WHAT IS FERTILITY?
Fertility is defined as the ability to conceive a child and indicates the general health and wellbeing of a person. Optimal fertility is thought to be between the ages of 18-35 years old for women and 16-40 years old for men.
WHAT IS INFERTILITY?
Conversely to fertility, infertility is the inability to conceive a child. Many couples, and either men or women, can experience infertility.
There are several sub-categories of infertility:
Primary infertility is where, despite regular unprotected intercourse, pregnancy does not occur within 12 months or longer. In women over 35 this reduces to 6 months and over 40, to 3 months. Although, levels of fertility vary and, to put this into perspective, only 25% of couples conceive after 1 month, 60% after 6 months and 85% after 12 months.
Primary infertility can be caused, in either men or women, by:
Issues with the production of healthy sperm or eggs,
Structural of functional issues of the reproductive system,
Hormonal disorders, and/or
Secondary infertility is where a couple have conceived in the past, but are unable to conceive again after trying to get pregnant for a period of 12 months or more, despite regular, unprotected intercourse. This can be caused by:
Irregularities in, or lack of monthly ovulation in women,
Sperm quality or quantity,
Timing and regularity of intercourse during each month, and/or
Tubal function (e.g. whether egg and sperm are able to reach the fallopian tubes for conception to occur)
Unexplained infertility is where despite there being no apparent reason for infertility, the couple are unable to conceive within 12 months or more, despite regular, unprotected intercourse. Sometimes this can be due to inadequate investigations to determine the cause.
Fertility in New Zealand today
According to New Zealand Government statistics (December 2017), the total fertility rate has declined to their lowest recorded level at 1.81 births per woman. Fertility New Zealand report that around 1 in 5 people in New Zealand experience infertility (as at 2017) stating common causes of infertility as:
1. Male infertility (40%) with causes including:
- Failed vasectomy reversal
- Retrograde ejaculation
- Blocked ducts
- Absence of vas deferens
- Undescended testes in childhood
- Automimmune disorders
- Female infertility (40%) with causes including:
- Tubal problems
- Disorders of ovulation
- Polycystic ovarian disease
- Frequent miscarriage
- Hormonal problems
- Autoimmune disorders
- Recurrent genito-urinary infections
- Unexplained infertility (20%), which includes secondary infertility.
Following investigations and tests, conventional fertility treatments range from the administration of fertility drugs to in vitro fertilisation (IVF).
Many causes of infertility are modifiable and can be addressed through stress management, lifestyle and/or dietary changes. In fact, anyone planning to get pregnant should consider these factors to optimise their chances of a healthy pregnancy.
This guide provides you with some information on factors that you can change to positively affect your chances of fertility.
Stress management is an important determinant of wellbeing and fertility is no exception. Prolonged or intense stress can affect hormone levels, digestion and immunity, all of which will impact fertility. Stress comes in all shapes and sizes, including environmental, physical, emotional, relationships, fears, expectations and financial pressures. Indeed, getting pregnant is often a source of stress in itself.
Some tips to reduce stress include:
Assessing the cause of stress and working out what you can change and what you can’t.
Changing your reaction to stressful events – this one can take some patience, but not sweating the small stuff can go a long way to reducing your stress levels.
Talking to someone you trust and respect, journaling, or seeing a counsellor.
Getting enough sleep, exercise and water.
Reading, painting, singing, playing a musical instrument.
Taking time out to spend with family and friends.
Meditation or mindfulness.
Acupuncture, massage or Reiki.
A long soak in the bath.
Spending time in nature.
Good nutrition can enhance your chances of fertility and of having a healthy pregnancy. There can be a perception that the onus is on the female to look after her health and diet in order to boost the chances of a healthy conception. Whilst, of course true during pregnancy, it does take two to make a healthy baby and both parents need to consider this when planning to get pregnant.
Prior to conception, the sperm and egg take 3-6 months to mature. During this time good pre-conception nutrition contributes to overall reproductive health and the health of the sperm and egg, allowing conception to take place.
Unsurprisingly, the overarching guidance, as with health and wellbeing in general, is to eat a varied, nutrient dense, whole foods diet. Maybe you already eat a healthy diet and you just need to stay consistent or maybe you are eating a lot of processed foods and you need to learn about ways to increase your nutrient intake. If your nutrition does need an overhaul, then don’t feel you have to do it all at once…. little steps lead to sustainable lifestyle changes and wherever we are, it’s just a starting point.
The core foods to eat include grains, vegetables, fruit, protein, fats and water.
Organically grown grains, such as wholegrain bread, wholemeal pasta, brown rice, oats, rye, millet or barley.
Organically grown vegetables (making up 40% of your daily intake). Remember, eat the rainbow! The colour of vegetables is indicative of its nutrient content, so eating a variety of colours and not consistently eating the same choices, will broaden your nutrient intake. Although, dark leafy green vegetables are packed full of nutrients, so try and include them every day – and mix up your choices (e.g. kale, spinach, salad leaves, and broccoli).
Organically grown fruit, but not too much. 2-3 apple sized fruits is enough, due to the sugar content, so keep this in mind. Dried fruits have a higher content, so fresh is best.
Organic protein, whether animal or plant based, should be consumed at least twice a day. Protein is metabolised (broken down) into amino acids, which are the building blocks of our cells, tissues and organs. So, as well as keeping our reproductive health going, it also helps to form healthy sperm and eggs. Animal products are “complete proteins” containing all the amino acids we need. Plant based protein should be combined to provide all the amino acids (combine nuts, grains/seeds and legumes/pulses).
Fats – use coconut oil or olive oil for cooking and cold-pressed oils for salads. Nut butters, avocado, seeds and nuts are also great choices.
Foods containing refined flour or sugar – these foods are stripped of nutrients and can lower levels of important pre-conception nutrients (e.g. zinc and folate) from our bodies.
Fatty or fried food – although we need saturated fats in our diets, too much is a bad thing and these foods contain high levels of saturated fats. Fried food is high in trans-fat which has no nutritional value and leads to oxidative stress and unhealthy cholesterol levels in the body.
Additives – are used to preserve, stabilise or maintain the appearance of foods. The body has to work harder to detoxify these chemicals, they can cause sensitivities or allergies in some people, and they can be toxic.
Processed meats – these tend to be high in salt, saturated fat and can also contain nitrites, herbicides, pesticides and chemical hormones.
Green potatoes – these are toxic.
Reheated foods or foods left standing – there is the potential for moulds to grow in these conditions and also nutrient content will be diminished.
Salt – you can get salt from the foods you are eating, including bread, so avoid adding salt.
Coffee and tea – caffeine reduces the absorption of iron and destroys B vitamins. Caffeine can affect the motility of sperm and negatively impacts reproductive health generally.
Allergens – if you are allergic to a food then avoid it.
Alcohol – although obvious during pregnancy, this also applies at preconception. Alcohol depletes vitamin and mineral levels, including B vitamins, Vitamin C, magnesium, calcium and chromium.
Eating a wholefoods diet will provide a broad spectrum of the nutrients and minerals required for reproductive health and for a healthy conception.
However, this is a time when your body may need extra support getting adequate nutrient levels. These days our soil is depleted of many minerals, which means we may need to look to supplementation for extra support. For example, through a prenatal supplement. It’s best to get your nutrient levels checked, so that you can identify areas where you may need support.
The key nutrients are:
Iron – is needed for both women and men, but particularly for women during the pre-menopausal years and in increased amounts during pregnancy. Iron is needed to support the increased volume of blood and in the formation and development of the foetus.
Zinc – is needed for male and female fertility. For men, it is needed for reproductive health, quality and quantity of sperm. For both sexes and for the foetus, zinc is essential for immune and brain health, skin integrity and for growth and development.
Selenium – a powerful antioxidant, selenium impacts sperm production and motility. It can reduce congenital abnormality and certain health conditions.
Vitamin C – an antioxidant that protects against mutagenic activity, promotes ovulation, reduces agglutination of sperm, and is needed for hormone production, absorption of iron and tissue integrity.
Vitamin A – is an antioxidant needed for reproductive health in both sexes, including fallopian tube and testes health, for the production of testosterone and for sperm production. However, excessive amounts can lead to foetal abnormalities and so levels need to be monitored.
Folic acid – is particularly important for growth and development, due to its role in cell division. This is important for sperm, egg and crucial for foetal development.
Magnesium – is needed for nerve and muscle function, for oestrogen and progesterone production, for reduce oxidative damage to the testes and sperm, to support immune function, conception, foetal growth and development.
Calcium – is needed for the production of fertile mucus, for muscle contraction and for the formation of bone, teeth, muscle and nerve tissue in the foetus.
B complex vitamins – are needed for many functions in the body, including the production and levels of sex hormones in both men and women.
Vitamin E – is an antioxidant that protects against mutagenic activity and is needed to ensure conception, a healthy pregnancy and easy delivery.
Other important nutrients include Vitamin D, manganese, iodine, chromium, copper and boron.
A healthy lifestyle is going to have a positive impact on your fertility levels. So work on stress management, keep active, participate in exercise and sport, and keep you diet healthy and nutritious.
The main reason that smoking, drugs, caffeine and alcohol should be avoided when planning to get pregnant, is that these lifestyle choices significantly deplete the nutrition and health status of both men and women, reducing levels of fertility.
Smoking significantly depletes levels of Vitamin C in the body, reducing immunity, increasing the toxic load and reducing our ability to deal with chemical, heavy metal and environmental toxin exposure. It also reduces zinc and testosterone levels, with reduced sperm quantity and quality. Smoking effects the development of the foetus, increases the chances of having a miscarriage and has detrimental to the long term health of the child.
Environmental toxins should also be considered in preconception health. Radiation, heavy metal and chemical exposure can have significant effects on fertility. Therefore, if you work in an environment that exposes you to industrial chemicals or pollutants, take precautionary safety measures to reduce the risk. Try and choose natural household cleaning and gardening products and buy organic foods.
Education can often be forgotten, but it empowers you to make healthy and informed choices about your health and body. Knowing your body and understanding the menstrual cycle is really important when planning a pregnancy. If you know when ovulation occurs within your cycle, then you know the best time of the month for unprotected intercourse.
Once the egg (ovum) is released at ovulation, there is a window of 24-48 hours for fertilisation to take place. Sperm can live for up to 5 days in the vagina. Therefore, those few days prior to ovulation are the most fertile days of the menstrual cycle.
Generally women will ovulate between days 12 and 16 of her menstrual cycle, but this is not always the case. If you are unsure, there are natural methods of tracking your menstrual cycle and determining when ovulation takes place for you.
References: Hechtman, L. (2012). Clinical naturopathic medicine. Chatswood, N.S.W: Churchill Livingstone. Jones, Dr. C. (n.d.). Hormone Dysregulation [Video presentation]. Retrieved from https://education.fxmed.co.nz/course/hormonal-dysregulation-with-dr-carrie-jones/ Naish, Francesca. (1991). Natural Fertility: 4th Edition. Australia: Sally Milner Publishing Naish, Francesca. (1996). The Natural Way to Better Babies, 4th Edition. Australia: Sally Milner Publishing Trickey, R., & Trickey Enterprises. (2011). Women, hormones & the menstrual cycle. Fairfield, Vic: Melbourne Holistic Health Group. Rodriquez, H. (2018, September 10). Stress and Your Fertility. Retrieved from https://natural-fertility-info.com/stress-and-your-fertility.html