which allows us to individualize patient care.
Finally, if you know you’re not tolerating certain foods, don’t stop at just eliminating them. Take it a step further by learning more about your gut health (intestinal hyperpermeability aka leaky gut) and how it impacts your entire body.
Check out Chapter 7 of this guide to learn more.
CHAPTER 5
Prenatal vitamins
Prenatal vitamins are backed by decades of research and linked to better birth outcomes.
Pre-pregnancy supplementation has also been shown to support fertility, including a shorter time to pregnancy.
We’ll tell you what to look for (and what to avoid) in your prenatal vitamin.
Even when we eat well, we can’t meet nutritional
requirements with diet alone
A healthy and varied diet is the best way of getting your nutritional needs met before pregnancy. It sets the foundation for full-body health and helps lay the building blocks for a successful pregnancy and postpartum recovery.
However, some nutritional requirements are hard to meet with diet alone…even if you eat very healthfully…
Here’s why.
Since 1940 there has been a tremendous decline in the micronutrient density of foods.25 This is partly due to modern agricultural practices which have degraded our once nutrient-dense topsoil,26 but also the nature of our lifestyles which don’t leave much time or space for preparing food in traditional ways which would enhance their nutritional value.
Prenatal vitamins are important for boosting fertility
Research shows that a proportion of women of childbearing age (including those who have fertility challenges), have lower than recommended levels of certain micronutrients27—AKA: vitamins, minerals, antioxidants, etc.
Now, listen up because this bit of information is important:
While micronutrient supplementation started during pregnancy can correct important maternal nutrient deficiencies, it is not sufficient to fundamentally improve the baby’s health.28
Which means (you guessed it), you’d ideally start supplementing with a high-quality prenatal multivitamin well before conception.
Pre-pregnancy supplementation has been shown to support fertility, including a shorter time to pregnancy.29
Thus, by optimizing your preconception nutritional status, you can positively impact fertility, and support the health of you and your future child.
Bottom line: (ideally) don’t wait until you’re pregnant to start taking a prenatal supplement.
When should I start taking prenatal vitamins?
In a perfect world we recommend you begin taking a prenatal multivitamin at least 6 months prior to conception, or longer, when possible.
In fact, the Centers for Disease Control (CDC) and American College of Obstetrics and Gynecology (ACOG) and other regulatory bodies recommend that all women of reproductive age take a supplement with 400 mcg of folic acid each day.30,31
However, we recommend you take an active form of folate (such as methylfolate) over plain old folic acid—keep reading for more info.
How to pick the best prenatal vitamin
A high-quality pharmaceutical-grade supplement is what we recommend in practice, and you’d typically have your doctor or practitioner order them for you.
While there’s a lot to consider when looking for the best prenatal vitamins, there is an easy way to weed out the poor quality ones: look at folate and B12 on the label.
Your folate (or Vitamin B9) should be in the form of bioactive, methylated folate (sometimes called methylfolate, or 5-MTHF)—NOT folic acid.32
What does “bioactive” mean? It means a nutrient is in its most active and therefore most usable form.
When you eat leafy greens or take a methylfolate supplement, the folate is already in its metabolically active form.
On the other hand, synthetic folic acid, found in supplements or processed and fortified foods, requires many steps in conversion to get to the metabolically active stuff.33,34
This can be especially problematic for women with digestive issues and/or genetic variations in folate metabolism like MTHFR (which is very common!).35
Synthetic folic acid metabolism is also influenced by the dihydrofolate reductase (DHFR) gene. Women with genetic variations in DHFR may actually have a reduced ability to break down synthetic folic acid, potentially blocking folate receptors—leaving them worse off (we know, it’s crazy, and more research is needed).36,37
Along the same line, we look for activated B12 in the form of methylcobalamin, hydroxocobalamin, or adenosylcobalamin—NOT the synthetic cyanocobalamin.38
Bottom line: if you see “folic acid” and/or “cyanocobalamin” on the label, you can do better.
There is much more to say about this loaded topic. To learn more, check out our article: How To Pick the Best Prenatal Vitamin.
We recommend this prenatal vitamin that contains the right kinds of B vitamins including methylated folate and B12, as well as 100% daily value of the FDA’s new recommended dose of choline and trimethylglycine (TMG) to help fetal brain development, nervous system health, digestive health and more.
CHAPTER 6
Other fertility supplements
Targeted supplementation can decrease your time to conception, optimize your egg health, and set you up for a healthy pregnancy.
This is especially relevant for women who struggle with hormone imbalance or who are starting their fertility journey later in life.
Following a healthy Hey Mami diet and taking a high-quality prenatal multivitamin should have most mamis covered with the basic fertility support they need.
However, for some women—especially those struggling with hormone imbalance or who are starting their fertility journey later in life—there are additional supplements to consider when trying to optimize egg quality and time to conception.
Now, before you go nuts and start ordering a bunch of fertility supplements, it’s important you work with a clinician who can help you determine which of the following could help support you (because there’s no sense in over-supplementing if you don’t need to).
Here are some of the most beneficial nutrients that have been studied to support fertility:
- CoQ10 (especially important for women over 35)
- Choline
- Folate
- Zinc
- Iron
- Omega 3s
- N-acetyl-cysteine (NAC)
- B complex
- Vitamin C
- Vitamin D
- Chaste Tree (AKA: Vitex agnus-castus)
- Magnesium
- L-arginine
- Ashwagandha
- Myo-inositol
One of our favorite supplements to support fertility, ovulation, and hormonal balance is this combination product that has Chaste Tree, Myo-Inosito and CoQ10.
CHAPTER 7
Mom’s gut health
It is well established that a healthy gut microbiome is largely responsible for our overall health.
While there is still much to learn with regards to gut health and fertility/pregnancy, we know there is an important link.
In this chapter you’ll learn about why gut health is important, and how you can support a healthier microbiome.
What is your gut microbiome?
Your gut microbiome is a collection of trillions of organisms—bacteria, viruses, fungi, and more—that live within us.
A healthy microbiome helps us to stay well by improving our digestion, hormone balance, gut permeability, and immunity to name a few of its functions.
An imbalanced microbiome, on the other hand, is linked to inflammation and chronic disease.
The balance of your gut microbiome is impacted by a multitude of things, especially:
- Antibiotic use—a single course of antibiotics can change the gut microbiome for up to a year!39
- Acid blocking medications, like proton pump inhibitors (i.e. Nexium, etc).40
- Sedentary lifestyle.
- Household chemicals and the hygiene hypothesis.41
- Processed foods, toxic fats (fast foods, fried foods, refined vegetable oils, etc), and a high sugar diet.
- Lack of diversity of foods.42
- Too much stress.
- C-section birth.
Gut health and fertility/pregnancy outcomes
It is well established that a healthy gut microbiome is largely responsible for our overall health. Much of our focus as functional medicine doctors is on this aspect of health.
With regards to gut health and fertility/pregnancy, there is still much to learn.
We know there is a link between gut health and hormone balance, as the gut microbiota regulates estrogens through an enzyme called β-glucuronidase.
An imbalanced microbiome can alter circulating estrogens and may contribute to a number of hormonally driven conditions, including obesity, endometriosis, polycystic ovary syndrome (PCOS), and fertility.43
We also know that mom’s microbiome plays an important role in pregnancy outcomes, and influences baby’s microbiome too.44
As just one example, when mom supplements with certain types of probiotics before delivery and during breastfeeding, babies have reduced risk of developing eczema.
In fact, the World Allergy Organization recommends using probiotics in pregnant women at high risk for having a child with eczema and allergies.45,46
How to support gut health for optimal fertility, a
healthy pregnancy, and overall well-being
A healthy microbiome is largely earned by avoidance (when possible) of all those “bad food players” and other toxins listed above, along with a diet of whole, unprocessed, organic food (like we recommend in The Hey Mami Diet).
In fact, a shift in diet can change your gut bacteria in a matter of days47
But, avoidance isn’t everything. You’ll also want to include the following types of foods in your diet to feed those healthy bacteria:
- Fermented probiotic foods (lactofermented sauerkraut, kimchi, kombucha, etc)
- Prebiotic foods (onion, garlic, asparagus, leeks, sunchokes, etc)
- Resistant starch (green bananas, plantains, cooked and cooled rice, cooked and cooled potatoes and sweet potatoes, etc)48
In our clinical practice, we also find that taking a high-quality probiotic supplement can be helpful.
Grocery and health food stores are flooded with probiotics, but not all probiotics are created equal. So, given the extensive role gut health plays in the health of mami and baby, it really pays to get picky about this one.
One of our favorites is this product that has five researched strains of Lactobacilli and Bifidobacteria in acid-resistant capsule with pH targeted release to deliver maximal viable organisms to the digestive tract.
CHAPTER 8
Environmental toxins and pre-pregnancy detox
Environmental toxins are everywhere, and can affect reproductive health for generations.
Preconception is a perfect time to focus on limiting these exposures—and it’s not as hard as you may think! In this chapter we’ll tell you what to do.
Environmental toxins are ubiquitous
Just a decade ago, it may have been considered quackery to suggest that common household chemicals could influence conception and birth outcomes.
Not any more.
For example, a 2004 study showed 287 chemicals in the umbilical cord blood of babies taken at birth, including pesticides, consumer product ingredients, and waste pollutants, and over 180 carcinogens.49
The American College of Obstetrics and Gynecology (ACOG) along with the American Society for Reproductive Medicine published a formal committee opinion on exposure to environmental chemicals in 2013 acknowledging that: “Patient exposure to toxic environmental chemicals and other stressors is ubiquitous, and preconception and prenatal exposure to toxic environmental agents can have a profound and lasting effect on reproductive health across the life course.”50
What this data confirms is that environmental toxins are everywhere, and can affect reproductive health for generations.
Thus, preconception is a perfect time to focus on limiting these exposures (and it’s not as hard as you may think, so keep reading).
Environmental toxins wreck fertility
Exposure to various environmental toxins can affect fertility in both men and women (and ultimately the health of your baby).
Some examples of how toxins can impact fertility include:
- Disrupting your hormone balance (these toxins are known as endocrine disruptors)51
- Damaging your eggs, causing impaired ovarian function, and infertility52
- Depleting follicles and cause premature ovarian failure (early menopause)53
- Decreasing sperm count and quality54
- Increasing the risk of miscarriage or birth defects, and affecting fetal growth later in pregnancy.
How can you decrease your toxic body burden before pregnancy?
While this may seem overwhelming, the truth is you can greatly reduce your exposure to environmental toxins by making some simple changes at home.
Our strategy for this type of “fertility cleanse” or “preconception detox” is twofold:
First—Avoidance, avoidance, avoidance. it’s important to look closely at your environment and think about any chemical exposures you may have in the places you spend the most time. This is the primary focus.
Second—support your body’s natural detoxification processes so you can better process and eliminate these toxins from your body.
Here are 10 simple changes you can make at home that will trickle over to the health of your growing family:
- Start by eliminating pesticides in your diet and opt for organic foods.
- Don’t spray your home, lawn, or garden with pesticides either.
- Make a no-shoes-indoors policy at home—shoes bring in a gross amount of pesticides, fecal matter, heavy metals, and chemicals from the outside world.
- Swap out plastics in your kitchen for glass, stainless steel, ceramic, or silicone.
- Stop drinking out of ALL plastic water bottles.
- Be sure you are drinking clean water and using a high quality water filtration system.
- Avoid chemical cleaning products and anything with “fragrance”, including candles, laundry products, and air fresheners. For an economical all-in-one cleaning product, we like Branch Basics, and recommend pure essential oils in place of fragranced air fresheners.
- Make a habit of opening your windows to purge stale air and improve natural ventilation. Even a few minutes a day can make a big difference.
- Use your vent hood when cooking and use the bathroom fans while showering.
- Clean up your personal care products by opting for natural/organic alternatives. This includes lotions, cosmetics, perfumes, deodorant, and tampons/pads. We’re big fans of Beautycounter for personal care products, organic feminine products like Seventh Generation or reusable period panties from Thinx.
This topic is so important, so under-reported, and so vast that we’ve written several detailed articles on the subject.
Since no one can avoid ALL toxins, it’s a comfort to know your body is already equipped to rid itself of many of them (this happens mostly through your liver and gut, urine and sweat).
As you clean up your environment, you can also support your body’s natural detox pathways.
Here are 5 simple ways you can help optimize this process:
- Aim for a daily BM (grandma was right about this one). Good hydration, fiber, and healthy fats can help with this. If you tend toward constipation then supplementing with magnesium citrate might be a good idea.
- Take good care of your liver. Minimize alcohol, Tylenol, bad fats, and other medications that can stress your liver out.
- Hydrate with about 80 ounces a day of filtered water in glass or stainless steel containers. This will help eliminate water soluble toxins through your urine.
- Sweat daily and keep things moving with regular exercise, and maybe even a sauna.
- Eat a variety of organic fruits, vegetables, and herbs to support detox. This includes cruciferous vegetables (like broccoli and cauliflower), onions, artichokes, lemons, rosemary, parsley, and cilantro.
Do I need a full-on preconception/fertility detox?
Many women can prepare beautifully for pregnancy by following the strategies outlined above.
However, women with conditions suggestive of environmental toxicity (multiple chemical sensitivity, chronic fatigue, fibromyalgia, autoimmune disease), known toxic exposures, or genetic polymorphisms like MTHFR, may wish to work with a functional medicine physician.
We have comprehensive tests to measure the toxic body burden and guide appropriate and safe preconception/fertility detoxification.
Supplements we use in our clinical practices to help support detox in general include milk thistle, NAC, NAD+, and glutathione.
However, if you’re trying to conceive we don’t recommend you upregulate detoxification with supplements (except for NAC, which has evidence to support decreased rates of miscarriage in the first trimester.55
If you do think you’d benefit from a fertility/preconception detox, it’s important to note that a preconception detox should occur more than 6 months prior to conception.
We make this recommendation because follicles take ~6 months to develop before they are ready to release their egg.56 Plus, it is less than ideal to mobilize stored toxins just before becoming pregnant for obvious reasons.
CHAPTER 9
Medication use
In this chapter we’ll address issues with some of the most common over-the-counter medications as well as birth control pills.
Which medications are safe to take when trying to conceive?
The American College of Obstetrics and Gynecology (ACOG) states: “Some medications, including vitamin supplements, over-the-counter medications, and herbal remedies, can be harmful to the fetus and should not be taken while you are pregnant.”57 Some of these medications may also affect fertility.
For instance, something as commonplace as ibuprofen could affect your ability to conceive.
There is a link between NSAID use (ibuprofen, naproxen, etc.) and reversible female infertility, thus stopping NSAIDs should be considered prior to fertility investigations.58
It is important to discuss all medications you are taking with your provider—remember this means not only prescription medications but also over-the-counter medications, vitamins, and supplements (including recommendations you may have learned about here).
What about birth control pills?
If you’re trying to conceive, you’ve likely already discontinued birth control pills.
Be aware that the birth control pill is known to deplete a number of nutrients which are important to fertility, including folate, vitamins B2, B6, B12, vitamins C and E, and the minerals magnesium, selenium, and zinc.59
The pill has also recently been shown to cause brain shrinkage (for real!) in women.60 Specifically, notable shrinkage of the hypothalamus, which is critical to hormone and neurotransmitter function, as well as mood and appetite regulation. This is a very new discovery that warrants further research, so we’ll revisit this topic as more research becomes available.
Post birth control syndrome (PBCS) is also a recognized issue. PBCS refers to symptoms that appear after stopping birth control pills—including loss of menstruation, painful periods, acne, hair loss, headaches, hypothyroidism, mood changes, etc.—likely as a result of nutrition depletions, HPA axis dysregulation, impaired liver detox, changes to the gut microbiome, and more.
CHAPTER 10
How your man (or donor) can optimize his fertility
Your man’s, or donor’s, health plays a huge role in your chances of a successful conception and healthy pregnancy.
Here’s what you need to pass along.
Which medications are safe to take when trying to conceive?
Male partners play a huge factor in infertility. An estimated 20-30% of infertility cases are solely because of a problem in the male partner, and up to 50% of cases overall involve the male!61,62
That means your man’s, or donor’s, health plays a significant role in your chances of a successful conception and healthy pregnancy.
Male factors that contribute to infertility include:
- Sperm count and quality (amount, movement and shape).
- Poor nutrition and nutrient status.
- Exposure to reproductive toxins.
- Lifestyle factors like smoking and heavy marijuana use.
- Medical conditions like obesity, diabetes and cystic fibrosis.
Since this is such an important and underappreciated topic, we wrote a whole article about it.
Here are some of the most important points to pass on to the father of your future baby:
- Eat more real food and less processed food. This means eating an organic, whole foods diet with lots of colorful vegetables, pastured meat/eggs, and sustainable, wild caught, low mercury fish and seafood.
- Avoid hidden toxins in your home and personal environment. This means avoiding heavy metals, pesticides, herbicides, dry-cleaning chemicals, BPA, and organic solvents found in common household products and paint.
- Stop smoking cigarettes, marijuana…and no vaping either!
- Cut back on the booze.
- Lose weight if you’re overweight.
- Exercise regularly.
- Eat foods with sperm-enhancing nutrients like zinc, selenium, vitamin C, carnitine, CoQ10, and B vitamins.
- Swap out bottled or tap water for filtered water.
- Avoid direct contact with EMF-producing devices (especially around the man parts) such as Smartphones, tablets, smartwatches, and laptops.
- Check your labs, including homocysteine, B12, hemoglobin A1c, and hsCRP.
- Talk to your clinician about sperm-enhancing supplements, including zinc, methylfolate, vitamin E, vitamin C, selenium, CoQ10, and carnitine.
CHAPTER 11
The most common causes of infertility
In this chapter we’ll review some common causes of infertility, as well as the diagnosis of unexplained infertility, and when you should seek out help.
- Structural or anatomical abnormalities:
About 40% of cases are due to structural or anatomical abnormalities. This is mostly related to adhesions (scar tissue) or damaged/blocked tubes due to Pelvic Inflammatory Disease (PID), prior abdominal surgery, ruptured appendix, endometriosis, etc. Special imaging tests and procedures such as ultrasound and hysterosalpingography.67
- Hormonal dysregulation:
Hormonal dysregulation accounts for about 30% of cases of female factor infertility. These are mostly problems with ovulation caused by the following conditions:
- polycystic ovarian syndrome (PCOS)
- thyroid disease
- premature ovarian failure
- severe insulin resistance
- obesity
- low body weight
- hyperprolactinemia
- other disorders of the hypothalamus-pituitary axis.
- Unexplained or unknown infertility:
Unexplained infertility
Infertility may result from a definable cause, like those mentioned above. But at the end of the day, ‘unexplained infertility’ is one of the most common diagnoses in a fertility clinic.68
Unexplained infertility means that the exact cause of infertility has not yet been determined… and we say keep digging.
Lesser known causes of infertility include:
- Celiac disease
- Autoimmune disease
- Inflammation
- Reproductive toxins
- Methylation impairment/MTHFR mutation and other genetic factors
Stay tuned for our article on unexplained infertility to learn more.
When to see a fertility specialist
Not getting pregnant as quickly as you would like? Worried about the possibility of infertility? First off: read our article How to Get Pregnant Faster.
And remember, it can take up to 6 months for a healthy couple to get pregnant…and some doctors recommend waiting it out for a whole year (and notice, we said “couple”, so your man’s (or donor’s) health also has a huge stake in this (check out Chapter 10 of this guide to learn more about that).
Also keep in mind that infertility affects only about 12% of women between the ages of 15-4469—so the odds of achieving natural conception are on your side.
However, you don’t have to wait 6-12 months. In some instances, seeing a fertility doc sooner rather than later is the best move.
The American College of Obstetrics and Gynecology (ACOG) recommends an infertility evaluation if any of the following apply to you:
- You have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
- You are older than age 35 years and have not become pregnant after trying for 6 months without using birth control.
- You are older than age 40 years and have not become pregnant within 6 months of trying without using birth control.
- Your menstrual cycle is not regular.
- You or your partner have a known fertility problem
Additionally, if you have a history of ectopic pregnancy, sexually transmitted infections, pelvic inflammatory disease (PID), or other hormonal or structural issues mentioned above that may affect fertility or pregnancy, it’s often a good idea to seek out a specialist sooner vs later.70
CHAPTER 12
Lifestyle factors that influence your fertility
Stress, relationships, sleep, mind/mood, and exercise/movement are all important for happy hormones!
In this chapter, we’ll review some of the most important factors to dial in.
Lifestyle factors can impact fertility
In our clinical practices, we also help women address other lifestyle factors which can impact fertility. These include: stress, relationships, sleep, mind/mood, and exercise/movement—all of which are important to keep your hormones happy while maximizing your chances of conception.
Let’s dive into each of these a little deeper.
How does stress affect fertility?
Stress, especially chronic stress, has the potential to impair fertility during critical periods of regular menstruation,71,72 ovulation, implantation, placental growth and development.73
Several studies have shown links between a woman’s stress levels and her fertility/time to conceive. For example, women whose saliva have high levels of alpha-amylase, an enzyme that marks stress, took 29% longer to get pregnant compared to those who had less, and have an increased risk of infertility.74
Basic science has also shown the links between the hypothalamic–pituitary gonadal axis, such that it is now accepted that physical stressors can alter women’s menstrual cycles.
Studies have also shown that stress-lowering exercises, group therapy, individual cognitive behavior therapy, and relaxation techniques like guided imagery have helped some infertile women get pregnant.
Stay tuned for our upcoming article that addresses stress and infertility.
Fertility and interpersonal relationships
Relationships can play a significant role in male and female fertility. Why? Because your relationships either make you feel safe or unsafe, stressed or relaxed, upset or happy, fulfilled or unfulfilled, etc.
And we’re not just talking about romantic relationships either. Friendships and family relationships can be toxic too, so it’s definitely worth looking at which relationships are lifting you up vs. dragging you down.
Bottom line: now is a great time to let go of any relationships which are no longer serving you.
Sleep and fertility
We could (and will) write an entire article on how sleep can impact fertility. But, for the purposes of this guide we’ll keep it short and sweet.
When you’re not getting enough sleep (defined as less than 7 ½ – 9 hours a night) it creates a cascade of hormonal imbalances which ultimately compromise your fertility. Some examples of hormones impacted by lack of sleep include insulin, estrogen, prolactin, follicle stimulating hormone, and melatonin.75,76
We recommend getting at least 8 hours of sleep per night if you’re trying to conceive, and more when you can swing it.
Here are some good sleep hygiene habits you can focus on establishing:
- Avoid caffeine after 2:00 p.m.
- Avoid screens and bright lights for an hour or two before bed. If you must work on a device, use blue block glasses.
- Avoid alcohol before bed. Though it can have a temporary sedative effect, it disturbs REM sleep.
- Get your exercise in early, preferably before evening, or it can amp you up.
- If you tend to get revved up in the evenings, channel that energy into quiet activities.
- Create a bedtime ritual. Once you’ve powered down for the day, make a cup of chamomile, lemon balm, or valerian tea, or take an Epsom salt bath.
- Try journaling before bed. This helps gets the day’s thoughts, worries, and excitement out of your head and prepares the space for tomorrow.
- Make your bedroom completely dark. This stimulates natural production of melatonin, your body’s master sleep hormone.
- Aim for your bedroom temperature to be somewhere around 65 degrees Fahrenheit, or use a Chili Pad to cool your bed.
- If you find yourself waking up at night, try eating a small, protein-rich snack before bed. This can help prevent blood sugar crashes that may cause night-waking.
Can mental health affect fertility?
The link between your mental health and your physical well-being is becoming widely accepted in medical circles. And there are many reasons for this.
One of the biggest new discoveries in this field has to do with the gut-brain connection, which we discussed in Chapter 7.
In summary, your gut and your brain are connected by what’s known as the gut-brain-axis, an information superhighway which transmits nerve signals from your brain all the way to your intestines.
So, if you’re gut microbiome health is not optimal it can have a significant impact on your brain/mood and hormonal levels. As discussed above, an imbalanced microbiome can also alter circulating estrogens and may contribute to a number of hormonally driven conditions, including obesity, endometriosis, polycystic ovary syndrome (PCOS), and fertility.77
Plus, many studies have proven the link between mood disorders like depression and anxiety and infertility.78
The good news is, now that you’re aware of this you can absolutely take steps to fix this with help from your doctor and/or a psychologist, counselor, etc. and get on the road to better mental health and fertility.
Best exercise for fertility
We touched on this above, but exercise plays an important role in optimizing fertility for several reasons including: lowering your risk of obesity, helping normalize insulin levels, promoting better sleep, regulating mood, and keeping stress in check.
BUT, if getting pregnant is your goal then moderation is the key.
Research has shown that moderate exercise such as yoga, walking, etc. for 1 to 5 hours a week can raise your odds of conception.79
This also makes common sense, as over-exercising has been shown to disrupt or even eliminate menstruation.
So, save those marathons and 90-minute workouts for well-after the baby is born (if ever).
Better emotional health leads to better fertility
You probably already know that stress (emotional, physical, spiritual, mental, and occupational) plays a significant role in your physical health.
Likewise, if you carry emotional stress (like feeling resentment or anger toward your partner or running on an incessantly-empty-tank because you feel pressured to do-do-do all the time)…your body responds in a purposeful, physiologic way that manifests as an upregulated sympathetic nervous system stress response. Also known as: fight-or-flight.
So what does this have to do with getting pregnant?
If your mind and body perceive danger, stress, lack of balance, resentment, distrust, exhaustion, unhappiness, or any dis-eased state…it may very well not prioritize pregnancy until these challenges are managed.
We encourage you to manage your stress response and focus on your emotional health, just as you focus on your physical health.
Some of our favorite tools for this include:
- Gratitude journaling—spend time writing down 5-10 things that you are grateful for every single day.
- Meditation and practicing mindfulness—this will help you become an observer of your thoughts, making it easier to choose a non-toxic path. Apps like Headspace® are excellent for this, or you can join a meditation group.
- Hypnosis—many of our thoughts, beliefs, and emotions are tied to early childhood experiences within our subconscious. A good hypnotherapist can help you break through these old patterns and realize a new way of life.
- Cognitive behavioral therapy—this is practiced with a professional therapist, and can be a wonderful way to help you repattern old habits, and let go of emotional baggage that is holding you back.
Stay tuned for our articles on sleep, stress, and mindset to learn more.
You got this!
But you might be feeling overwhelmed…
We just shared a ton of information that took us years to research and compile. That’s why we developed our preconception course. Women need to know there are better answers for preconception health and fertility, and we’re here to guide you.
About Us
We are doctors Alejandra Carrasco M.D. and Christine Maren D.O. We’re board-certified through the American Board of Family Medicine, and certified in functional medicine through the Institute for Functional Medicine. We’re on a mission to support women as they navigate mamihood—from preconception through pregnancy, postpartum, and beyond. As mamis of 3 (each!), we got you.
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