Planning a pregnancy can be an exciting yet overwhelming time for many families. Medical conditions like PCOS, endometriosis, and autoimmune disease can present frustrating challenges to conception and pregnancy maintenance. Additionally, it can be especially burdensome for families who are also faced with non-medical factors that influence their reproductive health outcomes; unfortunately, racial, gender identity, geographic, and other disparities influence access to fertility treatments and treatment outcomes. Economic disparity especially presents a major barrier to family building.
After 6–12 months without success, treatment options for fertility might include medications, surgery, intrauterine insemination, or Assisted Reproductive Technology, which may be accessible only to the economically advantaged and leave many undertreated or untreated. Implementing the following affordable and accessible strategies to optimize the different phases of conception can alleviate some of the economic barriers and lead to improved reproductive health outcomes for all.
Ovulation
Pregnancy depends on the occurrence of ovulation, the brief phase of the menstrual cycle when an egg is released from the ovary to be fertilized. Ovulation involves a delicate balance between the reproductive hormones, namely estrogen and progesterone. Optimal estrogen and progesterone production can be supported by increasing the intake of healthy fats within the diet (cold-water fish, nuts, seeds, avocado, olive oil), which supply the building material needed to synthesize the reproductive hormones.
Botanical medicines, such as vitex or “chaste tree berry,” may also support fertility by optimizing the estrogen:progesterone ratio that allows for ovulation to occur. Vitex can help to restore normal progesterone levels and improve luteal phase defect, a condition characterized by insufficient progesterone production throughout the second half of the cycle that may result in reduced uterine lining growth and pregnancy loss.
Fertilization
Fertilization is the multi-step process by which two haploid gametes (the spermatozoa and the oocyte, or egg) fuse to form a diploid zygote, or embryo. Suboptimal gamete quality due to advanced age and subsequent mitochondrial decline, toxin exposure, and poor dietary and lifestyle choices can interfere with the success of this process.
The developing zygote requires a vast supply of energy to fuel critical events, all of which is supplied by oocyte mitochondria, the powerhouse organelle that transforms fats, proteins, and carbohydrates into energy for the developing zygote. With advanced age, mitochondrial function declines, and suboptimal energy production can ultimately result in pregnancy failure.
Mitochondrial function can be improved by increasing mitochondrial-supportive nutrients like CoQ10/ubiquinol and acetyl-L-carnitine. CoQ10 is a fat-soluble nutrient concentrated within the mitochondria and acts as an antioxidant to neutralize harmful free radicals that can reduce oocyte quality. It can be supplemented or obtained from organically raised, grass-fed organ meats, fatty fish, and whole grains. Acetyl-L-carnitine is an amino acid within the mitochondria that facilitates the transformation of fats into energy, and adequate intake supplies the oocyte with sufficient energy to fuel critical events that lead to reproductive success.
Implantation
Implantation is the process by which the now-fertilized egg attaches to the wall of the uterus, and its success requires an appropriately regulated immune response. For the uterine wall to receive the embryo, the immune system must remain checked. Immune modulation and uterine receptivity can be enhanced by optimizing the reproductive microbiome. Probiotics and probiotic-rich foods (kefir, yogurt, kombucha, miso, kimchi, sauerkraut, pickles, tempeh) support the reproductive microbiome and fertility due to their antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory activities. The uterus was once believed to be a sterile environment; however, recent discoveries reveal the presence of a diverse microbial population within the upper genital tract, which—when optimized—has been associated with improved implantation rates.
Mindfulness
Stress has a negative impact on fertility. Perceived threats, big or small, trigger a cascade of biological responses that influence the activity of the hypothalamic-pituitary-gonadal axis, which controls the reproductive system. While practices like meditation and mantra cannot get you pregnant, they can minimize the health consequences of stress and create an environment that is more receptive to conception and pregnancy maintenance.
Dr. Aviles is a naturopathic doctor at Whole Health Natural Family Medicine in Hamden, CT, where she specializes in women’s health and pediatrics. She has a special interest in the management of gynecologic, hormonal/endocrine, and mental health conditions, acute and chronic pediatric care, as well as chronic diseases, such as diabetes and high cholesterol. Whole Health Natural Family Medicine, 203.288.8283 [email protected]